Lymphoma

Question 1

What is lymphoma?

Answer 1

cancer of the lymphocytes inside the lymphatic system and lymph nodes

Question 2

Types of lymphoma?

Answer 2

Hodgkins (specific disease)
Non-hodgkins (all other types)

Question 3

Epidemiology of Hodgkin’s lymphoma?

Answer 3

Bi modal (20yrs and 80 yrs)

Question 4

Risk factors for Hodgkin’s lymphoma?

Answer 4

HIV
EBV
Autoimmune (RA and sarcoidosis)
family history

Question 5

Subtypes of Hodgkin’s lymphoma?

Answer 5

Classical: Nodular sclerosing/ Mixed cellularity/ Lymphocyte rich/ Lymphocyte depleted

Nodular lymphocyte predominant: idolent

Question 6

Pathology of Hodgkin’s lymphoma?

Answer 6

Cloncal transformation of cells with B-cell origin
Reed-Sternberg cells

Unknown cause

Question 7

Presentation of Hodgkin’s lymphoma?

Answer 7

Lymph node pain after drinking alcohol.
* night sweats
* unintentional weight loss
* a high temperature (fever)
* a persistentcoughor feeling ofbreathlessness
* persistent itching of the skin all over the body

Question 8

Investigation of Hodgkin’s lymphoma?

Answer 8

Lymph node biopsy
Reed-sternberg cells (owl face)

uric acid and LDH often elevated

Question 9

Treatment for Hodgkin’s lymphoma?

Answer 9

Chemo and radio
Good 5yr survival rate

Question 10

Two main types of non Hodgins lymphoma?

Answer 10

High and low grade

Question 11

Types of cell involvement in high and low grade non hodgkins lymphoma?

Answer 11

High - B and T cell
low - B cell

Question 12

Notable subtypes of non-hogkin’s lymphoma?

Answer 12

Diffuse large B cell (rapid painless in older pts)
Burkitt lymphoma (EBV and HIV)
MALT lymphoma (affects mucosa-associated lymphoid tissue, usually around the stomach)

Question 13

Risk factors for non-hodgkins lymphoma?

Answer 13

HIV
Epstein-Barr virus
Helicobacter pylori (H. pylori) infection is associated with MALT lymphoma
Hepatitis B or C infection
Exposure to pesticides
Exposure to trichloroethylene (a chemical with a variety of industrial uses)
Family history

Question 14

Presentation of high grade lymphomas?

Answer 14

Aggressive and quick growing
Lymphadenopathy
B symptoms
Symptomatic
Short history

Question 15

Investigation for high grade lymphomas?

Answer 15

Blood tests - check RBC + WBC
uric acid and LDH often elevated
Bone marrow sample - to see if lymphoma has spread to bone marrow
CT, MRI, PET

Question 16

Treatment for high grade lymphomas?

Answer 16

Chemotherapy and target drug, followed by radiotherapy to the lymph nodes - 6-12 weeks.

Question 17

Prognosis for high grade lymphomas?

Answer 17

good - unlikely to come back if successful treatment

Question 18

Presentation of low grade lymphomas?

Answer 18

slow growing
long history
asymptomatic

Question 19

Investigation for low grade lymphomas?

Answer 19

CT, MRI, PET, Lymph node test
Check LDH levels
check for viruses HBV, HCV, HIV

Question 20

Treatment for low grade lymphomas?

Answer 20

Watch and wait
Chemo first line
control symptoms

Question 21

Prognosis for low grade lymphomas?

Answer 21

Chronic illness
comes and goes

Question 22

What is the staging for non-Hodgkin’s lymphoma?

Answer 22

Lugano staging

stage 1 - limited to one group of lymph nodes
2 - 2 or more affected on one side of diagram
3 - lymph nodes affected on both sides of diagram
4 - lyphoma spread beyond the lymphatic system (present in lymph nodes and organs)