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Complex Issues in Radiotherapy > Lymphoma > Flashcards

Lymphoma Flashcards

(59 cards)

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1
Q

what is lymphoma

A

malignant disease of MATURE lymphocytes, which divide uncontrollably and dont die

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2
Q

where does it accumulate

A

in the LN and the extranodal tissue/organs
can arise anywhere in the body/brain/lung/skin/ GI tract
can spontaneously wax and wane [grow and shrink without trt]

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3
Q

how do people present

A

swollen lymph glands
pain
can deteriorate quickly:
- dehydration
- anaemia
- hypercalcemia: release of osteoclasts
- infection
- critical organ damage

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4
Q

how are they diagnosed

A

FBC: WBC
chest x-ray: involvement in the mediastinum accumulation in the thymus could lead to an SVCO
BM aspiration: ONLY NHL
biopsy
PET/CT: lymphatic involvement/spread NOT for NHL

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5
Q

why is a biopsy needed

A

to find out if it is a HL or NHL due to its presence of reed-steinberg cells

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6
Q

risks of HL

A

EPV
smoking
HIV
incidence has risen 37% since 1990s
links with deprivation

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7
Q

presentation of HL

A

enlarged neck nodes: 60%
axilla: 20%
groin: 15%
enlarged spleen: 10%

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8
Q

what do HL have

A

reed-sternerg cells

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9
Q

what is a variant of RS cell in HL

A

nodular predominant HL

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10
Q

what is stage 1 of a HL

A

1 LN region or 1 extranodal site or organ

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11
Q

what is stage 2 of a HL

A

2 or more LN regions on the same side of diaphragm alone or with involvement limited contiguous

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12
Q

what is stage 3 of a HL

A

LN on both sides of the diaphragm including one organ or area near the LN or spleen

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13
Q

what is stage 4 of a HL

A

dissemination to one or more extra lymphatic organs or tissues with/without involvement of nearby LN

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14
Q

what is an A for modifying features

A

assymptomatic

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15
Q

what is a B for modifying features

A

unexplained fever (>38), night sweats, loss of more than 10% of body weight in 6 mths

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16
Q

what is a E for modifying features

A

involvement of a single, contiguous or proximal extranodal site

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17
Q

what is an X for modifying features

A

bulky disease (mass > 10cm)

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18
Q

what is INRT

A

involved node RT = CTV (node only) + no margin

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19
Q

what is ISRT

A

involved site RT = CTV (node + margin) + only involved nodes included

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20
Q

what is IFRT

A

involved field RT = CTV (entire nodal region)

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21
Q

what is EFRT

A

extended field RT = no longer seen

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22
Q

what used to be the RT technique

A

extended field: mantel + inverted Y + chemo

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23
Q

why was the old technique for HL stopped

A

patients were developing AML, secondary cancer. cardiac issues, greater risk of death than relapse in survivors

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24
Q

what is RT based on now

Study These Flashcards
A

age, site, size of RT field

25
what chemo is given
low dose for children ABVD [doxorubicin, bleomycin, vinblastine, dacarbazine]
26
what is the trt for stage IA/IIA
2-4 cycles of ABVD + RT
27
what is the trt for the other stages
6-8 cycles of ABVD +/- RT
28
what are the hodgkin RT sites
whole brain (meninges involvement: field extends to C2/3) breast bone (A/P) to cover whole bone thyroid: cervical lymphatics (also in trt field) orbit: single applied or angled parallel to avoid contralateral eye
29
early HL trt
favourable: 2 cycles of ABVD + 20Gy in 10 over 2 weeks unfavourable: 4 cycles of ABVD + 30Gy in 15 over 3 weeks
30
advanced HL trt
RT for residual disease is indicated after partial response chemo 30-36Gy in 15-20 over 3-4 weeks
31
what is given if relapse for HL occurs
high dose chemo is given single site relapse not previously irradiated has 30-34Gy after chemo 30Gy in 15 over 3 weeks persistent disease after chemo is 36-40Gy in 18-20 fractions over 3-4 weeks
32
what is given to younger pt who have HL relapse
SCT
33
what indicates high chance of relapse after SC transplant
high PET uptake
34
what are the palliative recommendations for HL
no definitive ones however 30Gy in 10 20Gy in 5 8Gy in 1
35
stats for NHL
6th most common in the UK lower in asian and black ethnic groups 1/39 males 1/51 females
36
what are the risks of NHL
age HEP C [26%] occupational exposure - 40% organochlorine - 22% organophosphate - 26% field crop autoimmune conditions - coeliac - rheumatoid arthritis
37
how are NHL categorised
how fast they grow what type they originate from (T or B cell)
38
what are NHL classified as
low or high grade
39
what is the most common NHL
diffuse large B cell
40
what is treatment for NHL dependent on
fitness, age, disease subtype
41
what chemo is given for NHL
R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone] intrathecal: methotrexate and cytarabine
42
what treatment can be given for NHL
chemo RT immunotherapy
43
why is RT given
if the disease is bulky or aggressive pt not responding/tolerating chemo
44
RT for NHL, early DLBCL
early DLBCL: 30Gy in 15
45
RT for NHL, CMR
CMR patients receiving consolidation RT: 30Gy in 15
46
RT for NHL with incomplete response to chemo
36-40Gy in 18-20 fractions in 3-4 weeks
47
what is the RT for bridging over for CAR-T therapy for NHL
30Gy in 10-15 over 2-3 wks 20Gy in 5
48
what is common in pregnancy
HL RT in the first trimester is avoided pt in 2nd or 3rd can be avoided
49
how long should pt wait to not get pregnant for after trt
2 years to avoid relapse
50
information on HL
more often localised to single axial group of nodes (cervical, media, para-aortic) orderly spread by contiguity mesenteric nodes + waldeyers ring rarely involved extranodal involvement uncommon
51
information on NHL
more frequent involvement of multiple peripheral nodes non contiguous spread mesenteric nodes + waldeyers ring commonly involved extranodal involvement is common
52
mycosis fungoides
T cell lymphoma - skin invasion superficial or electrons 10Gy in 5 sometimes TBE: 8Gy in 2 or 12Gy in 3
53
what does CNS lymphoma RT impact
cognitive function therefore 40-45Gy in 20-25 is given
54
how is RT controversial for
paediatrics
55
what is burkitt lymphoma
a B cell lymphoma rare
56
where does burkitt lymphoma often present
in the jaw/abdomen
57
what is the most common subtype of burkitt lymphoma
sporadic burkitt lymphoma which occurs occasionally and irregularly
58
who develops immuno-deficiency associated burkitt lymphoma
develops in people with HIV or people with an organ transplant
59
where is endemic burkitt lymphoma common
in areas where malaria is widespread. it is linked to the infection with malaria and EBV, which usually develops in young children

Complex Issues in Radiotherapy (12 decks)

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