Non-hodgkin Lymphoma Flashcards
(30 cards)
Non-Hodgkin lymphomas are the … most common type of cancer in the UK.
Non-Hodgkin lymphomas are the sixth most common type of cancer in the UK.
Lymphoma is a haematological malignancy arising from lymphoid tissue. They are commonly categorised as Hodgkin or Non-Hodgkin lymphoma:
Hodgkin lymphoma (HL): Characterised by the presence of Hodgkin/Reed-Sternberg cells (large, multinucleated cells). Further categorised as classical Hodgkin's lymphoma (nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted) and nodular lymphocyte-predominant Hodgkin's lymphoma. Non-Hodgkin lymphoma (NHL): Reed-Sternberg cells are not seen in NHL. There are more than 60 subtypes and they can be B-cell or NK/T-cell in origin. B-cell lymphomas are more common accounting for around 80%, though there is significant geographic variation. NHLs are more common than Hodgkin lymphoma, accounting for around 80-85% of lymphomas.
There are around 14,000 cases of .. diagnosed in the UK each year.
There are around 14,000 cases of NHL diagnosed in the UK each year.
Epidemiology
There are around 14,000 cases of NHL diagnosed in the UK each year.
In the UK, prevalence increases with age, with most diagnosed after the age of 55 - however it is one of the more common cancers in young people. The 80-84 age-group is most commonly affected.
In 2017, it was the sixth most common cancer in the UK and was responsible for around 4,900 deaths. Overall males are more often affected and there was no significant difference between ethnicities according to figures from Cancer Research UK.
The most common symptom of NHL is ….
The most common symptom of NHL is lymphadenopathy.
Features common to many NHLs include:
Lymphadenopathy Fever Night sweats Weight loss (unexplained, > 10% in the last 6 months) Pruritus Splenomegaly Hepatomegaly
Together, weight loss, night sweats and fever are called ‘..’ symptoms.
Together, weight loss, night sweats and fever are called ‘B’ symptoms.
Some patients will present with primary extra-nodal lymphoma, examples include:
Primary CNS lymphoma: Neurological features such as headache, confusion, seizures and coma may develop.
Primary cutaneous lymphoma: Patients may present with rashes, plaques and ulcers. Examples include mycosis fungoides, a cutaneous T-cell lymphoma.
Primary GI tract lymphoma: Patients may present with abdominal pain, nausea, obstruction and haemorrhage.
On occasion patients with NHL may present with, or develop, an oncological emergency.
These include, but are not limited to:
Superior vena cava obstruction (SVCO) Cord compression Hypercalcaemia Tumour lysis syndrome Neutropenic sepsis
Imaging in suspected NHL
Chest x-ray
CT neck, chest, abdomen and pelvis: Allows assessment and identification of enlarged lymph nodes, the liver and spleen and soft tissue masses.
PET CT: Used both in the staging and assessment of treatment response in many lymphomas. Lymphomas are often FDG avid, though some will not be.
MRI brain: Particularly used when leptomeningeal infiltration or mass lesions are suspected.
Testicular USS: Identify suspected testicular lymphoma (a rare type of testicular tumour).
Bone scan
Biopsy - Suspected NHL
Excision biopsy of affected lymph nodes or tissue is normally required in patients with suspected NHL.
Needle core biopsy may be considered in those unfit for excisional biopsy. However, if this fails to produce a sufficient sample an excisional biopsy will have to be reconsidered.
ADDITIONAL NHL tests
Bone marrow aspirate and biopsy
Lumbar puncture: In patients with suspected CNS disease, cytology and flow cytometry may be required.
Fluorescence in situ hybridisation (FISH): NICE advise using FISH to identify MYC rearrangement in those with high-grade B-cell lymphoma. If found, further testing to identify BCL2 and BCL6 rearrangements and the immunoglobulin partner should be arranged.
The … staging system is used to classify NHL.
The Lugano staging system is used to classify NHL.
‘B’ symptoms: ‘B’ symptoms refer to fever, night sweats and weight loss (unexplained, >10% in 6 months). ’B’ denotes presence and ‘A’ denotes absence.
Extranodal involvement: In limited stage disease ‘E’ is used to denote extranodal tissue involvement.
