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Lymphoma (Clinical presentation (Lymphadenopathy, Weight loss, Fatigue,…
Lymphoma
Clinical
presentation
Lymphadenopathy
Weight loss
Fatigue
Night sweats
Fever
Alcohol-induced LN pain (HL only)
Diagnosis
History
FH
Cancers
DH
Meds, allergies
PMH
Known medical conditions,
previous cancers
SH
Living arrangements, occupation,
smoking, alcohol
PC/HPC
Fatigue, weight loss,
night sweats, fever
Examination
Abdo exam
Hepatomegaly, splenomegaly, non-tender LNs
Investigations
Bloods
FBC (high WCC), CRP/ESR, U+E, LFT (deranged),
clotting (may be deranged), cultures (sepsis)
Electrophoresis (monoclonal bands)
LN/BM biopsy
Immunohistochemistry, cytogenetics
Microscopy: Large T/B cells, Reed Steinberg cells (HL)
Bedside
Obs (may have fever)
Height/weight (weight loss)
Imaging
CXR: any mediastinal LNs
CT abdo/pelvis: abdominal LNs; staging
CT head: CNS mets
PET: metabolically active areas
Grading
High grade
Aggressive, rapid onset
May be curable
E.g. DLBCL, Burkitt, T-cell
Low grade
Indolent, slow growing
Not curable mostly
Can transform to high grade
E.g. FL, MALT
Staging
(Ann Arbor)
Stages
Stage 1: single LN region
Stage 2: 2+ LN regions same side of the diaphragm
Stage 3: 2+ LN regions both sides of the diaphragm
Stage 4: Diffuse extra lymphatic disease
Complications
SVCO
Pleural effusion
Infection
Bronchial obstruction
Differentials
Autoimmune
SLE, RA
Sarcoidosis
Neoplastic
Leukaemia
Lymphoma
Local tumour
Met
Infection
Mononucleosis, CMV, HIV
TB, Toxoplasma
Management
Medical
Chemotherapy + RT
Indication: 1L HL
MOA: course of chemo plus RT,
can be curative in many
SEs:
RT:
secondary malignancies, lung fibrosis, hypothyroidism;
chemo:
pancytopenia, alopecia, nausea, infections
RT
Indication: 1L NHL localised disease
MOA: can be curative
Chemotherapy
Indication: 1L NHL diffuse disease or high grade disease
E.g. R-CHOP
MOA: controls symptoms and improves survival
SEs: pancytopenia, alopecia, TLS
Surgical
Stem cell transplant
Indication: refractory/relapsed HL; young fit patients NHL
MOA: replace BM with autologous stem cells
Conservative
Information, advice, support
MDT care (speciality medic, nurse, surgeon,
psychologists, counselling)
Watch and wait (low grade, asymptomatic NHL)
Pathophysiology
Defect
Mutation in lymphocyte, causing proliferation
Defective function, causing immunosuppression
Mechanism
Neoplastic lymphocytes accumulate in LNs,
may also infiltrate organs e.g. liver, spleen
Types
NHL: generally B-cell; low grade (e.g. FL, MALT)
or high (DLBCL, Burkitt's lymphoma)
HL: B or T cell
Epidemiology
HL
Peaks in YAs (20-25y) and elderly
M>F
NHL
Mainly affects older adults
Risk factors
HL
FH
EBV infection
SLE
Post transplant
Obesity
NHL
Immunodeficiency (HIV)
HTLV-1 infection
H pylori infection
Congenital disorders e.g. Downs
Prognosis
HL
Good prognosis if early stage,
treatment can be curable
NHL
Good prognosis if early disease,
not curable but usually indolent
Definition
Malignant neoplasm
of lymphocytes
