Lymphoma is cancer of lymphatic cells, typically presenting as a solid tumour.
Signs and symptoms include:
- night sweats
- fever
- weight loss
- fatigue
- palpable node
Diagnosis is by lymph node biopsy.
Other investigations include:
- CXR
- Staging CT
- Bloods – FBC, ESR, CRP, LDH, LFTs
The classical division of lymphoma is into:
- Hodgkins lymphoma
- characteristic Reed-Sternberg cell
- around 25% of lymphomas
- males >females
- Non-Hodgkin lymphomas
More detailed classification of lymphoma is fiendishly complex; the current system in
use is the WHO classification, which divides lymphomas into B cell and T
cell. A classification which is arguably more useful for 'basic'
doctors is the one below which divides lymphomas into 'low grade/indolent' and 'high
grade/aggressive'
Indolent:
- Hodgkin lymphoma - excellent prognosis, often cured
- Non-Hodgkins
- Lymphoma of mucosa-assoicated lymphoid tissue (MALT)
- Follicular lymphoma
Aggressive: (all are non-Hodgkins)
- Diffuse large B cell lymphoma (=30-60% of non-Hodgkins lymphomas)
- Mantle cell lymphoma
- Primary effusion lymphoma
- Burkitt lymphoma
Staging:
- I: single lymph-node region or single extralymphatic site
- II: two or more lymph node regions or sites but on same side of diaphragm
- III: involvement of lymph nodes/regions on both sides of diaphragm
- IV: disseminated
- A or B:
- A: no B symptoms
- B: fever, weight loss or night sweats
Increased risk of lymphoma with:
- Exposure to pesticides
- Immune deficiencies
- Common variably immune deficiency (lifetime risk 8%)
- Wiscott-Aldrich syndrome
- Severe combined immune deficiency
- Infections
- HIV - Burkitt lymphoma, primary effusion lymphoma, DLBCL
- EBV – Burkitt lymphoma
- Herpes virus 8 - primary effusion lymphoma
- Helicobacter pylori – MALT
- Campylobacter jejuni – small bowel lymphoma
- Medications
- Metotrexate – DLBCL, Hodgkins
- Infliximab – T cell lymphoma
Treatment:
- Hodgkins lymphoma:
- ABVD chemotherapy (=adriamycine, bleomycin, vinvlastine and dacarbazine
- Radiotherapy
- Exact treatment is based on a combination of the Ann Arbor staging and presence/absence of
- 3 involved lymph node areas
- high ESR
- large mediastinal mass
- extranodal disease
- High-grade Non-Hodgkins lymphoma
- CHOP chemotherapy (= cyclophosphamide, doxorubicin, vincristine, prednisone)
- rituxumab
- Low-grade Non-Hodgkins lymphoma
- multiple options ranging from 'watch and wait' to chlorambucil to CHOP and rituximad.
References:
Engert, A. et al. Hodgkin’s lymphoma: ESMO Clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009; 20(Suppl 4): 108-109.
Gribben, J. How I treat indolent lymphoma. Blood. 2007; 109(11): 4617-4626.
Gribben, J. How I treat indolent lymphoma. Blood. 2007; 109(11): 4617-4626.
Jaffe, E. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. ASH Education Book January 1, 2009 vol. 2009 no. 1 523-531.
NICE. Non-Hodgki’s lymphoma – rituximad: guidance. 2003. Available at http://guidance.nice.org.uk/TA65/Guidance/pdf/English
OMIM: Hodgkin's disease. Available at http://omim.org/entry/236000?search=hodgkin&highlight=hodgkin
NICE. Non-Hodgki’s lymphoma – rituximad: guidance. 2003. Available at http://guidance.nice.org.uk/TA65/Guidance/pdf/English
OMIM: Hodgkin's disease. Available at http://omim.org/entry/236000?search=hodgkin&highlight=hodgkin