Lecture 1.1: The Lymphomas COPY Flashcards

1
Q

What is the most common and second most common clinical presentation of Hodgkin Lymphoma?

A
  • Most common = PAINLESS peripheral LAD; often in the cervical or supraclavicular nodes
  • 2nd = mediastinal mass seen on CXR
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2
Q

What are “B symptoms” associated with advanced stage HL; what is another unusual but rather common symptoms?

A
  • “B symptoms” = temp >38 C; weight loss >10% BW; or drenching night sweats
  • Generalized pruritus is another common findings
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3
Q

Diagnosis of HL and NHL should be made how and what is the preferred method?

A

Biopsy; preferred method being excisional biopsy

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4
Q

Which 2 imaging modalities are important for the initial staging of HL?

A

CT and PET imaging

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5
Q

Using the Ann Arbor staging system for lymphomas what is stage I?

A

Involvement of a single LN region (I) or single extranodal organ site (IE)

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6
Q

Using the Ann Arbor staging system for lymphomas what is stage II?

A
  • Involvement of 2 or more LN regions or lymphatic structures on the same side of the diaphragm (II)

or

  • With involvement of limited, contiguous extranodal tissue (IIE)
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7
Q

Using the Ann Arbor staging system for lymphomas what is stage III?

A
  • Involvement of LN regions or lymphoid structures on BOTH sides of the diaphragm (III)
  • May involve the spleen (IIIS) or limited, contiguous extranodal tissu (IIIE)
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8
Q

Using the Ann Arbor staging system for lymphomas what is stage IV?

A

Diffuse or disseminated involvement of one or more extranodal organs or tissues, with or without lymphatic involvement

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9
Q

Using the Ann Arbor staging system for lymphomas what do the disease modifiers A, B, E, and X indicate?

A
  • A = Absence of B symptoms
  • B = Presence of B symptoms
  • E = Extranodal site or organ
  • X = Bulky disease (more than 10cm)
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10
Q

Why should a baseline cardiac function study (such as echocardiography) and PFT’s be done before treating HL?

A

Tx of HL involves the use of chemotherapy with an anthracycline and bleomycin

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11
Q

What is the most commonly used 4-drug regimen used for HL?

A

ABVD = doxorubicin + bleomycin + vinblastin + dacarbazine

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12
Q

How are pt’s with early stage HL treated and what is used especially if bulky mediastinal disease is present?

A

Abbreviated course (2-3 months) of chemo followed by radiation to the involved region (especially with bulky mediastinal disease)

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13
Q

How are patients with advanced stage HL treated?

A

Longer course (6 months) of chemo ALONE

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14
Q

What are some of the common adverse risk factors which must be accounted for when considering treatment options for HL?

A
  • erythrocyte sedimentation rate (ESR)
  • Male gender
  • Age >40 y/o
  • Stage IV
  • Bulky mediastinal disease
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15
Q

What is the recommended follow-up schedule for HL pt’s during the first five year after completing tx?

A
  • Every 3-6 months for the first 3 years
  • Every 6 months in the 4th and 5th year
  • Annually thereafter
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16
Q

What should HL survivors be screened for and managed at their follow-up appointments?

A
  • Annual visits with a CBC to screen for BM dysfunction
  • Thyroid function testing in those who received radiation to the neck
  • Annual influenza vaccine in pt’s who received bleomycin or chest irradiation
17
Q

Women who received radiation prior to age 35 for tx of HL should undergo breast cancer screening w/ annual mammography starting when?

A

Beginning 8-10 years post-treatment or at age 40, whichever comes first

18
Q

How do indolent NHL’s typically present?

A

Slowly growing LAD, enlarged spleen or liver, or with CBC abnromalities such as anemia, thrombocytopenia or leukopenia

19
Q

Which findings sx’s and labs are more common of aggressive NHL’s?

A
  • B symptoms
  • LDH
  • uric acid
20
Q

Patients diagnosed with NHL should also be tested for what infections?

A

HIV and hepatitis B and C

21
Q

Which imaging studies should be performed in pt with NHL and to what regions?

A

CT scans of the chest, abdomen, and pelvis; in some cases integrated PET/CT scans are useful

22
Q

When would lumbar puncture with cytologic evaluation of the CSF be important in the management of NHL?

A

In highly aggressive NHL (i.e., Burkitt lymphoma) and in some types of aggressive NHL (i.e., testicular diffuse large B-cell lymphoma)

23
Q

What are treatment options for indolent NHL’s?

A
  • May often be observed without tx
  • Nearly always respond to chemotherapy when tx is indicated
24
Q

For B-cell lymphoid NHL’s what is used for tx?

A

Cytotoxic chemotherapy used concurrently with the anti-CD20 monoclonal antibody, RITUXIMAB

25
Q

Following tx for NHL, how often should pt’s be seen for follow-up during the first 5 years and what studies should be done?

A
  • Should be seen every 3-6 months during the first 3-5 years after tx and annually thereafter
  • Imaging of the chest, abdomen, and pelvis w/ CT scans is often performed
26
Q

Patients who receive radiation to the neck for HL and NHL are at risk for what future complications?

A

HYPOthyroidism