Lymphoma

Question 1

what is lymphoma

Answer 1

clonal neoplastic prolilferation of lymphoid cells- Hodgkin and non hodgkin

Question 2

what is the % B cell and T cell lymphomas in NHL

Answer 2

85% B cell, 15% T cell

Question 3

what is present in histology HL

Answer 3

Reed Sternberg cells

Question 4

which is more common HL or NHL

Answer 4

NHL is 7x more common

Question 5

most freq NHL B cell cancers

Answer 5

diffuse large B cell, follicular lymphoma

Question 6

presentation patient

Answer 6

enlargement lymph nodes, systemic symptoms- weight loss, night sweats, local mass.

Question 7

what are NHL split into

Answer 7

B cell and T cell

Question 8

examples T cell NHL

Answer 8

T cell prolymphocytic leukaemia; mycosis fungoides; sezary syndrome

Question 9

examples low grade B cell NHL

Answer 9

small lymphocytic leukaemia, follicular lymphoma, mantle cell, marginal cell

Question 10

examples high grade B cell NHL

Answer 10

diffuse large B cell, burkitts

Question 11

what are the types of Burkitts

Answer 11

spontaneous, endemic, immunodeficiency associated

Question 12

what can patient with sporadic Burkitts present with

Answer 12

abdominal mass

Question 13

what do patients have with immunodeficiency associated BL

Answer 13

HIV

Question 14

do less or more aggressive tumours respond better to treatment

Answer 14

more aggressive. low grade tend to relapse

Question 15

what is the cell origin of hodgkins

Answer 15

B cell

Question 16

which type of HL has the best prognosis

Answer 16

lymphocyte rich

Question 17

classifications classic hodgkins

Answer 17

nodular sclerosis, lymphocyte rich, mixed cellularity, lymphocyte depleted

Question 18

classification HL

Answer 18

nodular lymphocyte predominant HL, Classic HL

Question 19

what are reed Sternberg cells

Answer 19

multinucleate cells- mirror image nuclei

Question 20

worst prognosis in classical HL

Answer 20

lymphocyte deplete

Question 21

features HL

Answer 21

lymphadenopathy- cervical and painless; nodes fluctuate in size; 25% systemic upset- weight lo;ss, sweats, pruritus, lethargy

Question 22

signs HL

Answer 22

lymph node enlargement. cachexia, anaemia, spleno/hepatomegaly

Question 23

lab features HL

Answer 23

anaemia (normochromic, normocytic) leucocytosis, raised ESR, abnormal LFTs

Question 24

diagnosis

Answer 24

biopsy of lymph node. FBC, film, ESR, LFT, LDH, urate, Ca

Question 25

what indicates a worse prognosis on bloods in HL

Answer 25

incr ESR or decr Hb

Question 26

what system is used for staging in HL

Answer 26

ann arbor staging

Question 27

staging of HL

Answer 27

1- single lymph node area; 2- >2 lymph node areas above diaphragm; 3-above and below diaphragm; 4- involvement of other organs- A- no systemic symptoms, B- presence systemic syptoms

Question 28

what diagnostic tool is used for staging

Answer 28

PET/CT

Question 29

what treatment for early disease HL- stage 1A or 2A

Answer 29

radiotherapy

Question 30

what treatment for advanced disease HL- stage 1B,2B,3,4

Answer 30

chemo- combination- 6 cycles ABVD

Question 31

what does ABVD stand for- chemo

Answer 31

Adriamycin, bleomycin, vinblastine, dacarbzine

Question 32

if pt relapses following radiotherapy alone in HL what is the prognosis following CCT

Answer 32

very good, >80% complete remission

Question 33

if HL patient relapses

Answer 33

poor, consider stem cell transplantation

Question 34

what is the prognosis HL

Answer 34

stage 1-2: >90%; 4: 50-70%

Question 35

poor prognostic factors for HL

Answer 35

increasing age, male, anaemia, leucocytosis, stage 4, B symptoms, bulky tumour, incr sites disease, early relapse, high ESR, lymphopenia

Question 36

what happens in NHL

Answer 36

clonal expansion of an abnormal cell

Question 37

risk factors NHL

Answer 37

EBV- Burkitts; bacterial infection, radiation, drugs, autoimmune disease, immune suppression

Question 38

clinical features NHL

Answer 38

lymphadenopathy- widely disseminated at presentation, splenomeg, extranodal disease, extranodal disease more common than in HL

Question 39

lab features NHL

Answer 39

anaemia, pancytopenia, lymphocytosis, paraprotein, LDH raised

Question 40

diagnosis NHL

Answer 40

tissue biopsy, immunophenotyping to see if B or T cell origin, antigenic markers, CT, MRI, PET, bone marrow aspirate, trephine

Question 41

how is NHL staged

Answer 41

same as for HL

Question 42

management- what can be given to patient with follicular lymphoma

Answer 42

rituximab

Question 43

what can diffuse large B cell be treated with

Answer 43

full course chemo

Question 44

clinical course follicular lymphoma

Answer 44

indolent for many years, transforms to a more aggressive large cell lymphoma in 1/3

Question 45

what does splenic marginal cell lymphoma present with

Answer 45

enlarged spleen, AIHA, paraprotein, monoclonal B lymphocytes

Question 46

where does MALT occur

Answer 46

mucosa associated lymphoid tissue in stomach assoc with H pylori

Question 47

what is the prognosis of mantle cell

Answer 47

poor- only a few years

Question 48

what is the most common NHL T cell

Answer 48

peripheral T cell lymphoma

Question 49

how can aggressive lymphoma be treated

Answer 49

deep x ray therapy (DXT) with adjuvant CCT

Question 50

difference in treatment for B and T cell tumours

Answer 50

rituximab is not used in T cell

Question 51

what can be used for indolent tumours NH if they need treatment

Answer 51

single agent chemo or CCT

Question 52

how is mycosis fungoides treated

Answer 52

skin targeted therapies- PUVA, topical steroids, vit D

Question 53

what does rituximab do

Answer 53

monoclonal antibody for CD20 protein (antigen), which is found on the surface of B cell.