Bulky disease: Definition of bulky is nuanced but typically refers to disease > 10cm.
‘B’ symptoms: ‘B’ symptoms refer to fever, night sweats and weight loss (unexplained, >10% in 6 months). ’B’ denotes presence and ‘A’ denotes absence.
Extranodal involvement: In limited stage disease ‘E’ is used to denote extranodal tissue involvement.
Bulky disease: Definition of bulky is nuanced but typically refers to disease > 10cm.
R-CHOP
R-CHOP is a commonly used chemotherapy regimen in those with NHL.
There are many treatments regimens for NHL. However the one you will be commonly expected to know about at undergraduate level is R-CHOP.
Rituximab: A monoclonal antibody with activity against CD20 - an antigen found on the surface of B-cells. Serious side effects include infusion reactions, hepatitis B reactivation, mucocutaneous reactions and progressive multifocal leucoencephalopathy.
Cyclophosphamide: An alkylating agent, inhibits DNA synthesis through cross linking of DNA. It has carcinogenic tendencies and has been linked to the development of a number of malignancies including transitional cell carcinoma of the bladder. Other serious side effects include bone marrow suppression and infertility.
Doxorubicin: An anthracycline that inhibits topoisomerase II leading to inhibition of DNA and RNA synthesis. Side effects include cardiomyopathy, myelosuppresion and skin reactions.
Vincristine: Inhibits microtubule formation by binding to tubulin. Side effects include peripheral neuropathy and bladder atony.
Prednisolone: Is a glucocorticoid steroid. Its side effects are those of steroids.
Diffuse large B cell lymphoma (DLBCL) is the most common form of ..
Diffuse large B cell lymphoma (DLBCL) is the most common form of NHL.
… accounts for around 25-30% of all NHL. Within the condition, a number of distinct entities exist and are listed in the WHO classification. It is slightly more common in men than women, and appears to present at a younger age in those of black ethnicity.
DLBCL accounts for around 25-30% of all NHL. Within the condition, a number of distinct entities exist and are listed in the WHO classification. It is slightly more common in men than women, and appears to present at a younger age in those of black ethnicity.
Diffuse large B cell lymphoma (DLBCL) is the most common form of NHL.
Patients tend to present with a rapidly enlarging mass, commonly in the neck, abdomen or mediastinum. ‘B’ symptoms are seen in around a third of patients.
Extranodal disease is common and can arise essentially anywhere but is most commonly seen in the GI tract.
Disease in the mediastinum may lead to SVCO whilst bony destruction may result in a presentation with cord compression.
Disease in the mediastinum may lead to .. whilst bony destruction may result in a presentation with cord compression.
Disease in the mediastinum may lead to SVCO whilst bony destruction may result in a presentation with cord compression.
Treatment of DLBCL
Treatment of DLBCL is enormously complex. Patients will typically be categorised as having limited disease (stage I/II) or advanced disease (stage III/IV). They require assessment for CNS involvement and consideration as to the need for CNS prophylaxis.
Limited stage disease: Is commonly treated with chemoimmunotherapy in the form of R-CHOP. Combined modality therapy (CMT) may be used where chemoimmunotherapy is combined with radiotherapy.
Advanced stage disease: Treatment may involve R-CHOP or other regimens such as (da)-EPOCH-R.
… lymphoma is a B-cell NHL, and the second most common form.
Follicular lymphoma is a B-cell NHL, and the second most common form.
Follicular lymphoma is the second most common form of NHL. It often presents insidiously, with gradual lymphadenopathy.
The exact pathogenesis is not understood. Around 85% have a translocation between chromosomes 14 and 18, t(14;18), however this is a non-specific change that may be seen in many without lymphoma.
Follicular lymphoma is the second most common form of NHL. It often presents insidiously, with gradual lymphadenopathy.
The exact pathogenesis is not understood. Around 85% have a translocation between chromosomes 14 and 18, t(14;18), however this is a non-specific change that may be seen in many without lymphoma.
Follicular lymphoma is the second most common form of NHL. It often presents insidiously, with gradual lymphadenopathy.
The exact pathogenesis is not understood. Around 85% have a translocation between chromosomes 14 and 18, t(14;18), however this is a non-specific change that may be seen in many without lymphoma.
