Lymphomas Flashcards
(41 cards)
What are lymphomas?
Malignancies of the lymphoid system and hence may arise at any site where lymphoid tissue is present
At what ages is Hodgkin’s lymphoma most prevalent?
16-65
What are risk factors for Hodgkin’s lymphoma?
Epstein-Barr virus infection
Smoking, HIV
What cancer is Epstein-Barr virus linked to?
Hodgkin’s lymphoma; up to 40% of patients with HL have increased EBV antibody titres
What is the most common lymphoma?
Non-HL
What is the clinical presentation of Hodgkin’s lymphoma
The commonest presentation of HL is painless cervical lymphadenopathy, commonly described in examination as ‘rubbery’
Signs and symptoms of Hodgkin’s lymphoma may include:
- Persistent fatigue
- Fever
- Night sweats
- Unexplained weight loss
- Severe itching
- Increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol
How is Hodgkin’s lymphoma classified?
- Classical Hodgkin’s lymphoma (cHL) (hallmark Reed-Sternberg cell)
- Nodular lymphocyte-predominant HL (NLPHL) (popcorn cells)
What cancer type has Reed-Sternberg cells?
Classical Hodgkin’s lymphoma (cHL)
What investigations would you do for Hodgkin’s lymphoma?
- FBC: The degree of any anaemia, leukocytosis and lymphopenia are prognostic indicators
- ESR: an ESR of greater than 70 carries an unfavourable prognosis
- LFT
- Lymph node biopsy
- CXR
- CT for staging
What is the most common type of Hodgkin’s lymphoma?
Nodular sclerosis classical Hodgkin’s lymphoma
How would you manage Hodgkin’s lymphoma?
Cardiac and pulmonary function tests are mandatory
- Early disease: chemo + radio
- Advanced disease: extended chemo
- After relapse: high dose chemo + stem cell transplant
What is the risk of chemotherapy in Hodgkin’s lymphoma?
Leukaemia
What is the prognosis for Hodgkin’s lymphoma?
With modern treatment strategies, 80-90% of patients achieve permanent remission and can be considered cured[
What is non-Hodgkin’s lymphoma?
Non-Hodgkin’s lymphomas (NHLs) are an heterogeneous group of lymphoproliferative malignancies with differing patterns of behaviour and responses to treatment. There is a much greater predilection to disseminate to extranodal sites than in Hodgkin’s lymphoma. The prognosis depends on the histological type, stage and treatment.
They can be divided into two prognostic groups:
1. Low-grade: relatively good prognosis, with median survival as long as 10 years. However, they are usually not curable in advanced clinical stages.
- High-grade: shorter natural history but a significant number of these patients can be cured with intensive combination chemotherapy regimens.
How would you classify non-Hodgkin’s lymphoma?
- Precursor B-cell neoplasms: precursor B-lymphoblastic lymphoma.
- Mature (peripheral) B-cell neoplasms (including Burkitt’s)
- Precursor T-cell neoplasms: precursor T-lymphoblastic lymphoma.
- Mature (peripheral) T-cell neoplasms:
What is the median age of presentation for non-Hodgkin’s lymphoma?
50 and over
What are the most common types of non-Hodgkin’s lymphoma?
Diffuse large B-cell lymphoma and follicular lymphoma
What are the risk factors for non-Hodgkin’s lymphoma?
Chromosomal translocations and molecular rearrangements.
Viral infections
Environmental factors such as pesticides, solvents, preservatives
Congenital and acquired immunodeficiency states.
How does non-Hodgkin’s lymphoma present?
Painless, slowly progressive peripheral lymphadenopathy
Fatigue, weakness, fever, night sweats, weight loss
Splenomegaly, hepatomegaly
What are the investigations for non-Hodgkin’s lymphoma?
FBC: anaemia and thrombocytopenia and neutropenia
Renal function and electrolytes: obstructive nephropathy, hypercalcaemia.
CXR: mediastinal adenopathy
CT scans
How is non-Hodgkin’s lymphoma staged?
The Ann Arbor staging system is the most commonly used
How is non-Hodgkin’s lymphoma managed?
Options include watchful waiting, single-agent or multi-agent chemotherapy and regional or extended radiotherapy.
What is the prognosis for non-Hodgkin’s lymphoma?
Low-grade NHL types have a relatively good prognosis, with median survival as long as 10 years; however, they are usually not curable when advanced.
What is the cellular origin of most non-Hodgkin’s lymphoma?
- 80% are B-cell origin
- 20% are T-cell origin
