Lymphoma (zero to finals)

Question 1

What is lymphoma?

Answer 1

A type of cancer affecting the lymphocytes inside the lymphatic system.

Cancerous cells proliferate inside the lymph nodes, causing the lymph nodes to become abnormally large (lymphadenopathy).

Question 2

What are the main 3 sites where enlarged lymph nodes can be palpated on examination?

Answer 2

Cervical
Axillary
Inguinal

Question 3

What are the 2 main types of lymphoma?

Answer 3

Hodgkin’s lymphoma (specific disease)

Non-hodgkin’s lymphoma (includes all other types)

Question 4

What is the most specific type of lymphoma?

Answer 4

Hodgkin’s lymphoma

Question 5

Average ages affected by Hodgkin’s lymphoma?

Answer 5

Bimodal age distribution with peaks around 20-25 and 80 years.

Question 6

What are the risk factors for Hodgkin’s lymphoma?

Answer 6

HIV

Epstein-Barr virus

Autoimmune conditions, such as rheumatoid arthritis and sarcoidosis

Family history

Question 7

Non-hodgkin’s lymphoma consists of many types. What are 3 main ones?

Answer 7

Diffuse large B cell lymphoma typically presents as a rapidly growing painless mass in older patients

Burkitt lymphoma is particularly associated with Epstein-Barr virus and HIV

MALT lymphoma affects the mucosa-associated lymphoid tissue, usually around the stomach (cause includes H.pylori)

Question 8

What are some risk factors for non-hodgkin’s lymphoma?

Answer 8

HIV

Epstein-Barr virus

Helicobacter pylori (H. pylori) infection is associated with MALT lymphoma

Hepatitis B or C infection

Exposure to pesticides

Exposure to trichloroethylene (a chemical with a variety of industrial uses)

Family history

Question 9

What is a major presenting feature of lymphomas?

Answer 9

Lymphadenopathy is the key presenting symptom.

The enlarged lymph node or nodes might be in the neck, axilla or inguinal region.

They are characteristically non-tender and feel firm or rubbery.

Question 10

When may patient’s with Hodgkin’s lymphoma experience lymph node pain?

Answer 10

After drinking alcohol

Question 11

What are the B symptoms (systemic symptoms) of lymphoma?

Answer 11

Weight loss

Night sweats

Fever

Question 12

What are some additional non-specific symptoms that can occur with lymphoma?

Answer 12

Fatigue

Itching

Cough

Shortness of breath

Abdominal pain

Recurrent infections

Question 13

What is the main diagnostic investigation for lymphoma?

Answer 13

Lymph node biopsy

Question 14

What cells would a Hodgkin’s lymphoma lymph node biopsy show?

Answer 14

Reed-Sternberg cells are the characteristic finding from a biopsy of Hodgkin’s lymphoma.

They are large cancerous B lymphocytes with two nuclei and prominent nucleoli, giving them a cartoonish appearance of an owl face with large eyes.

Question 15

Apart from lymph node biopsy, what other investigations may be used?

Answer 15

CT, MRI, and PET scans may be used to help diagnose and stage the disease.

Question 16

What is the Lugano classification system?

Answer 16

Used for Hodgkin’s and non-Hodgkin’s lymphoma (replacing the older Ann Arbor system).

It emphasises whether the affected nodes are above or below the diaphragm.

Question 17

What are the main management options for Hodgkin’s lymphoma?

Answer 17

Chemotherapy and radiotherapy

Treatment aims to cure disease however there is still risk of relapse and side-effects.

Question 18

Side effects of chemotherapy for Hodgkin’s lymphoma?

Answer 18

Chemotherapy may result in:

Infections

Cognitive impairment

Secondary cancers (e.g., leukaemia)

Infertility

Question 19

Side effects of radiotherapy for Hodgkin’s lymphoma?

Answer 19

Radiotherapy creates a risk of:

Tissue fibrosis

Secondary cancers

Infertility

Question 20

Management options for Non-Hodgkin’s lymphoma?

Answer 20

Depends on the type and stage. It may involve:

Watchful waiting
Chemotherapy
Monoclonal antibodies (e.g., rituximab, which targets B cells)
Radiotherapy
Stem cell transplantation