Lymphoma

Lymphoma is a group of cancers caused by malignant proliferations of lymphocytes in the lymphatic system, accumulating in the nodes to cause lymphadenopathy. The 2 main types of it are:

• Hodgkin’s - very specific disease

• Non-Hodgkin’s - umbrella term for all other lymphomas

Hodgkin’s Lymphoma

This is a malignant lymphoma characterised by the presence of Reed-Sternberg cells. It's risk factors are:

• EBV

• Immunosuppression e.g. HIV, Drugs

• Smoking

Presentation:

• Painless, cervical/supraclavicular lymphadenopathy

• Weight loss, night sweats, fever

N.B. Lympahedonapthy may become painful with alcohol.

Investigations:

• Lymph node biopsy - Shows presence of Reed Sternberg cells (like an owl face)

• Bloods - Hb, LDH (raised indicates a poorer prognosis)

Staging - Ann Arbor Staging with CT/MRI/PET:

• Stage 1 - 1 region of nodes

• Stage 2 - Nodes on same side of diaphragm (above/below)

• Stage 3 - Nodes on both sides of diaphragm (above + below)

• Stage 4 - Widespread involvement of non-lymphatic organs

Managed with chemoradiotherapy.

Non-Hodgkin’s Lymphoma

This is a malignant lymphoma characterised by the absence of Reed-Sternberg cells. Its 2 main types are:

• Burkitt’s lymphoma - associated with EBV and HIV

• Gastric MALT (mucosa-associated lymphoma tissue) - associated with H. pylori infection

Presentation:

• Painless lymphadenopathy - Compared to Hodgkin’s lymphoma, the lymphadenopathy is more likely to be symmetrical, at multiple sites, and spread discontinuously across nodal sites

• Weight loss, night sweats, fever

Investigations:

• Lymph node biopsy - No Reed Sternberg cells (like an owl face)

• Bloods - Hb, LDH (raised indicates a poorer prognosis)

Management - Watchful waiting, Chemoradiotherapy, Rituximab, Stem cell transplant