Lymphoma

Question 1

What are the two main types of lymphoma?

Answer 1

Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma

Question 2

Non-hodgkin’s lymphoma is more common in women. T/F?

Answer 2

False - it is more common in women

Question 3

What is the peak age of incidence of Hodgkin’s lymphoma?

Answer 3

20-24 years old

Question 4

What is the usual presentation of lymphoma?

Answer 4

Lymphadenopathy
Splenomegaly
Anaemia
B symptoms

Question 5

What are the B symptoms of lymphoma?

Answer 5

Night sweats
Weight loss
Unexplained fever

Question 6

Itch is a B symptom. T/F?

Answer 6

False

Question 7

Rarely there is alcohol induced pain in Hogdkin’s lymphoma. T/F?

Answer 7

True

Question 8

What are the usual presentations of lymphadenopathy?

Answer 8

Painless

Rubbery

Question 9

Describe the Ann-Arbor classification system for lymphoma.

Answer 9

Stage I - single lymph node group
Stage II - more than one lymph node group SAME side of the diaphragm
Stage III - lymph node groups on both sides of the diaphragm
Stage IV - extra nodal involvement e.g. liver, bone marrow
A or B added to signify absence or presence of B symptoms

Question 10

How is possible lymphoma investigated?

Answer 10

Lymph nodes and splenomegaly
Blood tests include FBCs, U&Es, LFTs, Ca, ESR and LDH
Imaging tests include CT scans and PET scans

Question 11

Which antigen is expressed on B -lymphoctes?

Answer 11

CD-20

Question 12

What monoclonal antibody can be used to treat lymphoma?

Answer 12

Ritixumab

Question 13

Give an example of an indolent B cell lymphoma.

Answer 13

Follicular lymphoma

Question 14

Follicular lymphoma is characterised by translocations involving which gene?

Answer 14

BCL2 gene

Question 15

What is the median age of diagnosis of follicular lymphoma?

Answer 15

65 years

Question 16

B symptoms are common in follicular lymphoma. T/F?

Answer 16

False

Question 17

Not all patients require treatment at diagnosis for follicular lymphoma. T/F?

Answer 17

True

Question 18

How are early stage follicular lymphomas treated?

Answer 18

Radiotherapy

Question 19

How are advanced stage follicular lymphoma which are asymptomatic, with no bulk and no end organ comrpomise treated?

Answer 19

Watchful waiting

Question 20

How are advanced stage follicular lymphomas which are symptomatic and/or show organ compromise treated?

Answer 20

Immunochemotherapy with rituximab and chemotherapy followed by maintenance of rituximab every 2 months for 2 years.

Question 21

Follicular lymphoma is very responsive to treatment but has a tendency to relapse. T/F?

Answer 21

True

Question 22

With newer therapies, what is the average survival of follicular lymphoma?

Answer 22

> 15 years

Question 23

What is the most common subtype of non-hodgkin’s lymphoma?

Answer 23

Diffuse large B cell lymphoma

Question 24

Diffuse large B cell lymphoma mostly occurs in adults. T/F?

Answer 24

True

Question 25

Where can extra-nodal presentations occur in diffuse large B cell lymphoma?

Answer 25

Waldeyers ring, Gi tract, skin, bone and CNS

Question 26

What B symptoms can occur in diffuse large B cell lymphoma?

Answer 26

Pyrexia of unknown origin Night sweats Weight loss

Question 27

Diffuse large B cell lymphoma is aggressive but curable. T/F?

Answer 27

True

Question 28

Early stage diffuse large B cell lymphoma is treated with...?

Answer 28

Three rounds of R-CHOP chemotherapy and radiotherapy

Question 29

Late stage diffuse large B cell lymphoma is treated with...?

Answer 29

Six rounds fo R-CHOP and radiotherapy

Question 30

Elderly and unfit patients need assessment of general frailty and co-morbidities before treatment for diffuse large B-cell lymphoma. T/F?

Answer 30

False

Question 31

What drugs are used in R-CHOP chemotherapy?

