Lymphoma and Myeloma Flashcards
1
Q
How does Hodgkin’s Lymphoma present?
A
- Bomidal age incidence (20s-30s and 70s)
- Risk factors include:
- HIV
- EBV
- Autoimmune conditions (i.e. RA, sarcoidosis)
- FHx
- Painless lymphadenopathy in the neck, axilla or inguinal region that is characteristically non-tender and feel ‘rubbery’
- Some patients experience pain when they drink alcohol
- Haematogenous spread to liver, lungs and bone marrow
- May have B symptoms:
- Fever
- Weight loss
- Night sweats
2
Q
How is Hodgkin’s lymphoma investigated and treated?
A
- LDH often raised
- Lymph node biopsy is key diagnostic test - Reed-Sternberg cell is key finding (owl eyes)
- CT, MRI and PET scans for staging
- Treated with chemotherapy and radiotherapy
- Chemotherapy - ABVD:
- Adrimycin (cardiotoxic)
- Bleomycin (pulmonary toxic)
- Vinblastine
- Dacarbazine
- Chemotherapy creates risk of leukaemia and infertility
- Ratiotherapy creates risk of cancer
3
Q
How does diffuse large B cell lymphoma (Non-Hodgkin’s) present?
A
- Usually >60yrs
- Rapidly growing painless lymphadenopathy, hepatosplenomegaly, extranodal presentation and systemic upset
4
Q
How is diffuse large B cell lymphoma (Non-Hodgkin’s) treated?
A
- R-CHOP
- Rituximab
- Cyclophosphamide
- Adriamucin
- Vincristine
- Prednisolone
5
Q
How does follicular lymphoma (Non-Hodgkin’s) present?
A
- Associated with t14:18 translocation
- Asymptomatic lymph node enlargement
- Hepatosplenemegaly and B symptoms
6
Q
How is follicular lymphoma (Non-Hodgkin’s) treated?
A
- CD20 is an antigen expressed on B-lymphocytes and is the target for treatment with the monoclonal antibody Rituximab
7
Q
How are lymphoma’s staged?
A
- Ann Arbor Staging System
- A/B = absence/presence of B symptoms
- Stage 1 = single LN region
- Stage 2 = ≥2 LN areas, same side of diaphragm
- Stage 3 = LN areas on both sides of diaphragm
- Stage 4 = extensive disease (liver, bone marrow)
8
Q
How is multiple myeloma diagnosed?
A
- Presentation - CRAB features:
- Calcium elevated
- Renal failure
- Anaemia (normocytic, normochromic)
- Bone lesions/pain
- Diagnosis:
- Myeloma is typified by ↑ plasma cells in bone marrow, clonal IG or paraprotein and lytic bone lesions
- FBC (NN anaemia, ↓WCC and platelets)
- ↑ESR
- ↑Ca
- ↑ plasma viscosity
- Serum protein electrophoresis and urine for Bence-Jones protein
- Testing in myeloma (remember BLIP)
- Bence-Jones protein (require urine electrophoresis)
- Serum-free Light-chain assay
- Serum Ig
- Serum Protein electrophoresis
- Imaging required to assess for bone lesions
- X-ray signs include:
- Punched out lesions
- Lytic lesions
- Raindrop skull
9
Q
What is the pathophysiology of multiple myeloma?
A
- Cancer or plasma cells which produce an abnormal monoclonal protein called a paraprotein or ‘M’ protein
- There are 5 subtypes (IgG, IgA, IgM, IgD and IgE)
- Bence Jones Protein can be found in the urine of patients with myeloma and is actually part of the antibody called the light chains
10
Q
How is myeloma treated?
A
- Depends on CRAB features
- First line is chemotherapy with Bortezomid, Thalidomide and Dexamethasone
- SCT can be used
- VTE prophylaxis important
11
Q
How does MGUS differ from myeloma?
A
- <10% marrow plasma cells - IgG <20g/l and IgM <10g/l in serum - No CRAB features
12
Q
How dose Burkitt lymphome (Non-Hodgkin’s) present?
A
- Associated with EBV, malaria and HIV
13
Q
How does Mucosa-Associated Lymphoid Tissue/MALT lymphoma (Non-Hodgkin’s) present?
A
- Usually around the stomach
- Associated with H. pylori infection
14
Q
How is Non-Hodgkin’s lymphoma treated?
A
- Watchful waiting
- Chemotherapy
- Monoclonal antibodies such as rituximab
- Radiotherapy
- Stem cell transplantation
