Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
48 Cards in this Set
- Front
- Back
|
This is a cancer of the lymphocytes?
|
Lymphoma
|
|
|
Exact etiology is unknown
Family History Association with Epstein-Barr Virus infection In about 50% of cases, EBV proteins are identified in tumor cells Mixed Cellularity 60-70%, Nodular Sclerosis 15-30% Increase risk in patients with HIV/AIDS or post organ transplant |
Hodgkin lymphoma
|
|
|
What are the five types of classic Hodgkin lymphoma?
|
Nodular Sclerosis
Mixed Cellularity Lymphocytes Depleted Lymphocyte Rich Nodular Lymphocyte Predominant |
|
|
Hodgkin Lymphoma Type:
More common in females than males, young adults Usually affects the mediastinum & other supradiaphragmatic sites |
Nodular Sclerosis
|
|
|
Hodgkin Lymphoma Type:
More common in males than females, older adults > young adults Usually affects the abdominal lymph nodes & spleen Observed most commonly in those with HIV |
Mixed Cellularity
|
|
|
Hodgkin Lymphoma Type:
More common in males than females Usually affects lymph nodes of the abdomen and pelvis Associated with older age and HIV |
Lymphocytes Depleted
|
|
|
Hodgkin Lymphoma Type:
Similar to MCHD |
Lymphocyte Rich
|
|
|
Hodgkin Lymphoma Type:
More common in males > females, 3rd -5th decade Usually affects nodes in the neck, chest & armpits Reed Sternberg cells replaced by “Popcorn Cells” express CD 19 & CD 20 antigens |
Nodular Lymphocyte Predominant
|
|
|
What is the classic presentation of Hodgkin lymphoma?
|
Persistent, painless enlarged lymph node
Neck (cervical/supraclavicular), armpit, groin |
|
|
Apart from the classic presentation of Hodgkin lymphoma, what are the other presentations?
|
Pain in lymph nodes after consumption of alcoholic beverages
Mediastinal Mass: Discovered on CXR, Nonspecific chest pain, SOB, cough Constitutional “B” Symptoms: Fever, night sweats, weight loss Fatigue or Anemia, Frequent Infections, Increased Bruising or Bleeding Generalized Pruritus, Edema Splenomegaly or Hepatomegaly may be present with or without abdominal swelling, pain Incidental enlarged lymph nodes on CXR or CT |
|
|
In the diagnosis of Hodgkin lymphoma what are you looking for in the lymph node biopsy?
|
Reed Sternberg Cells -
Large multinucleated cancerous cells Express CD30 & CD15 antigens |
|
|
What other laboratories do you run with diagnosis of Hodgkin lymphoma?
|
CBC
Erythrocyte Sedimentation Rate (ESR) Lactate Dehydrogenase (LDH) Serum Creatinine Alkaline Phosphatase HIV Bone Marrow Biopsy Liver Function Tests PT/INR/PTT |
|
|
What diagnostic imaging do you order with Hodgkin lymphoma?
|
CXR
Chest, Abdomen & Pelvic CTs |
|
|
What is the pattern of spread in Hodgkin lymphoma?
|
Hodgkin’s typically demonstrates an orderly pattern of spread
Lymph node progression from one group to the next The disease rarely skips over an area of lymph nodes as it spreads |
|
|
Hodgkin Lymphoma:
Classified I-IV The higher the number, the more lymphoma has spread |
Ann Arbor Staging
|
|
|
Hodgkin lymphoma:
What are the factors that are associated with unfavorable prognosis for Stage I & II patients? |
Bulky disease
ESR >50mm/h, if the patient is asymptomatic >3 sites of involvement Presence of B symptoms Presence of extranodal disease |
|
|
What is the treatment for Hodgkin lymphoma?
|
Combination Chemotherapy and Radiation are more effective than either modality alone
Chemotherapy ABVD: Doxorubicin (Adriamycin), Bleomycin, Vinblastine & Dacarbazine Localized radiation Increase risk of cancer later in life |
|
|
Tx options for recurrence of Hodgkin lymphoma include?
|
Treatment options for recurrence include high-dose chemotherapy and bone marrow or stem cell transplant
|
|
|
What is involved with the follow up of Hodgkin Lymphoma?
|
Follow-up every 2-4 months for the first 1-2 years & every 3-6 months for next 3-5 years
H&P CBC, Chemistry Panel, LDH, ESR TSH CXR & Chest, Abdominal, Pelvic CTs every 6-12 months in the first couple of years PET scans Females with chest irradiation-annual mammogram age 40 or 5-8 years following radiation Vaccines: pneumococcus, H. influenzae, meningococcus, influenza |
|
|
The following are risk factors for what?
Advancing Age Chemical Exposure Herbicides, Insecticides Radiation Exposure Immune System Deficiency Organ transplant recipients Autoimmune Diseases RA, Lupus Infections Human T-Cell Leukemia/Lymphoma Virus, Epstein-Barr Virus, HIV, Helicobacter pylori, Hepatitis C |
Non-Hodgkin Lymphoma
|
|
|
What are the clinical manifestations of Non-Hodgkin lymphoma?
|
Enlarged painless lymph nodes
Abdominal pain, tenderness, nausea, vomiting, ascites Cough, difficulty breathing Superior Vena Cava Syndrome Swelling of arms, face, bluish discoloration of the head, arms & upper chest Headache, difficulty thinking & concentrating, personality changes, movement disorders, seizures Skin lesions, generalized pruritus Anemia (decreased RBCs), Infections (decreased WBCs), Increased Bruising or Bleeding (decreased platelets) B Symptoms Unexplained weight loss Fever Night Sweats |
|
|
What are the three things you use to diagnose Non-Hodgkin Lymphoma?