Answer 31

``` Rituximab Cyclophosphamide Adriamycin Vincristine Prednisolone ```

Question 32

R-CHOP chemotherapy is given on day one on a cycle of how many days?

Answer 32

21 day cycle

Question 33

Translocations of which gene are associated with Burkitt lymphoma?

Answer 33

MYC gene

Question 34

There is a very high rate of proliferation and cell death in Burkitt lymphoma. T/F?

Answer 34

True

Question 35

There is a good prognosis for Burkitt lymphoma treated with intensive chemotherapy. T/F?

Answer 35

True

Question 36

What are the common extra-nodal sites of Burkitt lymphoma?

Answer 36

Jaws and facial bone Ileocaecal region of GIT Ovaries, kidneys, breast, lymph nodes, bone marrow, CNS

Question 37

Burkitt lymphoma is a low grade lymphoma. T/F?

Answer 37

False - it is high grade

Question 38

Classic Hodgkin Lymphoma is associated with which virus?

Answer 38

Epstein Barr Virus

Question 39

Classic Hodgkin Lymphoma is characterised by strong expression of which antigen?

Answer 39

CD30

Question 40

What is the peak age of incidence of Hodgkin Lymphoma?

Answer 40

20-30 years | later peak >50 years

Question 41

Describe the presentation of Hodgkin Lymphoma

Answer 41

Pains Lymphadenopathy B symptoms Itch

Question 42

How is early stage Hodgkin's lymphoma treated?

Answer 42

ABVD Chemotherapy and radiotherapy

Question 43

How is advanced stage Hodgkin's lymphoma treated?

Answer 43

ABVD chemotherapy

Question 44

What are the late effects of Hodgkin's lymphoma?

Answer 44

``` Malignancy Cardiac Pulmonary Fertility Endocrine ```

Question 45

ABVD chemotherapy is used in the treatment of Hodgkin Lymphoma. Which drugs are used in this type of chemotherapy?

Answer 45

Adriamycin Bleomycin Vinblastine Dacarbazine

Question 46

On what days of a 28 day cycle are ABVD chemotherapy agents given?

Answer 46

days 1 and 15

Question 47

How long is a cycle of ABVD chemotherapy in the treatment of Hodgkin's lymphoma?

Answer 47

28 days

Question 48

Myeloma is a cancer of which cells?

Answer 48

Mature plasma cells

Question 49

What is the median age of onset of myeloma?

Answer 49

71 years

Question 50

What plasma cell markers are often shown in myeloma?

Answer 50

CD138 CD56 Cyclin D1

Question 51

What are the presenting features of myeloma?

Answer 51

``` Backache or rib pain Fatigue Symptoms of hypercalcaemia Recurrent infections Renal Impairment ```

Question 52

What term is used to describe the abnormal monoclonal protein which is found in most myeloma patients?

Answer 52

Paraprotein

Question 53

IgE paraprotein is very rare in myeloma. T/F?

Answer 53

True

Question 54

IgM paraprotein is rare in myeloma. This is associated with...?

Answer 54

Waldenstroms macroglobulinaemia

Question 55

What classic triad of signs characterises myeloma?

Answer 55

Increased plasm cells in bone marrow Paraproteins Lytic bone lesions

Question 56

Urine tests can be used in the diagnosis of myeloma. What would these urine tests be looking for?

Answer 56

The presence of kappa light chains in the urine (Bence jones protein)

Question 57

What blood tests are used in the diagnosis of myeloma?

Answer 57

``` FBC ESR U&Es Ca Serum protein electrophoresis ```

Question 58

In addition to blood and urine tests, how would possible myeloma be investigated?

Answer 58

Bone marrow aspirate | MRI imaging

Question 59

Asymptomatic myeloma is treated with aggressive chemotherapy. T/F?

Answer 59

False - this undergoes watchful waiting

Question 60

How is symptomatic myeloma treated?

Answer 60

Autologous SCT Chemotherapy including a steroid and thalidomide Radiotherapy Supportive therapies

Question 61

Why would bisphosphonates be used in the treatment of myeloma?

Answer 61

To reduce pain, pathological fractures, hypercalcaemia and the need for radiotherapy

Question 62

What supportive therapies can be used in the treatment of myeloma?

Answer 62

Bisphosphonates Blood transfusion / EPO Surgery Interventional radiology

Question 63

Explain how myeloma differs from a condition called monoclonal gammopathy of unknown significance (MDUS)

Answer 63

There is >10% marrow plasma cells present, variable but high levels of serum paraportein, pence jones protein often present, immune paresis present, lytic bone lesions often present and symptoms such as anaemia, raised calcium, bone pain and renal dysfunction often present in myeloma

Question 64

Describe the appearance of the Reed Sternberg cell seen in Hodgkin's lymphoma?

Answer 64

Large, two nuclei with smaller nuclei inside give an 'owl eye appearance'