Lymphoma - patho, dx, staging and tx

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  1. Lymphomas are clonal expansions of cells at certain developmental stages
    • Clonal expansion
    • arrest of dxn
    • loss of apoptotic pathways/ responses
  2. Leukemia vs lymphoma
    • origin- leukemia (bone marrow or blood)
    •           Lymphoma (lymph node)
  3. common cancer, accounting for 4% of all
    new cases.
    nonhodkin lymphoma
  4. Acute Lymphoid leukemia: origin
    lymphoid progenitor origin
  5. Chronic lymphoid leukemia
    B lymphocytes origin
  6. mechanism of lymphomagenesis
    genetic alteration, infection, antigen stimulation, immunosurppression
  7. H. pylori induced lymphoma tx
  8. Immune suppression - example
    –congenital (Wiskott-Aldrich)

    –organ transplant


    –increasing age
  9. DNA repair defect - example
    –ataxia telangiectasia

    –xeroderma pigmentosum
  10. NHL vs HL
    • HL: 1 lymphoma. can be cured by rad. 
    • NHL: multiple lymphoma. dont know exactly which one
  11. Lymphoma Classification: Clinical
    Indolent Disease: slow-growing  but incurable (come back, residual). 85-90% present in Stage III or IV

    Intermediate/Aggressive Disease: a little more rapid growing (weeks and months). curable

    High-grade/Very Aggressive Disease: rapid growing (hours). curable
  12. Non-Hodgkin’s Lymphoma - epidemeology
    6th most common cause of cancer death in United States.

    Increasing in incidence and mortality.

    Since 1970, the incidence of lymphoma has almost doubled
  13. Clinical features - nonhodkin - lymphoma

    Cytopenias: low RBC, WBC, platelet

    Systemic symptoms


    • B - symptoms (worse prognosis)
    • Fever, Night sweats, Weight loss
  14. Clinical feature - lymphadenopathy
    fluctuate or spontaneously remit, especially in low-grade lymphomas.
  15. Clinical features- B symptoms
    more common in high-grade lymphomas
  16. Clinical features - heamtogenous spread of disease
    no predictable pattern
  17. Diagnosis of NHL
    • Excisional biopsy is preferred to
    • show nodal architecture

    –Evaluate Morphology

    –Evaluate Nodal Architecture (where the malignant cells are in the node)
  18. Diagnosis of NHL
    • biopsy
    • immunogistochemistry
    • flow cytometry
    • chromosome changes
  19. Staging Workup
    CBC, chemistries, urinalysis

    CT scans of chest, abdomen and pelvis

    Positron Emission Tomomgraphy (PET)

    Bone marrow biopsy and aspirate

    Lumbar puncture

    • –AIDS lymphoma
    • –T cell lymphoblastic lymphoma
    • –High grade lymphoma with positive marrow
  20. how is staging different in lymphoma than breast cancer?
    it is used to evaluate the burden of the disease. it's curable even at higher rate
  21. Reasons to Treat in Advanced Indolent Lymphomas
    Constitutional symptoms

    Anatomic obstruction

    Organ dysfunction

    Painful lymph nodes



  22. Follicular lymphoma
    Most common type of “indolent” lymphoma

    Usually widespread at presentation

    Often asymptomatic

    Not curable (some exceptions)

    Associated with BCL-2 gene rearrangement [t(14;18)]

    Cell of origin: germinal center B-cell
  23. Rituximab
    CD20 antibody --> recruit complement, cell-mediated cytotoxicity, apoptosis
  24. Diffuse large B-cell lymphoma
    Most common type of aggressive” lymphoma

    Usually symptomatic

    Extranodal involvement is common

    Cell of origin: germinal center B-cell

    Treatment should be offered

    Curable in ~ 60-75%
  25. DLBCL: Clinical Presentation
    Present with a rapidly enlarging symptomatic mass, most usually nodal enlargement in the neck or abdomen.

    Systemic "B" symptoms (ie, fever, weight loss, drenching night sweats) are observed in approximately 30 percent of patients

    Serum LDH is elevated in over one-half

    60 percent of patients will present with advanced stage DLBCL (usually stage III or IV disease) while 40 percent have more localized disease, usually defined as that which can be contained within one irradiation field

    Bone marrow is involved in up to 30 percent of cases

    Extranodal extramedullary disease occurs in up to 40 percent of cases
  26. Burkitt’s Lymphoma
    Jaw mass

    In U.S., about 50% EBV infection.

    May present as abdominal mass.

    Most rapidly growing human tumor.

    Typical chromosome abnormality: c-myc oncogene linked to one of the immunoglobulin genes.
  27. Classical feature for hodkin's lymphoma
    diffuse itching
  28. what need to make dxn for hodgkin's disease
    reed-sternberg cell
  29. Hodgkin's sign and symptom
    • Lymph node enlargement, usually
    • cervical or mediastinal.

    Systemic “B” symptoms common.

    Pel-Ebstein fever.

    • –relapsing, high-grade fever that
    • can reach 105-106°F, periodicity of 7-10 days. Fever spikes abrupt in onset and
    • resolution

    Pain on drinking alcohol.
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Lymphoma - patho, dx, staging and tx
2013-07-29 18:33:15

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