|
Excisional biopsy of lymph nodes
Bone marrow biopsy Lumbar puncture |
|
|
What additional laboratory studies can you use in diagnosing Non-Hodgkin Lymphoma?
|
CBC
Lactate Dehydrogenase (LDH) Liver Function Tests Serum BUN and Creatinine Coagulation Tests (PTT, PT/INR) |
|
|
What imaging studies can you use in Non-Hodgkin Lymphoma?
|
CXR
Chest, Abdomen, Pelvic, Head & Neck CT MRI of Brain & Spinal Cord Positron Emission Tomography (PET) Gallium Scan Bone Scan Ultrasound |
|
|
Non-Hodgkin lymphoma can be classified as what?
|
B-Cell Lymphoma
Account for about 85% or T-Cell Lymphoma Account for about 15% |
|
|
Non-Hodgkin Lymphoma:
What are the Beta-Cell Lymphomas? |
Primary mediastinal
Mantle Cell lymphoma Marginal zone Extranodal Nodal Splenic Lymphoplasmacytic lymphoma Hairy Cell leukemia Burkitt's lymphoma Primary central nervous system lymphoma |
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Starts in the mediastinum More common in women (mid-30s) Fast growing but treatable, half are patients can be cured |
Primary Mediastinal
|
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Average age at presentation is about 60 More frequent in men Typically widespread when diagnosed: lymph nodes, bone marrow, spleen |
Mantle Cell Lymphoma
|
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Extranodal (AKA Mucosa-Associated Lymphoid Tissue {MALT} Lymphomas) Most occur in the stomach; associated with infection by Helicobacter pylori Other sites: lung, skin, thyroid, salivary glands Nodal Splenic |
Marginal Zone
|
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Lymphoma cells produce immunoglobulin M (IgM) antibody Slow growing, isn’t considered to be curable |
Lymphoplasmacytic Lymphoma (Waldenstrom Macroglobulinemia)
|
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Small B lymphocytes with projections causing a “hairy” appearance Found in the bone marrow, spleen and circulating in blood Slow growing, some patients may not require treatment |
Hairy Cell Leukemia
|
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Fast growing In African children it is associated with jaw and facial bone tumors In US, the abdomen is the most common location, majority of those affected are men, half can be cured with chemotherapy |
Burkitt’s Lymphoma
|
|
|
Non-Hodgkin Lymphoma:
Beta Cell Lymphoma: Involves the brain, spinal cord, meninges Tends to spread throughout the nervous system More common in patients with AIDS |
Primary Central Nervous System Lymphoma
|
|
|
What are the Non Hodgkin T-Cell lymphomas?
|
Mycosis fungoides
Precursor T-Lymphoblastic lymphoma/Leukemia Peripheral T-Cell Lymphomas |
|
|
Non Hodgkin T-Cell Lymphoma:
Most common cutaneous lymphoma Usually occurring after the age of 50 Categorized as patch, plaque or tumor stage Prognosis is related to stage May be treated with radiation or chemotherapy if spread to organs or lymph nodes has occurred |
Mycosis fungoides
|
|
|
Non Hodgkin T-Cell Lymphoma:
Considered either a lymphoma or leukemia depending upon the amount of bone marrow involvement Often starts in the thymus gland & can develop into tumors of the mediastinum Occurs more often in young adults, males > females Fast growing Once in the bone marrow, only half of patients are cured |
Precursor T-Lymphoblastic Lymphoma/Leukemia
|
|
|
Non Hodgkin T-Cell Lymphoma:
Cutaneous T-Cell Angioimmunoblastic Extranodal Natural Killer Enteropathy Type Subcutaneous Panniculitis-like Anaplastic Large Cell Peripheral T-Cell Not Otherwise Specified |
Peripheral T-Cell Lymphomas
Develop from mature T cells |
|
|
NHL limited to 1 lymph node group
NHL in an organ or site other than the lymph nodes but has not spread |
Ann Arbor Stage I NHL
|
|
|
NHL Limited to 2 lymph nodes groups on same side of the diaphragm
Limited to one extranodal site with spread to one or more lymph node groups on the same side of the diaphragm |
Ann Arbor Stage II NHL
|
|
|
NHL Lymphoma on both sides of the diaphragm
|
Ann Arbor Stage III NHL
|
|
|
NHL Lymphoma spread outside of the lymph system to the bone marrow, liver, bone, spinal cord or lungs
|
Ann Arbor Stage IV
|
|
|
What are the principles of treatment for NHL?
|
Radiation
Chemotherapy Surgery Biological Therapy Stem Cell or Bone Marrow Transplant |
|
|
Principle of NHL TX:
May be primary treatment or used in conjunction with chemotherapy Can also be used for palliation of symptoms |
Radiation
|
|
|
Principle of NHL TX:
Can be primary treatment or used in conjunction with radiation Several different regimens based on type and stage Cyclophosphamide, Doxorubicin, Vincristine and Prednisone is a common regimen |
Chemotherapy
|
|
|
Principle of NHL TX:
Rarely used as a treatment option |
Surgery
|
|
|
Principle of NHL TX:
Monoclonal Antibodies: Rituximab (Rituxan), Ibritumomab tiuxetan (Zevalin), Tositumomab (Bexxar) |
Biological Therapy
|
|
|
What is involved with the follow up for NHL?
|
Follow-up
Routine physicals every 2-3 months during the first year Repeat laboratory work, CXR, CT PET scans |
|
|
What are the details of NHL and relapse?
|
Relapses can occur or new cancers can develop
Relapses are usually treated with high-dose chemotherapy followed by stem cell transplant Potential for cure varies amongst the different types, stage and response to initial therapy |
