no
no
no

Lymphoma

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:
author profile image
Abdelghafour

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book.

no
Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)