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Flashcards in Lymphomas Deck (39):
1

What is lymphoma?

- malignant tumours of lymphoid origin which can arise anywhere lymphoid tissue is present

2

What are the two classifications of lymphomas?

- Hodgkin's lymphoma
- Non-Hodgkin's lymphoma

3

What is the epidemiology of lymphomas?

- more common in males
- age-dependent which varies with type

4

What is the lymphatic system?

- systemic network of various tissues, glands, organs and ducts
e.g. lymph nodes, bone marrow, spleen, liver
- produces, stores and transports lymph

5

What is lymph?

- a portion of blood plasma separated from interstitial fluid
- contains waste from cell
- travels one-way toward the subclavian veins to be returned to the venous system
- lymph nodes treat and filter harmful entities

6

What are the similarities between HL and NHL?

- lymphocyte origin
- painless swelling of LNs
- can occur anywhere in the body but most frequently occur in LNs
- General symptoms of weight loss, fevers, night sweats

7

What is the orgin of HL?

- arise mostly from b-cells
- reed-sternberg cells
- distinct under light micro (enlarged, multi or bi-loaded nucleus)

8

What characterises HL?

- reed-sternberg cells
- two age groups (15-40; 55+)
- more often in upper body
- usually contiguous nodes
- rarely extra-nodal
- distinct type

9

What characterises NHL?

- risk increases with age (60+)
- no site predominance
- widely disseminated node groups
- common extra-nodal involvement (90% stage 3 or 4 include bone marrow involvement)
- more then 30 types

10

What is the aetiology of HL?

- genetic
- familial (siblings especially identical twins)
- socioeconomic status-higher
- environmental
- infections EBV, glandular fever, HIV

11

What are the histological subtypes of HL?

- lymphocyte predominant
- nodular sclerosis
- mixed cellularity
- lymphocyte depleted

12

What are the signs and symptoms of HL?

- lymphadenopathy (cervical and sup'clav, mediastinal)
- splenomegaly/abdo mass
- spread to contiguous nodes
- alcohol induced pain
- chest pain
- bronchial obstruction
- SVC obstrucion
SYSTEMIC
- pruritus
- fatigue
- bone pain

13

Where does HL metasesis extranodally to?

- liver (20%)
- bone marrow (10%)
- bone (7%)
- lung (5%)

14

What is used to diagnose HL and NHL?

- biopsy
- physical exam
- full medical history
- chest x-ray/CT
- CT abdomen, pelvis
- FBC
- bone marrow biopsy

15

What is the staging of HL and NHL?

- stage 1: single lymph node group
- stage 2: multiple LNs on same side of diaphragm
- stage 3: multiple LNs on both sides of diaphragm
- stage 4: mutliple extranodal sites of Lns and extranodal disease
- stage 5: bulk>10cm
A/B
- B symptoms: weight loss>10%, fever, drenching night sweats

16

What is the clinical management of HL?

- dependent on stage
- RT (highly radiosensitive)
- chemo
- combined modality

17

What is the clinical management of stage IA and IIA for HL?

1. extended or involved field RT, salvage chemo
2. Extended field RT then 6 cycles of chemo

18

What is the clinical management of stage IIIA for HL?

- may apply TNI; however chemo alone is effective
- Chemo: Adriamycin, Bleomycin,
Vinblastine, & Dacarbazine

19

What is the clinical management of stage IIB, IIIB, IVB for HL?

CHEMO ABVD
- adriamycin
- bleomycin
- vinblasine
- dacarbazine

20

What is the RT fields used from HL?

- involved field: involved nodal group only
- extended field: mantle or inverted-Y
- total nodal irradiation (TNI): mantle + inverted-Y

21

What is the patient positioning for RT of HL?

- supine (or prone)
- arms by side
- handy on hips
- elbows flexed and supported mantle board
- vac bags
- lung shields

22

What is the RT dose for HL? (extended field following chemo)

- 35Gy in 20#
- 40Gy in25#

23

What is the RT dose for HL? (involved field)

early stage: 20Gy in 10f
advanced stage/post chemo: 30Gy in 15f

24

What is the RT dose for HL? (palliative/post relapse)

-20GY in 5#
- 30Gy in 10#
- 8Gy in 1#

25

What is the RT acute side effects for HL?

size of volume:
- blood count
- fatigue (blood count)

location of volume:
- nausea, vomitting, diarrhoea
- alopecia
- erythema

26

What is the RT late side effects for HL?

- malignancy
- cardiac sequelae
- thyroid dysfunction
- radiation pneumonitis
- gonadal effects

27

What are some consideration of side effects for paediatrics?

- skeletal effects
- stertility
- many psychological

28

What is the aetiology of NHL?

- viral infection (EBV, HIV, Hep C)
- immunodeficiency (AIDS, transplant patients, coaeliac disease)
- environmental (peticide exposure)

29

What are the classifications of NHL?

B CELL
- low grade: follicular
- high grade: burkitts lymphoma

T-CELL
- low grade: mycosis fungoides
- high grade: large cell

30

What are the signs and symptoms of NHL?

- lymphadenopthy neck
- presenting symptoms may be due to compression

31

What is the common clinical management for an eldery with folicular lymphoma?

- watch and wait

32

What is the clinical management for stage I and II NHL?

- extended field RT

33

What is the clinical management for recurrent NHL?

- RT to chase the spread
- chemo + RT not as effective

34

What are the clinical management options for NHL?

- watchful waiting
- chemotherapy
- MAB therapy (monoclonal antibody)
- RT
- steroid therapy
- peripheral blood stem cell transplant

35

What are the common treatments for cutaneous T-cell NHL (mycosis fungoides)

- topical treatment (steroid creams; nitrogen mustard)
- widespread disease - psoralens and UV light or total body electrons

36

What is the RT dose of Stage I, IE, II, IIE NHL?

24-30Gy in 12-15f

37

What is the RT dose post chemo for NHL?

30Gy in 15f

38

What is the palliative RT dose for NHL?

- 20Gy in 5f
- 30Gy in 10f
- 4Gy in 2f

39

What is the dose for splenic irradiation?

10-12Gy in 0.5-1.5Gy/f up to 3f/week