Lymphoma is ___?
malignant proliferation of lymphocytes which accumulate in lymph nodes but may also be found in peripheral organs
Hodgkins and Non Hodgkins
Hodgkins versus Non
Hodgkins
- characterised by Ree-sternberg cells
- 2 peak incidence - young adults and elderly
- Rx: family Hx, EBV, SLE, obese
- Types: nodular sclerosing 70%, mixed cellularity, lymphocyte rich, lymphocyte deplete (worse prognosis)
Non-Hodgkins
- all other lymphomas
- Very diverse category
- Rx: HIV, immunodeficiency, EBV, toxins, congenital
- B cells (most common) and T cell lines
- Low grade = indolent, wide spread, incurable
- High grade = aggressive, rapidly enlarging lymphadenopathy
Symptoms for lymphoma?
Nodes = superficial, rubbers, painless, fluctuating size, typically cervical
Constitutional upset = fevers, weight loss, night sweats, lethargy, fatigue
Mediastinal involvement = bronchial or SVC obstruction, pleural effusion
Extranodal disease = oropharynx, bone, gut, cns, lung
Infection + bleeding = from pamncytopenia
Past Hx. Ix and treatment
PMHx:
- Infection
- predisposing condition (HIV, AI, I suppressive drugs)
Ix:
- node biopsy
- CT or MRI
- bone marrow aspirate
Tx:
- Chemotherapy +/- radiation
- Peripheral stem cell transplants
Examination
Cachexia, Anaemia
Lymph node enlargement
Spleno/hepatomegaly
Extra nodal involvement
Differential for cervical lymph node enlargement
Infection: acute pyogenic, mono, CMV, TB, HIV Autoimmune: RA Drugs: Phenytoin Primary lymph node malignancies secondary malignancies
Ix for lymphoma
Blood: CBC, ESR differential count, film, UEC, eGFR, LFTs, Ca, LDH
Imaging: CXR (mediastinal widening?) CT/PET CAP
Bone marrow biopsy
Excision biopsy
Cytology of effusion
Cytology of CSF if CNS signs
Staging for Lymphoma
Ann Arbor Staging: I - confined to single node II - more than 2 nodal areas same side of diaphragm III - More than 2, both sides IV - spread beyond nodes
in addition: A - no systemic symptoms other than pruritis B - B symptoms E - extranodal S - spleen involvement
Management of Hodgkins and Non- H Lymphoma
HODGKINS = 80% 5 year survival - depending on staging
Radiotherapy and chemotherapy with high dose chemo and peripheral stem cell transplantation for relapsed disease
NON-H = 40% 5 year survival
low-grade = radiotherapy + chemo + alpha-interferon or rituximab for maintenance remission
high grade = R’CHOP
- Rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, perdnisolone. (+ GCSF helps with neutropemnia)
SE of treatment
Radiotherapy: inc risk of second malignancy, IHD, hypothyroidism, lung fibrosis
Chemotherapy: myelosuppression, nausea, alopecia, infection, AML, NH lymphoma, infertility
