Internal Diseases and Therapy · MU Sofia

64. Non-Hodgkin’s lymphomas

Covers non-Hodgkin's lymphomas as a group of lymphocyte cancers, split into B-cell and T-cell forms, with a note on how the disease arises during immune cell development. It sets out incidence, age and sex patterns, inherited and infective risk factors, and the typical presentation with lymphadenopathy, systemic symptoms and extranodal sites. It also outlines biopsy and staging investigations and briefly lists low-grade and high-grade management, including the CHOP regimen with rituximab.

Inside: 1 section · 3 labelled pictures · 13 flashcards · 3 min

Topic 64 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 1 section, about 451 words (3 min of reading), with 13 flashcards.

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  1. Non-Hodgkin's lymphomas

Non-Hodgkin's lymphomas

Soooo, take a look at all the stuff above about Hodkin’s and there are some bits there about Non-Hodgkin's as well, here we’ll look a bit more detailed at Non-Hodgkin’s.

So there are actually 60 different types of NHL, these are a group of lymphoproliferative malignancies. Brek that term down, lymph = lymphocytes, proliferative = expanding, malignancies. So these are just lymphocyte cancers. Broadly speaking they can be broken down into B-cell NHL or T-cell NHL.

NHL is the sixth most common cancer in the UK with an incidence of about 1/10000. Peak incidence is amongst those age 65-75 and more commonly affects males. There are several inherited disorders that increase the risk of NHL, the most common of these are Wiskott-Aldrich syndrome and ataxia telangiectasia. Meanwhile other factors that may be related to lymphoma are Epstein Barr virus, HSV-8 (AIDS related lymphoma), human T-cell lymphocytic virus (T-cell lymphoma), H.pylori, Autoimmune diseases (SLE, coeliac, RA), and immunosuppression.

NHL are derived from cells of the immune system at varying stages of differentiation, review the two images below to get a feel for the process, the top is the normal development pathway for T and B cells, while the bottom shows the possible path towards a lymphoma.

You can see on the image there are different types of lymphoma based on when the tumour begins to form, for instance Burkitt Lymphoma is an aggressive rapid growing, high grade B-cell NHL. There are many different types of NHL and it is important to understand that this is not one disease that we are dealing with. The most common is diffuse large B-cell lymphoma, followed by follicular lymphoma.

Around 75% of NHL present with lymphadenopathy, mostly cervical, axillary or inguinal. Nodes are generally firm, non tender and not associated with a regional infection. Note the lymphadenopathy may be found in the mediastinum or retroperitoneum. NHL often presents with systemic symptoms such as fever, night sweats and weight loss.

Despite this it is worth noting that NHL can involve any organ in the body, brain lymphoma, lymphomas of the lung, and gastric lymphomas all have symptoms specific to the system.

Image: “DIagram showing where lymphoma can spread in the body CRUK 382” by Cancer Research UK, CC BY-SA 4.0, via Wikimedia Commons.

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