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Lymphoma

Background knowledge 🧠

Definition

  • Lymphoma is a type of blood cancer that originates in the lymphatic system, the disease-fighting network spread throughout your body.
  • It is characterised by the uncontrolled growth of lymphocytes, which are a type of white blood cell.

Epidemiology

  • Non-Hodgkin Lymphoma (NHL) is more common than Hodgkin Lymphoma (HL).
  • NHL can occur at any age, but the risk increases with age.
  • HL is most common between ages 15-40 and above 55.

Types

  • Hodgkin Lymphoma (HL): Marked by the presence of Reed-Sternberg cells.
  • Non-Hodgkin Lymphoma (NHL): Includes a diverse group of cancers derived from either B, T, or NK lymphocytes.

Pathophysiology

  • Hodgkin Lymphoma (HL): The Reed-Sternberg cells are usually derived from B lymphocytes that have become malignant.
  • Non-Hodgkin Lymphoma (NHL): Can originate from B, T, or NK cells, and its behaviour ranges from slow-growing (indolent) to rapidly progressing (aggressive).

Clinical Features 🌡️

Clinical Features

  • Painless swelling of lymph nodes in the neck, armpits, or groin.
  • Systemic ‘B’ symptoms: fever, night sweats, and weight loss.
  • Fatigue.
  • Itching.
  • Coughing or breathlessness if the lymphoma is in the chest area.

Investigations 🧪

Tests

  • Physical Examination: Palpation of peripheral lymph nodes, liver, and spleen.
  • Blood Tests:Complete blood count (CBC), lactate dehydrogenase (LDH), and ESR.
  • Imaging: CT, PET, or MRI scans to determine the extent of the disease.
  • Biopsy: Excisional biopsy of an enlarged lymph node for histological diagnosis.
  • Bone Marrow Biopsy: To check for spread to the bone marrow.

Management 🥼

Management

  • Hodgkin Lymphoma (HL): Often curable with standard treatment protocols which may include chemotherapy, radiation therapy, or stem cell transplantation.
  • Non-Hodgkin Lymphoma (NHL): Treatment varies widely depending on the type and may include chemotherapy, immunotherapy, targeted therapy, radiation therapy, and stem cell transplantation.

Prognosis

  • Prognosis depends on the type of lymphoma, stage, and biological characteristics.
  • HL has a high cure rate.
  • The prognosis of NHL varies widely with subtype.

Prevention

  • There are no specific measures to prevent lymphoma.
  • Risk factor modification, like avoiding known carcinogens and maintaining a healthy immune system, may be beneficial.

Key Points

 

  • Lymphomas are a heterogeneous group of malignancies with varied presentations and outcomes.
  • The two types are Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).
  • Common features include painless swelling of the lymph nodes and Systemic ‘B’ symptoms.
  • HL is often curable with effective treatment, unlike NHL which varies depending on the type.
  • Management commonly requires chemotherapy, radiation therapy, or stem cell transplantation.

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Which of the following statements is true of lymphomas?

‘B’ symptoms confer a worse prognosis.

These are large multinucleated cells classically seen in Hodgkin’s lymphoma.

High-grade lymphomas are potentially curable.

There is an association with Epstein–Barr virus.


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