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Oncology > Non-Hodgkin's lymphoma > Flashcards

Non-Hodgkin's lymphoma Flashcards

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1
Q

what is it?

A

cancer of lymph organs with non reed-sternberg cells

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2
Q

origin

A

B cells, NK cells or T cells

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3
Q

how many subtypes?

A

60

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4
Q

what are the most common origins?

A

B cell

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5
Q

who is most affected?

A

males
prevalence increases with age
most diagnosed after 55 - 80-84 are most commonly affected group
but one of the more common cancers in younger people

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6
Q

presentation

A

depends on type and grade

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7
Q

general clinical features

A 
lymphadenopathy
fever 
night sweats
weight loss 
pruritus 
splenomegaly
hepatomegaly 
ranges from dermatological conditions to bowel obstruction to SVC obstruction
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8
Q

high grade and aggressive symptoms

A 
rapidly enlarging mass
malaise 
weight loss 
fevers 
night sweats
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9
Q

low grade symptoms

A

gradual lymphadenopathy
malaise
marrow involvement signs

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10
Q

extra-nodal lymphoma

A

primary CNS, cutaneous and GI tract lymphomas

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11
Q

primary CNS lymphoma

A 
neurological features 
headache 
confusion 
seizures 
coma
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12
Q

primary cutaneous lymphoma

A

rashes
plaques
ulcers
mycosis fungoides = cutaneous T cell lymphoma

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13
Q

primary GI tract lymphoma

A

abdominal pain
nausea
obstruction
haemorrhage

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14
Q

oncological emergencies

A 
superior vena cava obstruction 
cord compression
hypercalcaemia
tumour lysis syndrome 
neutropenic sepsis
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15
Q

investigations

A 
excision biopsy
FBC
U&Es
LFTs
ESR
bone profile
LDH
uric acid
HIV
Hep B
Hep C
CXR
CT
PET CT
MRI
USS
bone scan 
bone marrow aspirate and biopsy 
lumbar puncture 
fluorescence in situ hybridisation
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16
Q

excision biopsy

A

fine needle aspiration is not appropriate and core biopsy is inferior to excisional biopsy

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17
Q

CT

A

of neck, chest, abdomen and pelvis to assess and identify enlarged nodes, liver, spleen and soft tissue masses

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18
Q

what is PET CT for?

A

staging and assessing treatment response

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19
Q

what is MRI used for?

A

brain when suspicion of leptomeningeal infiltration or mass lesions

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20
Q

what is USS for?

A

testicles to identify testicular lymphoma

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21
Q

when is lumbar puncture done?

A

if suspected CNS disease
cytology
flow cytometry

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22
Q

what is fluorescence in situ hybridisation for?

A

to identify MYC rearrangement in high grade B cell lymphoma

if found further testing to identify BCL2 and BCL6 rearrangements and immunoglobulin partner arranged

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23
Q

what is the staging?

A

Lugano

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24
Q

Lugano staging

A

describes anatomical distribution of disease
important for prognostic and therapeutic importance
modified by presence or absence of B symptoms, extranodal involvement and bulky disease

