Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

18 Cards in this Set

  • Front
  • Back
List the conditions that may lead to lymph node enlargement.
1. infection or reaction to infections

2. tumors

3. miscellaneous
Examples of infections or reactions to infections that may lead to lymph node enlargement
1. Enlargement of nodes draining areas of local infection or portals of entry of infection
-- skin or oral infections

2. Generalized LN enlargement due to systemic infections
-- mono

3. Infection of LN by organisms
-- Staph
-- Pasteurella pestis

4. Granuloma formation as reaction to infection
-- TB
-- Histoplasma capsulatum
Examples of TUMORS that may lead to lymph node enlargement
Primary tumors of lymphocytic lineage
1. Hodgkin's lymphoma
2. Non-Hodgkin's lymphoma
3. ALL
4. CLL

Tumors that metastasize
1. adenocarcinomas and epithelial tumors
-- breast, lung, head, neck
2. Myeloid leukemias
-- acute and chronic
Examples of MISCELLANEOUS causes that may lead to lymph node enlargement
1. Autoimmune D/O's
-- SLE
-- RA
-- other "collagen disorders"

2. Immune response to non-infectious agent
-- serum sickness after ingestion foreign protein

3. Sarcoidosis

4. Berylliosis
What is important in the Hx and PE when evaluating pt w/ lymphadenopathy?
1. Age and occupation

2. Location and size of LN

3. Duration of lymphadenopathy

4. Presence of associated symptoms

5. Physical characteristics of LN
-- hard vs. rubbery
-- static vs. freely moveable
What basic lab evaluations of a patient w/ lymphadenopathy?
1. CBC

2. Mono test

3. BM aspiration if abnormal cells in the peripheral blood, anemia, or persistance of symptoms

-- CXR
-- CT of chest, abdomen, pelvis
-- excisional LN biopsy
Why is it important to understand Hodgkin's lymphoma (HD)?
1. historical importance: first dissiminated malignancy ever cured w/ systemic chemo

2. Majority of pts w/ HD diagnosed today can be cured

3. Since mostr pts diagnosed w/ HD will be cured, primary care physicians will ultimately have to follow these patients and manage many of the long-term complications of the therapy of HD
Clinical characteristics of HD?
-- centripetal and axial involvement, including cervical, supraclavicular, mediastinal lymphadenopathy
-- typically spreads to contiguous nodal areas
-- adenopathy can be waxing and waning

More than 80% of patients have lymphadenopathy above the DIAPHRAGM
-- disseminated is rare
-- Waldeyer's ring involvement is rare
-- occipital, epitrochlear, mesenteric sites are rare

Approx 40% experience systemic or "B" symptoms
-- fever, night sweats, pruritis, or 10% body loss
-- occur more frequently in elderly and have negative impact on prognosis
How is HD staging based?
ANATOMICALLY BASED since it spreads to contiguous nodal areas in the majority of the cases
Staging should include...?
1. Hx and physical
2. CBC
3. LFTs
4. LDH, albumin, calcium
5. CXR
6. CT of chest, abdomen, pelvis
7. BM aspiration and biopsy
8. Lymphangiogram in selected cases
9. Staging laparotomy in selected cases
Ann Arbor Staging Classification?
-- involvement of single LN region or a lymphoid structure (spleen, thymus, waldeyer's ring, etc)

-- involvement 2 or more LN regions on SAME side of diaphragm

-- LN regions or structures on both sides of the diaphragm

-- involvement of extranodal site(s) beyond the designated "E"
-- typically means extranodal disseminated disease such as BM and liver involvement

A --> no systemic symptoms
B --> presence of systemic symptoms
-- fever >38C, night sweats, weight loss of more than 10% body weight over 6 months

E: involvement of a single, extranodal site contiguous to known nodal site
HD Treatment?
1. without --> 5-yr survival of less than 5%

2. Stage is most important determinant of treatment and outcome

3. Sensitive to radiation and chemo; all pts should be treated w/ curative intent

4. Stages I and II: radiation
Stages III and IV: combination chemo

5. Disease is so sensitive to chemo that some pts initially treated w/ radiation that relapse can be salvaged w/ combo chemo

6. Pts that do not attain complete remission or suffer relapse can be cured w/ high dose chemo and autologous BM transplant
Long-term complications of HD treatment?
-- myelodysplastic syndromes
-- acute myelogenous leukemia
-- non-Hodgkin's lymphoma
-- acute lymphocyic leukemia
-- sarcoma, lung, thyroid
-- other solid tumors

-- infertility
-- hypothyroidism

-- pulmonary fibrosis
-- bleomycin lung toxicity

-- cardiomyopathy
-- accelerated atherosclerotic heart disease
-- pericarditis and pericardial fibrosis
What are non-Hodgkin's lymphomas (NHL)?
heterogenous group of lymphoid malignancies
-- different morphologic features
-- varying clinical course
-- varying response to therapy

Neoplasms arise from monoclonal prolif of a malignant cell of lymphoid origin
-- T OR B cell

Rationally subclassified according to histologic findings and clinical behavior
Etiology and Epidemiology of NHL?
-- About 45K new cases/yr
-- incidence rising rapidly

Cause remains unclear
-- virus and infectious agents
-- chrom translocations
-- chemo and radiation therapy
-- immunodeficiencies
Staging of NHL?
Ann Arbor can be applied to NHL but:
-- does not reflect the noncontiguous nature of NHL
-- fails to account for tumor bulk or number of extranodal sites

NHL trtmt requires different therapy based on areas of involvement -- extent of disease important for prognosis and treatment planning

HISTOLOGIC SUBCLASS is primary determinant of survival and cure potential
Treatment of low grade NHL?
-- less aggressive behavior, prolonged survival

Most pts have advanced disease at diagnosis
-- only 10% have stage I or II disease

Few pts that present w/ localized disease: treat w/ radiation

Dissiminated disease: NOT curable w/ chemo
-- treat w/ palliative intent
Treatment of aggressive NHL?
Most: combo chemo
-- rapidly progressive disease that requires treatment

Commonly use "CHOP"
-- cyclophosphamide
-- Adriamycin
-- Oncovin
-- Prednisone

Treatment program cures 1/3 pts w/ diffuse large cell lymhoma (one of most common intermediate-grade)

40-50% that relapse after first-line chemo can be cured w/ BM transplant