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'

  • 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 

  • 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 

  • 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.

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