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30 Cards in this Set
- Front
- Back
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Who gets Hodgkins and NHL? |
It is Bi-modal
The young (adolescents and young adults)
Then the very old people. NHL has seen increasing incidence of people over 60. |
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Malignant cell of Hodgkins |
Reed-Sternberg cell |
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What are the 4 types of classical hodgkins -how common are they -which one has the best prognosis and the worst? |
Lymphocyte predominant: 5-10% Nodular sclerosis 30-60% (good prognosis) Mixed cellularity 20-40% Lymphocyte depleted 5% (worst prognosis) |
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Nodular lymphocyte predominant hodgkins lymphoma |
5% of patients It is non-classical
Tumor cells retain features of germinal center B cells. |
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Where does Hodgkins lymphoma typically start? |
90% of the time in a superficial cervical lymph node enlargement.
It starts focal then spreads. |
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Contiguity model vs susceptibility model of hodgkins patterns of spread |
Contiguity model: HL starts as a local process and spreads to contiguous lymph nodes. Hematogenous spread occurs late.
Susceptibility model: HL is a systemic disease from the start and it is from an infection by an oncogenic virus. |
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Constitutional symptoms of HL |
Fatigue, weakness, anorexia, cachexia, pruritis LN pain after ETOH ingestion "B symptoms" --which reduce survival -weight loss (10% 6 months prior) -drenching night sweats -unexplained fever |
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What tests must be ordered to stage HL |
Routine biochemical and hematologic studies Excisional biopsy of involved LN CT of chest, abdomen, pelvis Bone marrow aspirate/biopsy PET scan |
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Stage 1 hodgkins and NHL (Ann Arbor Criteria) |
Involvement of a single lymph node region or single extra lymphatic organ or site |
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Stage 2 hodgkins and NHL (Ann Arbor Criteria) |
Involvement of two or more LN regions on the same side of diaphragm alone. or With involvement of limited contiguous extra lymphatic organ or tissue
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Stage 3 hodgkins and NHL (ann arbor criteria) |
Involvement of LN regions or structures on both sides of the diaphragm which may include the spleen or a contiguous extralymphatic organ or site or both. |
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Stage 4 hodgkins and NHL (ann arbor criteria) |
Diffuse or dissemeniated foci of involvement of one or more extra lymphatic organs or tissues with or without associated lymphatic involvement. |
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Radiation therapy and chemotherapy with HL |
HL is responsive to radiation and it is curative in majority of patients with stage 1 or2.
Chemo is curative in majority of cases it is combination method of drugs.
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What is the chemo regimen for HL and what are some side effects |
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)
Complications Cardiotoxicity (doxorubicin) Pulmonary toxicity (bleomycin) Neutropenia and thrombocytopenia
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how do we treat stage 1 and 2? and stage 3 and 4? |
1 and 2: Radiation is primary treatment with chemo in abbreviated fashion (3-4 cycles) in high risk disease.
3 and 4: Chemo is primary therapy. Radiation used for residual disease. |
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How do we treat large mediastinal masses?
How do we treat relapse? |
Mediastinal mass: Chemo followed by radiation
Relapse: don't use the treatment method that was used before. bone marrow transplant for poor prognosis. |
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What are the 3 categories of lymphoma At what stage do they typically present? |
Indolent: survival in years (presents as stage 3/4)
Aggressive: survival in months (presents at stage 1/2)
Highly Aggressive: survival in weeks (stage 1/2) |
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Etiology of lymphoma |
HTLV-1 causes T cell lymphoma and leukemia EBV causes Burkitt's lymphoma
People who are immunosuppressed (AIDS, Transplant recipients and genetic immunodeficies) have a higher risk. |
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Clinical Presentation of Indolent Lymphoma |
Asymptomatic Disease discovered incidentally. B symptoms may be present may have massive mediastinal or retroperitoneal node involvement. |
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Clinical presentation of aggressive and highly aggressive lymphoma |
aggressive: History of waxing and waning adenopathy for several weeks or months. Fatigue, weakness, and weight loss Splenomegaly
highly aggressive: rapid development of adenopathy and symptoms. "came up over night" |
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What are associated symptoms with lymphoma |
GI involvement in 10-20% Autoimmune hemolytic anemia Richter's syndrome |
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Lab evaluation which must happen for diagnosis |
Same as hodgkins but they look for elevated beta-2 microglobulin (especially indolent lymphomas)
they test for viruses such as HIV and Hep B and C |
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When to use surgical treatment in lymphoma |
Just to get the LN out for histopath diagnosis. We need to know if its indolent, aggressive, or highly aggressive. |
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Chemotherapy regimen for NHL |
CHOP Cyclophosphamide, doxorubicin, vincristine, and prednisone
Standard of care for treatment of more aggressive lymphomas. Give until complete remission then for 2 more cycles. |
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When to use Rituximab |
CD20 anti body
use as adjunct chemo to the CHOP regimen in indolent and aggressive CD20+ lymphomas. (R-CHOP) |
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Treatment of stage 1 and 2 indolent lymphoma |
primary treatment is radiotherapy.
if high risk (large masses or 3 or more nodal sites on one side of diaphragm) treat with 2-3 cycles of chemo first. |
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Treatment of stage 3 and 4 indolent lymphoma |
Primary treatment is chemo.
May use radiation if disease is bulky or responds slowly. |
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Treatment of aggressive lymphoma -All stages |
combination chemo is mainstay of treatment.
Radiation may be needed for consolidation of local nodal regions or large masses. |
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Treatment of highly aggressive lymphoma |
Patients are treated with acute lymphocytic leukemia regimen. |
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Prognosis of indolent and aggressive lymphoma |
indolent: median duration survival of 8 years. Most are incurable.
aggressive: mean duration of survival 4 years. but 50% of the patens who make it past 5 years are cured. |
