Lymphoma Flashcards
(17 cards)
What is lymphoma?
cancer of lymphatic system, where lymphocytes proliferate quickly
How does lymphoma generally present?
firm, tender, swollen lymph nodes in the neck, groin and axillary areas
- generally B symptoms seen
compare Hodgkins and non-hodgkins?
Hodgkins - contiguous manner spread to nearby lymph nodes, rarely extra nodal, better prognosis, Reed-Sternberg cells, younger pt, alcohol induced pain
non - can sometimes spread non-contiguously, involving extra nodal sites, older age
What is the characteristic feature of Hodgkin’s?
B cells derived from germinal centres of lymphoid tissues mutate and lead to presence of large, multi-nucelated giant cells called ‘Reed-Sternberg’ cells
*B cells stop expressing surface immunoglobulins and transform into reed-sternberg cells - hence resistant to apoptosis
What are some risk factors of developing Hodgkin’s?
- previous EBV infections
- increasing age
- immunosuppression
- previous cancer - NHL
- family history
- smoking
What are some clinical features of Hodgkin’s?
- enlarged lymph nodes - rubbery, commonly in cervical supraclavicular and neck
- hepatosplenomegaly
- generalised pruritus seen (rare with non-hodgkin’s)
- B symptoms seen in 1/3
- cough
- SOB
- Weight loss
- alcohol induced lymph node pain
What are some differentials to consider in lymphoma?
- sarcoidosis
- lymphocytic lymphoma
- miliary tuberculosis
- infectious mononucleosis
- thoracic aortic aneurysm
- thymoma
- chronic lymphocytic leukaemia
How might you investigate suspected Hodgkins?
- FBC - normocytic anaemia due to bone marrow infiltration, hypersplenism // eosinophilia due to cytokine production
- LDH raised - bad prognostic factor
- CXR - mediastinal widening
- CT scan +/- PET
- lymph node biopsy - Reed-Sternberg cells diagnostic
- “multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion” - owl’s eye
How is Hodgkins staged and graded?
*Ann arbour staging - localised, 2+ LN regions, above and below diaphragm and mets
*A or B depending on systemic involvement
How might Hodgkin’s be treated?
- chemo with AVBD, BEACOPP
- combined chemo and radio
- antibody meds
- autologous stem cell post myeloblasia
What are some side effects of lymphoma chemo?
hair loss, N+V, myelosuppression, allergy, neuropathy or delayed infertility, pulmonary/ cardiac toxicity
What is the significance of types of non-hodgkin’s ?
- divided into low and high grade
- low grade - good prognosis, incurable eg: follicular, marginal zone
- high grade - worse but cure potential eg: diffuse B cell, burkitt
What are some risk factors associated with NHL?
- Elderly
- Caucasians
- History of viral infection (specifically Epstein-Barr virus)
- EBV link - Burkitt’s
- T cell lymphotropic virus
- Family history
- Certain chemical agents (pesticides, solvents)
- History of chemotherapy or radiotherapy
- Immunodeficiency
- Autoimmune disease
What is the clinical presentation of NHL?
- superficial lymphadenopathy - painless
- effects of BM infiltration - anaemia, thrombocytopenia, neutropenia
- constitutional symptoms - lethargy, fatigue, anorexia
- B symptoms - fevers, night sweats, weight loss
- extranodal - GI tract, testes, brain, thyroid, hepatosplenomegaly
What are the investigations done for NHL?
- excision node biopsy
- CP CAP for staging
- HIV test
- FBC
- LDH
- LFT
- LP
- PET CT
- BM aspiration
What is the management of NHL?
- Subtype dependent - watchful waiting, chemo or radiotherapy
- Rituximab in combo with chemo (R-CHOP)
- localised: radiotherapy if in peripheral areas
- immunotherapy with MAB
- stem cell transplants
- CAR-T therapy where patients
- patients own T cells are genetically modified with CAR receptors to detect and attack cancerous cells
- advanced: watch and wait as no survival advantage for immediate treatment
- non-curative: over several years remitting and recurring courses
- flu/ pneumococcal vaccines
- antibiotic prophylaxis if neutropenic