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25
what are the categories in Lugano staging?
limited stage II bulky disease advanced
26
limited disease stages
I and II
27
stage II bulky disease
stage II with bulky disease
28
what is bulky disease
disease >10cm
29
advanced disease stages
Stage III and IV
30
stage I
1 node or group of adjacent nodes, single extra-nodal lesion without nodal involvement
31
stage II
2 or more nodal groups on same side of diaphragm | stage I or II by nodal extent with limited contiguous extra-nodal involvement
32
stage III
nodes on both sides of diaphragm, nodes above diaphragm with spleen involvement
33
stage IV
additional non-contiguous extra-lymphatic involvement
34
treatment
chemotherapy
35
chemotherapy
R-CHOP
36
R-CHOP
``` Rituximab Cyclophosphamide Doxorubicin Vincristine Prednisolone ```
37
Rituximab
monoclonal antibody with activity against CD20 which is on surface of B cells
38
side effects of Rituximab
infusion reactions hepatitis B reactivation mucocutaneous reactions progressive multifocal leukoencephalopathy
39
Cyclophosphamide
alkylating agent inhibits DNA synthesis through cross linking carcinogenic tendencies linked to development of malignancies - transitional cell carcinoma of bladder
40
side effects of cyclophosphamide
bone marrow suppression | infertility
41
doxorubicin
anthracycline | inhibits topoisomerase II leading to inhibition of DNA and RNA synthesis
42
side effects of doxorubicin
cardiomyopathy myelosuppression skin reactions
43
vincristine
inhibits microtubule formation by binding to tubulin
44
side effects of vincristine
peripheral neuropathy | bladder atony
45
prednisolone
glucocorticoid steroid
46
side effects of prednisolone
typical of steroids
47
types of non-Hodgkin's lymphoma
Burkitt's lymphoma Follicular lymphoma Diffuse large B cell lymphoma
48
Diffuse large B cell lymphoma
most common form more common in men present at younger age in people of black ethnicity
49
presentation of diffuse large B cell lymphoma
rapidly enlarging mass in neck, abdomen or mediastinum B symptoms extranodal disease - GI tract
50
disease of mediastinum
may lead to SVC obstruction
51
bony destruction
may lead to cord compression
52
treatment for limited diffuse large B cell disease
R-CHOP chemotherapy | or combined modality therapy
53
combined modality therapy
chemoimmunotherapy and radiotherapy
54
treatment for advanced diffuse large B cell disease
R-CHOP or EPOCH-R
55
treatment for recurrent diffuse large B cell disease
autologous haematopoietic cell transplant
56
follicular lymphoma
second most common
57
presentation of follicular lymphoma
gradual lymphadenopathy - may come and go | B symptoms
58
genetics in follicular lymphoma
85% have 14:18 translocation
59
prognosis assessment for follicular lymphoma
Follicular Lymphoma International Prognostic Index
60
Treatment for follicular lymphoma
depends on stage at diagnosis
61
treatment for early stage follicular lymphoma
local radiotherapy
62
treatment for stage II + follicular lymphoma
depends on whether patient is symptomatic or not
63
treatment for stage II+ symptomatic follicular lymphoma
chemoimmunotherapy = Rituximab and chemo, e.g. R-CHOP
64
treatment for stage II+ asymptomatic follicular lymphoma
immunotherapy with Rituximab
65
cure rate for follicular lymphoma
uncommon in those with stage II-IV disease | relapse is frequent
66
what is Burkitt's lymphoma?
high grade rapidly proliferating B cell lymphoma
67
how common is Burkitt's lymphoma?
uncommon more common in males commonly affects children
68
types of Burkitt's lymphoma
endemic sporadic immunodeficiency
69
endemic Burkitt's lymphoma
strongly associated with EBV and follows distribution of malaria
70
sporadic Burkitt's lymphoma
less associated with EBV | seen in Europe and North America
71
immunodeficiency Burkitt's lymphoma
associated with AIDs or conditions/medications causing immunosuppression
72
genetics of Burkitt's lymphoma
caused by mutation in c-myc proto-oncogene | translocation between chromosomes 8 and 14
73
presentation of endemic Burkitt's lymphoma
rapidly enlarging tumour in child's jaw or enlarged neck/abdominal lymph nodes/masses
74
presentation of sporadic Burkitt's lymphoma
abdominal symptoms with ileocaecal valve affected causing bowel obstruction
75
how to manage Burkitt's lymphoma?
depends on patient's health, wishes and disease type | highly chemosensitive
76
1st line treatment for Burkitt's lymphoma
immunochemotherapy
77
risks of Burkitt's lymphoma treatment
tumour lysis syndrome due to rapid tumour breakdown on initiation of treatment prophylaxis is needed

Oncology (5 decks)

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