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Long Case - Haematology > Lymphoma > Flashcards

Flashcards in Lymphoma Deck (10)
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1

Lymphoma is ___?

malignant proliferation of lymphocytes which accumulate in lymph nodes but may also be found in peripheral organs

Hodgkins and Non Hodgkins

2

Hodgkins versus Non

Hodgkins
- characterised by Ree-sternberg cells
- 2 peak incidence - young adults and elderly
- Rx: family Hx, EBV, SLE, obese
- Types: nodular sclerosing 70%, mixed cellularity, lymphocyte rich, lymphocyte deplete (worse prognosis)

Non-Hodgkins
- all other lymphomas
- Very diverse category
- Rx: HIV, immunodeficiency, EBV, toxins, congenital
- B cells (most common) and T cell lines
- Low grade = indolent, wide spread, incurable
- High grade = aggressive, rapidly enlarging lymphadenopathy

3

Symptoms for lymphoma?

Nodes = superficial, rubbers, painless, fluctuating size, typically cervical
Constitutional upset = fevers, weight loss, night sweats, lethargy, fatigue
Mediastinal involvement = bronchial or SVC obstruction, pleural effusion
Extranodal disease = oropharynx, bone, gut, cns, lung
Infection + bleeding = from pamncytopenia

4

Past Hx. Ix and treatment

PMHx:
- Infection
- predisposing condition (HIV, AI, I suppressive drugs)

Ix:
- node biopsy
- CT or MRI
- bone marrow aspirate

Tx:
- Chemotherapy +/- radiation
- Peripheral stem cell transplants

5

Examination

Cachexia, Anaemia
Lymph node enlargement
Spleno/hepatomegaly
Extra nodal involvement

6

Differential for cervical lymph node enlargement

Infection: acute pyogenic, mono, CMV, TB, HIV
Autoimmune: RA
Drugs: Phenytoin
Primary lymph node malignancies
secondary malignancies

7

Ix for lymphoma

Blood: CBC, ESR differential count, film, UEC, eGFR, LFTs, Ca, LDH
Imaging: CXR (mediastinal widening?) CT/PET CAP
Bone marrow biopsy
Excision biopsy
Cytology of effusion
Cytology of CSF if CNS signs

8

Staging for Lymphoma

Ann Arbor Staging:
I - confined to single node
II - more than 2 nodal areas same side of diaphragm
III - More than 2, both sides
IV - spread beyond nodes

in addition:
A - no systemic symptoms other than pruritis
B - B symptoms
E - extranodal
S - spleen involvement

9

Management of Hodgkins and Non- H Lymphoma

HODGKINS = 80% 5 year survival - depending on staging
Radiotherapy and chemotherapy with high dose chemo and peripheral stem cell transplantation for relapsed disease

NON-H = 40% 5 year survival
low-grade = radiotherapy + chemo + alpha-interferon or rituximab for maintenance remission
high grade = R'CHOP
- Rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, perdnisolone. (+ GCSF helps with neutropemnia)

10

SE of treatment

Radiotherapy: inc risk of second malignancy, IHD, hypothyroidism, lung fibrosis
Chemotherapy: myelosuppression, nausea, alopecia, infection, AML, NH lymphoma, infertility