Non hodgkins lymphoma

Question 1

Why imporatnt get diagnosis correct

Answer 1

Each subtype has different optimal treatment

Question 1

What are non hodgkins lymphomas

Answer 1

Malignant proliferation of lymphocytes derived from B cells
Remainder occuring form T cells or NK cells
6th ost common cancer in YK

Question 2

NHL vs HL

Answer 2

NHL - B/T cells at various maturation stages, increases with age, non contigious spread, extra nodal disease common, systemic symptoms uncommon, AI disorders, organ transplant etc , lymphadenopathy anywahere

HL - RS cells mature B cells, bimodal age, contigious spread upper body lymhp nodes, extranodal uncommon , systemic symptoms common

Question 3

Infections increasing risk of NHL

Answer 3

HIV - burkitts or diffuse large B cell
HTLV-I - T cell leukaemia
EBV - burkitt
H.pylori - MALT lymphoma
Hep C

Question 4

Risks for NHL

Answer 4

Infection
Immunosupression esp post transplatn
AI disease - RA, SLE, sjrogens, coeliac, hashimotos thyroiditis

Question 5

What gene is ass with follicular lymphoma

Answer 5

BCL12 translocation

Question 6

What gene is ass with bukitt lymphoma

Answer 6

MYC transloaction

Question 7

What type of NHL is most aggressive and hoe common is it

Answer 7

Diffuse large B cell lymphoma
30-58% of all NHL

Question 8

What is most common indolent NHL

Answer 8

Follicular lymphoma
35% of all NHL

Question 9

Most common lymph noes in NHL adenopathy

Answer 9

Cervical, axillary, inguinal, femoral
Extranodal aslo common

Question 10

Most common effected extra nodal sites NHL

Answer 10

GI tract - esp stomach
Skin
Bone marrow -> cytopneia

Question 11

Symptoms due to mass effect from enlarging lymph nodes

Answer 11

SVC syndrome
External biliary tree compression - jaundice
Ureter compression - hydronephrosis
Bowel obstruction
Vomitting and constiaption
Impaired lymph drainage - chylous pleural or peritoneal fluid or lymphoedema of lower limbs

Question 12

NHL features

Answer 12

Lymphadenopathy
Compression symptoms from above
GI tract, skin or bone marrow affected
B sympmots = worse prognosis

Question 13

What is mycosis fungoides

Answer 13

Skin lesions incl eczematous reaction -> plaques, tumours, fungating ulcers and erythroderma extremely itchy

Question 14

Features of NHL severe

Answer 14

mediastinal mass, superior vena cava syndrome and meningeal disease with cranial nerve palsies

Question 15

Features of adult T cell leukaemia lmphoma

Answer 15

fulminating clinical course with skin infiltrates, lymphadenopathy, hepatosplenomegaly, and leukaemia
May have hyperalcemia

Question 16

Features of anaplastic large cell lymphoma

Answer 16

rapidly progressive skin lesions, adenopathy, and visceral lesions

Question 17

Features of burkitts lymphoma

Answer 17

Large abdo mass
Bowel obstruction

Question 18

Initial investigations NHL

Answer 18

Bloods - FBC, U+Es, LFTs, LDH,, viral screening, B2 microglobulin
CXR
MRI brain and spinal cord if neuro symotos

Question 19

What look for on CXR w NHL

Answer 19

Mediastinal adenopathy
Pleural or pericardial effusions and parenchymal involvement

Question 20

Diagnostic tests for NHL

Answer 20

If lesion palpable, excisional biopsy preferred
Lesion ling or abdomen - core needle biopsy
Immunophenotyping - FISH for MYC -> burkitts lymphoma - BL2 or 6

Question 21

Painless lymphadenopathy differntatisl

Answer 21

EBV - IM
Toxoplasmosis
CMV
Primary HIV
Leukaemia
HL

Question 22

Peripheral lymphocytosis differntiasl

Answer 22

Leukaemia
EBV
Duncan syndrome - X linked lymphoproliferative syndrome

Question 23

Staging NHL

Answer 23

Lugano classification - same as HL
I - one node affected
IV - systemic/extranodal - not local to one organ

Question 24

Criteria for urgent referral NHL

Answer 24

Persistent (>6 weeks) lymphadenopathy One or more lymph nodes >2 cm in diameter Rapidly increasing lymphadenopathy Generalised lymphadenopathy Persistent and unexplained splenomegaly

Question 25

Vaccines receive w NHL

Answer 25

Pneumococcal polyvalent, Influenza Men C, H.influenzae esp treatment and asplenia or splenic dysfunction

Question 26

What can reduce the duration of chemo induced neutropenia

Answer 26

Recombinant granulocyte colony stimulating factor - rhG-CSF Stimulates neutrophil production

Question 27

Options for indolent NHL

Answer 27

Local radiotheraoy w IIA localised follicular Watchful eait if asymtpomatci Rituximab with or without chemo Combo chemo Palliative radio

Question 28

Aggressive NHL treatment opetions

Answer 28

R-CHOP = Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone Radiation therapy Bone marrow or stem cell transplantation

Question 29

If HIV positive what treatment give

Answer 29

Combo chemo an HAART porphylaxis against PCP

Question 30

What patients are at high risk of CNS involvement

Answer 30

Lymphoma involved in bone marrow Testis Nasal or paranasal sinuses Orbits Bone Peripheral blood

Question 31

What do if high risk CNS involevement NHL

Answer 31

CNS prophylaxis - intrathecal methrotrexate or cytarabine

Question 32

What subtype is intitally responsive but ofetn relapses after chemo

Answer 32

Mantle cell lymphoma

Question 33

General chemo used in NHL

Answer 33

R-CHOP FCR - fludarabine, cyclophosphamide, rituximab CVP, MCP, CHVPi (late stage follicular) Methotrexate - Primary CNS

Question 34

What need to do w treatment of gastric MALT lymphoma

Answer 34

H pylori eradication therapy THEN progress to chemo or gastric radio can watch and wait

Question 35

CVP chemo combo

Answer 35

Cyclophosphamide, vincristine and prednisolone

Question 36

RCHOP

Answer 36

Rituximab Cyclophosphamide, doxorubicin, vincristine and prednisolone

Question 37

MCP drugs

Answer 37

Mitoxantrone, chlorambucil and prednisolone

Question 38

CHVPi drugs

Answer 38

Cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-α

Question 39

Complications of disease

Answer 39

Neutropenia, TP, anaemia - bone marrow infiltration Bleeding - TP, DIC or direct vascular infiltrate Large pericardial effusion or arrhythmias - cardiac mets Resp -pleural effusion or parenchymal lesions SVC obstriction Neuro problems Gi obstruction, perf, bleed Pain

Question 40

What can cause neuro symptoms NHL

Answer 40

primary CNS lymphoma, lymphomatous meningitis, or vertebral metastases