Non-hodgkins lymphoma

Question 1

Differences between HL and NHL

AGE

Answer 1

Bimodal 15-30 and 50 yrs in H

Increaseswith age, median age being 50. Low grade NHL is 55-60

Question 2

Gender difference

Answer 2

M;F =5;1 IN H

M;F=7;1 IN NHL

Question 3

Hodgkins lymphoma

Answer 3

More in males

rises in adolescence peaks in 3rd decade

Question 4

Stages difference

Answer 4

stages 1 and 2 at presentation in H

stages 3 and 4 at presentation in NHL

Question 5

b symptons and signs

Answer 5

25-40% in H

15% in NHL

Question 6

direction of spread difference

Answer 6

predictable axial spread in H

Random spread in NHL

Question 7

Leukemic phase

Answer 7

rare in H

Common in NHL

Question 8

ORIGIN DIFFERENCE

Answer 8

MAjority originate from nodal region -H

80% nodal and 20% extranodal NHL

Question 9

Trochlear, mesenteric, pharyngeal nodes

Answer 9

Rarely involves these areas-H

Occasional involvement-NHL

Question 10

mediastinum involvement

Answer 10

50% involvement-H

20% NHL

Question 11

Lymph node involvement

Answer 11

subdiaphragmatic LN. gENERALISED ln AND EXTRA LYMPHATIC DX LATER-H

Widespread LN involvemenr- NHL

Question 12

Bone marrow involvement

Answer 12

less than 10% in H

70% in NHL

Question 13

Spread

Answer 13

Contiguous-H

Non contiguous- NHL

Question 14

GIT AND LIVER INVOLVEMENT

Answer 14

Rare-H

COMMON-NHL

Question 15

Superior vena cava obstruction

Answer 15

Common-NHL

Non common- H

Question 16

CAUSES OF NHL

Answer 16

EBV
HTLV 1
immunosuppression

Question 17

First implicated virus

Answer 17

EBV

Question 18

What type of infection by EBV is associated with lymphomas

Answer 18

Latent

Question 19

Type 1 EBV latency causes

Answer 19

burkitts lymphoma

Question 20

Type 2 EBV latency causes

Answer 20

hodgkins dx

nasopharyngeal ca

Question 21

Type 3 EBV latency causes

Answer 21

HIV LYMPHOMA

Question 22

Classification of NHL

Answer 22

Indolent NHL
B cell lymphomas
T cell lymphomas

Question 23

Examples of B cell lymphomas

Answer 23

Diffuse large B cell lymphomas
Follicular lymphoma
Mantle cell lymphoma
Marginal zone lymphomma
Burkitts lymphoma
Lymphoplasmacytic lymphoma

Question 24

Example of T cell lymphoma

Answer 24

Cutaneous T cell lymphoma
Angioimmunoblastic T cell lymphoma
Anaplastic large cell lymphoma
Enteropathy type t cell lymphoma

Question 25

Investigations in NHL

Answer 25

Investigation of waldeyers group of LN Bone biopsy

Question 26

is staging laparatomy justifies in NHL

Answer 26

no

Question 27

Symptom status B meaning

Answer 27

unexplained fever Drenching night weats weight loss greater than 10%

Question 28

Bulk

Answer 28

Mediastinal mass greater than 1/10 the max diameter of the chest

Question 29

Recommendations for clinical imaging

Answer 29

``` size - >1.5 Spleen- physical exam,Chest X rat, CT Lymph angiography to identify abnormal LN Gallium scan MRI ```

Question 30

Clinical features of NHL

Answer 30

Lymphadenopathy-widespread Hepatosplenomegaly Fever, night sweats, weight loss

Question 31

Systemic symptoms and signs

Answer 31

due to involvement of particular organs like GIT, lungs, CNS Can cause delay in diagnosis and can decrease survival

Question 32

Less frequent symptoms

Answer 32

``` abdominal pain fatigue painful adenopathy malaise dysphagia cough bone pain edema pruritus ```

Question 33

Burkitts lymphoma presents with

Answer 33

extranodal dx in the jaw in africa in GIT and intraabdominal sites in the west

Question 34

Lymphoblastic lymphoma symptoms

Answer 34

Thymic mass Systemic symptoms Bone marrow failure

Question 35

In advanced NHL about half obtain

Answer 35

Complete remission | the rest obtain useful dx control

Question 36

Those who have complete remission

Answer 36

Relapse in 5 yrs

Question 37

Front line therapy being studied

Answer 37

Fludarabine and 2 chloro deoxyadenosine

Question 38

Management of treatment failures

Answer 38

Repeat previous combination after a long period of remission Quick relapse after chlorambucil; give CHOP/fludarabine

Question 39

Valuable in 2/3 of patients heavily pretreated

Answer 39

Fludarabine, mitoxantrone, dexamethasone