Lymphoma

Lymphadenopathy: location (often neck, axilla, groin), duration (refer if >6wks), usually painless, is it changing

Risk factors for HIV/TB

Contact with cats (toxoplasmosis may cause lymphadenopathy)

Any immunosuppression e.g. post-transplant

Travel history

B symptoms: weight loss, drenching night sweats

Lymphadenopathy: size, shape, suface, mobility, consistency

Examine other lymph node areas

Examine skin for bruising (BM failure rare)

Neuro exam if indicated

• Initially: FBC, U+Es, LFTs, ESR, monospot test (for EBV), viral screen
• blood film
• cell surface markers (immunophenotyping)
• LDH
• B2 macroglobulins
• toxoplasma screen
• Igs
• ferritin
• CXR
• biopsy required for Dx (FNA not enough): core biopsy may do it but if this fails, need excision biopsy

Can give steroids for treatment but caution with doing this before biopsy- makes it harder to get Dx (especially in brain lymphoma)

Ann Arbor staging:

• stage 1: 1 lymph node above diaphragm
• stage 2: 2+ lymph nodes above diaphragm
• stage 3: lymph nodes below diaphragm (or other lymph tissue)
• stage 4: outside of lymph tissue

Most staging via PET- used for staging and end-of-treatment monitoring, difficult to interpret if infection (causes increased uptake) or diabetes

10% of all lymphoma

Reed-Sternberg (owl's eyes) cells on biopsy- diagnostic

Can be low-high grade.

Variable survival if untreated, but mostly curable so treat!

Treatment with chemo +/- radiotherapy. Can still cure if they relapse after 1st line Rx, so give less agressive Rx at first

Aggressive (high grade)

Survival of only weeks if untreated

Treat with chemo +/- radiotherapy

High risk of tumour lysis syndrome- give allopurinol as prophylaxis and maintain adequate hydration

Commonest form of lymphoma

Long natural history- very slow growing so sually stage IV at presentation

Stage 1 = rare but can be cured by radiotherapy alone

Can transform into high-grade non-Hodgkin's lymphoma

2nd most common form of lymphoma. 

Can evolve from chronic lymphoid leukaemia and follicular non-Hodgkin's lymphoma

Immunohistochemistry: CD20 positive (so can give rituximab- antiCD20 monoclonal Ab)

Rapidly growing so need to treat