Flashcards in Lymphoma Deck (32):
what is lymphoma?
It is a cancer of certain types of white blood cells. these cells circulate throughout the body in the blood stream and in the lymphatic system which part of the body's immune system.
Is hodgkin's or non-hodgkin's more common? what is their age distributions?
non-hodgkin's is more common. increases with incidence as you age. hodgkin's is less common, and it is bimodal age distribution (early 20s and then 65-80s)
What causes hodgkin's lymphoma?
unknown, maybe thought to be EBV and it is increased in people with immunodeficient states
What causes non-hodgkin's lymphoma?
Risk factors include previous radiation, chemo, immuosupressive tx or conditions. Agricultural pesticides, viral infections (HIV, Hep B&C, EBV--> Burkitts, H.Pylori--> MALT), autoimmune disease (RA, SLE), family history.
H. Pylori can cause what type of NH lymphoma?
MALT, which can be cured by a regimen of PPI, and 2 antibiotics.
what is the most common type of NH lymphoma?
diffuse large B cell
What HL histological type is most common?
What NHL type of cell is the most common?
B cell and most express CD20. T cell is less common and usually a lower survival rate.
What are the physical findings for HL?
1. painless mass (tendency to arise in a single node, usually cervical or supraclavicular node)
2. Mediastinal mass found on CXR
3. B symptoms (fever, unexplained weight loss of 10% of BW over last 6 months, drenching night sweats)
5. pain after alcohol ingestion in lymph node
What are the physical finding for NHL?
1. B symptoms (fever, weight loss, drenching night sweats)
2. painless lympadenopathy
3. Type specific:
-Indolent lymphomas: slow growing, hepatomegaly, splenomegaly
- GI lymphoma: anorexia, n/v, early safety, fullness
-CNS lymphoma: HA, lethargy, seizures
(sometimes you will see skin rash, itching, alcohol pain,fatigue)
Do the symptoms of NHL and HL tend to be the same?
Yes, they tend to present the same way.
What is the mainstay for evaluation of lymphoma?
Excisional lymph node biopsy. (FNA is NOT acceptable)
What lab work will you want to get for HL?
CBC with diff: could be normal
ESR: elevated in active disease
Immunophenotyping: Reed Sternberg Cells
Histological type: 4 types, most common is nodular sclerosis
What lab work will you want to get NHL?
1. CBC with diff: could be normal, but later you may see anemia, leukopenia, pancytopenia, etc
2. CMP: could see abnormal LFT levels
3. Serum LD: elevated LD indicates poor prognosis
4. ESR: elevated
What other diagnostics (besides labs) may you want to order for lymphoma?
1. CXR: looking for mediastinal mass
2. CT Scan: staging, get info on nodes
3. Bone marrow biopsy: staging purposes
What staging system does lymphoma use?
Ann Arbor System I-IV
What could be a differential for lymphoma?
CMV/Mono, the other type of Lymphoma (either reed stern berg cells or no reedsternberg cells), Sarcodosis, TB, Cancer
describe low grade NHL (indolent) lymphoma:
stage: rarely limited, usually extensive. It is felt to be incurable. most transform to intermediate or high-grade survival <1 year. Tend to have splenomegaly, and cytopenia. It is hard to treat this because treatment is based on active dividing cells, and these cells divide too slowly for treatment.
Describe Follicular B-Cell Lymphoma
2nd most common NHL. It usually affects middle aged. There is typically bone marrow involvement, and most are B cell types and CD20 positive. The cytogenetic abnormality t(14;18).
Describe some of the grading follicular lymphoma:
grade 1: 0-5 centroblasts, small cleaved.
grade 2: 6-15 centroblasts, mixed small and large
grade 3: >15 centroblasts, large
What is prognostic index used for follicular lymphoma grading?
uses N, LASH
Stage (1/2 or 3/4)
H( hemoglobin low or high, 12)
What is an example of low grade NHL?
follicular B-cell lymphoma t(14:18)
describe intermediate to high grade NHL :
it is aggressive. more sensitive to chemo, higher response rates is treatment. most relapses will occur within 2years, so look for them at that point. usually exhibit B symptoms.
What is an example of high grade NHL?
diffuse large b-cell lymphoma
Describe Diffuse large b-cell lymphoma:
median age is 64, tend to spread to other sites. cytogenetic abnormality is t(3:22). symptomatic at diagnosis is common.
What is the staging system for B-Cell?
p= performance status
e= extranodal sites
What is mantle cell lymphoma?
accounts for 6% of lymphomas. very rare, but very aggressive. usually affects older men. GI tract is typically involved so you want to do a colonscopy at diagnosis. Cytogenetic abnormality is t(11:14).
What should be included in the INITIAL WORKUP for mantle cell?
What is peripheral T-Cell lymphoma?
Poor prognosis, very rare but usually presents with skin lesions called mycosis lymbodies
What is the treatment for HL?
Chemotherapy is first line
What is the treatment for NHL?
indolent lymphomas: irradiation, but it is considered incurable. MALT: can be treated with antibiotics and a PPI. Diffuse large B-cell lymphoma: short course immunochemotherapy. Mantle cell lymphoma = intensive immunochemothrapy including stem cell transplantation. Primary CNS: high dose Iv methotrexate. High grade lymphomas= intense, cyclic chemotherapy and intrathecal chemotherapy at CNS...BASICALLY GIVE CHEMO AND RADIATION