Shared Flashcard Set



Additional Accounting Flashcards




• Palpable Lymph Nodes – what's normal?
based on features, can evince at normal, reactive, or malignant Dx:
o Size – smaller is more normal; (opp. malignant)
o Shape – soft, flat, & fixed is normal; firm, spherical & movable is more malignant
o Tenderness – non-tender is normal; (opp. malignant)
o Stability – non-growing is normal; (opp. malignant)
Sx of lymph node changes?
can be asymptomatic, or notice lymph node changes & B-symptom (constitutional) changes:
o Asymptomatic – find lymphoma incidentally
o Lymph node changes – usually painless enlargement in neck/axilla/groin
o B-Symptoms – unexplained fever, drenching night sweats, 10% weight loss over 3 months
o Other constitutional changes – fatigue and pain based on location and size of mass
Dx ?
• Dx – can be made through lymph node biopsy, or if still unsure, a bone marrow biopsy
Lymphoma: Hodgkin’s vs. Non-Hodgkin’s
• Hodgkin’s Lymphoma – has 3-4 main subtypes, 3 treated the same and have same prognosis
o Prevalence – more rare; about 3 times less common than NHL
o Demographic – generally younger(20-29) patients, but also late peak after 60 yo
o Spread – predictable spread through contiguous lymph nodes
• Non-Hodgkin’s Lymphoma – many subtypes with varying behavior/prognosis/Tx
o Prevalence – 3 times more common than Hodgkin’s Disease
o Demographic – incidence increases with age
o Spread – more random spread
o Sites – can involve Waldeyer’s ring, CNS, skin, GI tract/mesenteric
staging according to diaphragms
if lymph nodes on one side of diaphragm involved  stages I/II; if both  stages III/IV; if patient has B symptoms then add B to stage; E = extralymphatic, S = splenic
Hodgkin's Disease Treatment in 1. Limited/early, 2. Advanced stage, 3, salvaging failed treatments, 4. late risks/complications?
• Limited (Early) Stage HD – stages IA, IB, IIA; treated by:
o Chemotherapy + Radiation Therapy – most common treatment
 ABVD – adriamycin, bleomycin, vinblastive, dacarbazine  general chemo treatment
o Radiation Therapy Alone – older method; irradiate lymph nodes affected & adjacent ones
o Chemotherapy Alone – debated for use among young; limits SEs of radiation (particularly effects later in life)
o Prognosis – good; 80-90% prevention of 5-year relapse
• Advanced Stage HD – stages IIB & up; treated by:
o Chemotherapy – plays larger role, use longer treatment course
o Prognosis – okay; about 2/3 cured (prevent 5-year relapse)
• Salvaging Failed Treatments – a number of options:
o Chemotherapy – if radiation therapy was only given previously, chemotherapy = 60% success
o High-dose chemotherapy + Autologous stem cell transplant – if previous chemo failed; 60%
o Post-transplant salvage – very poor
• Late Risks – some of the complications of Tx now more concerning than HD itself:
o 2o cancer, heart/lung damage – common risks post-treatment
o Reduce/eliminate radiation – proposed solution to reduce risks
Non-Hodgkin’s Lymphoma types that are based on aggressiveness, curability
1. • Indolent, but incurable
2. aggressive, incurable
3. aggressive, curable
4. highly aggressive, curable
• Indolent, but incurable – Follicular lymphoma, CLL/SLL, marginal zone, lymphoplasmacytic
• Aggressive, incurable – Mantle cell lymphoma
• Aggressive, curable – Diffuse large cell lymphoma
• Highly aggressive, curable – Burkitt’s lymphoma, lymphoblastic
• (Italics = most common NHLs); 85% of NHL are B-cell
indolent NHLs?
1. follic
3. lymphoplasmacytic
• Follicular lymphoma – most common indolent lymphoma; many invading follicles in lymph node
• Marginal zone lymphoma (MALT) – pale marginal zone of MALT is abnormally expanded
• Lymphoplasmacytic lymphoma – memory B cells tend to activate into plasma cells  macroglobulinemia
Prognosis of indolent NHL - what's a good indicator?
• Prognosis – difficult treatment, but very slow progression
o FLIPI – Follicular Lymphoma International Prognostic Indicator  predicts prognosis
Treatment for indolent NHL?
is it okay to chill out and not do anything?
which antibodies are good for therapy?
when to use radiation?
• Treatment Options – observation, radiation, chemo, antibody, transplantation:
o Watch & wait – maintain good QOL while observing progression of disease; treat when symptoms/complictation emerge; no difference in survival whether treated immediately or observed; 2-3 years to treatment
 Pros – avoids treatment toxicity, spontaneous regressions occur, new treatments or new standards may become available
 Cons – requires periodic monitoring
o Radiation therapy – good for early stage; knocks out lymph nodes, but remission w/ adv. stage
o Chemotherapy – ABVD?
o Antibody therapy – such as Rituximab, monoclonal Igs against surface markers (CD20)
 CD20 surface marker – present in Pre-B cell  Activated B-cell, not plasm
 Given with chem – higher response rates and longer remissions than chemo alone
o Radioactive antibodies – bind to lymphoma, also irradiate nearby lymphoma cells
 Zevalin, Bexxar – both radioactive antibody treatments for indolent lymphomas
 Regimen – a single cycle treatment, lasts 1 week, two infusions
 Response – great overall survival, also many without relapse…remission shown w/ PET scan
o Transplantation – replace bone marrow
aggressive curable NHLs - prognosis factors, treatment
• Diffuse Large B-cell Lymphoma – most common type of lymphoma
• Prognosis – also scaled by various risk factors into a prognostic index
o Elderly – worse prognosis, if chemo fails, many elderly can’t withstand bone marrow x-plant
o CNS inolvement risk – bone marrow, sinuses, testes pose higher risk of CNS involvement
• Treatment – should be initiated as soon as possible after diagnosis:
o Chemotherapy – central role, “CHOP” chemotherapeutic combination of drugs, 6-8 cycles
o Rituximab – also part of standard Tx for B-cell lymphomas
o Low stage disease – fewer cycles
o Salvage – less than 20% of those who do not achieve CR with initial therapy are cured but best option is autologous HSCT
aggressive incurable NHL - prototype, prog, treatment
• Mantle cell lymphoma – pre-follicular cells of mantle zone become neoplastic & invade outside boundary
• Prognosis – bleak; median survival of 3-4 years
• Treatment – initially give chemotherapy, but relapse & resistance high:
o Chemotherapy – give “CHOP” chemotherapeutic combination of drugs
o Remission – short remission time; relapse rate high  often resistant to salvage regimens
highly aggressive curable NHL - prototype, prognosis, tx
Highly Aggressive Curable NHL
• Burkitt’s lymphoma – as well as lymphoblastic lymphoma, both aggressive follicular lymphomas
• Prognosis – due to rapid division, can be easily targeted and very responsive to chemo
• Treatment – give chemotherapy, also need to prophylax for CNS involvement
o Chemotherapy – standard treatment
o CNS involvement – has a high risk for this, need CNS prophylaxis (intrathecal chemo and cranial radiation)
new therapies for NHL
• Antibodies – nextgen CD20 antibodies, against other antigens (CD22, 23, 40, 80)…
• Proteosome inhibitors
• Deacetylase inhibition
• Targeting B-cell receptor pathways
• PI3 Kinase inhibitors
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