hodgkins lymphoma Flashcards
(23 cards)
what lymph nodes can be effected?
cervical
axillary
inguinal
most common lymphoma?
non-hodgkins
most common age
20-25
80+
risk factors
- HIV
- Epstein-Barr virus
- Autoimmune conditions, such as rheumatoid arthritis and sarcoidosis
- Family history
key presenting symtpoms
- Lymphadenopathy (enlarged lymph nodes)
- non-tender
- feel firm and rubbery
- may feel pain in lymph node after drinking alcohol
what are B symtpoms?
systemic symptoms of lymphoma:
- fever
- weight loss
- night sweats
additional symptoms to B symtpoms
Fatigue
Itching
Cough
Shortness of breath
Abdominal pain
Recurrent infections
lymphadenopathy - often neck
mediastinal mass
intractable itch
investigations
- lymph node core biopsy
- reed-sternberg cells
- CT/MRI/PET
describe the appearance of reed-sternburg cells
- large B lymphocytes
- 2 nuclei
- prominant nucleoli
whats the point of the lugano classification
- emphasises weather the affected nodes are above or below the diaphram
outline the stages of the lugano classification
Stage 1: Confined to one node or group of nodes
Stage 2: In more than one group of nodes but on the same side of the diaphragm (either above or below)
Stage 3: Affects lymph nodes both above and below the diaphragm
Stage 4: Widespread involvement, including non-lymphatic organs, such as the lungs or liver
can be A or B - B means B symptoms are also present
management
chemotherapy
radiotherapy
subcatagories of hodgkins lymphoma
Classical Hodgkin lymphoma
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) - behaves and is treated like a low grave NHL
prognosis
Reasonably good prognosis:
Limited disease: Of those with stage I and II disease, 90% survive 5 years.
Advanced disease: Of those with stage III and IV disease, 75-90% survive 5 years.
Upwards of 75% of patients will be cured of the condition, though this is dependent somewhat on the staging at diagnosis.
presentation
Common presentation
- LYMPHADENOPATHY – often neck
- Mediastinal mass – 10%
- Can lead to SVC obstruction
- Splenomegaly
- B symptoms – 30%
- Intractable itch – 25%
- FBC – may be normal
- Normocytic anaemia +-↑platelets
Neutrophilia, eosinophilia, lymphopenia
- Raised ESR commonly
Treatment of Hodgkin lymphoma (3)
- ABVD immunochemotherapy (adriamycin, bleomycin, vinblastine, dacarbazine)
- +/- radiotherapy
- Marrow transplant
What is Febrile neutropaenia? What is it treated with? (3)
- Massive risk in patients with recent/high dose chemo (or on carbimazole)
- Fever, tachycardia, sweats, rigors, tachypnoea
- Treated with immediate broad spectrum antibiotics
cancer of what cells and what effects this has
cancer of the B cells
reed Sternberg cells
they don’t produce antibodies
release pro-inflammatory cytokines
viruses associated
EBV often found in tumour
HIV may also increase risk
ESR
raised
level of cell types
- inc Neutrophils → bc of inflammation
- inc Eosinophils → IL-5 production by Reed-Sternberg (RS) cells
- inc Platelets
- ± RBCs (Normocytic Anemia) → Chronic disease, marrow suppression
- ↓ Lymphocytes (Lymphopenia) → RS cells secrete IL-10 & TGF-β, suppressing normal lymphocyte function
unfavourable prognosis in stage I + II
presence of 1 or more of the following:
- large medistinaal lymphadenopathy
- ESR>50 eithout B symtpoms
- ESR >30 with B symtpoms
- age >50
- 4 lymph node sites involved
describe the difference between hodgkins lymphoma and CLL if in both conditions the B cells are affected
Hodgkins - mature B cells are malignant in the lymph nodes - reed Sternberg - lymphadenopathy
CLL - also mature B cells which are in the bone marrow and blood - smudge cells - anaemia, fatigue, splenomegaly
