Oncology: Lymphoma

Definition

• Definition: Cancer of Lymphocytes
  • Often Considered a Cancer of Lymph Nodes
• Classification:
  • Hodgkin’s Lymphoma (HL) – Presence of Reed-Sternberg Cells
  • Non-Hodgkin’s Lymphoma (NHL) – Does Not Contain Reed-Sternberg Cells

Hodgkin’s Lymphoma (HL)

• Less Common Type
• Younger Patient Population – Median Age is 39
• 86% 5-Year Survival
• Cell Types:
  • Reed-Sternberg Cells – Large Mutated B Lymphocytes
    • Appearance of “Owl’s Eye” Nuclei
  • Popcorn Cells – Variant of Reed-Sternberg Cells
    • Appearance of “Popcorn”
    • Also Called Lymphocytic & Histiocytic (L&H) Cells
• Subtypes (5):
  • Classical Hodgkin’s Lymphoma (90%) – Presence of Reed-Sternberg Cells
    • Nodular Sclerosis Classical Hodgkin’s Lymphoma
    • Mixed Cellularity Classical Hodgkin’s Lymphoma
    • Lymphocyte-Rich (Best Prognosis)
    • Lymphocyte-Depleted (Worst)
  • Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma (10%) – Presence of Popcorn Cells

Non-Hodgkin’s Lymphoma (NHL)

• Most Common Type
• Older Patient Population – Median Age is 66
• 70% 5-Year Survival
• Subtypes (> 60):
  • B-Cell Lymphoma (85% – Most Common):
    • Diffuse Large B-Cell Lymphoma (DLBCL) – Most Common Subtype
    • Follicular Lymphoma
    • Mantle Cell Lymphoma
    • Marginal Zone Lymphoma
    • Burkitt Lymphoma
    • Many Others
  • T-Cell Lymphoma (15%):
    • T-Lymphoblastic Lymphoma
    • Peripheral T-Cell Lymphoma
    • Many Others

Primary Gastrointestinal (GI) Lymphoma

• *See Stomach: Primary Gastrointestinal Lymphoma

Presentation

• Variable/Diffuse Lymphadenopathy
• Constitutional Symptoms (Fever, Night Sweats, Weight Loss)
• Hepatosplenomegaly
  • NHL is the Most Common Cause of Splenomegaly
• Nausea & Vomiting
• Most Common Cause of Chylous Ascites

Diagnosis

• Gold Standard Work-Up: Excisional Bx
  • *Core Needle Biopsy May Be Sufficient in Diagnosing Cancers with Metastasis to Nodes
  • FNA is Inadequate Exclude the Diagnosis or Make a Definitive Classification
• Generally Need to Excise a Node & Send it Fresh for Flow Cytometry
• Usually Try to Sample Nodes that are Easiest to Access with Lower Chance of Complications Such as Axillary or Inguinal Nodes

Diagnostic Yield of Palpable Nodes

• Overall Yield: 70.4%
• Supraclavicular: 90% – Highest Yield
• Cervical: 76.4%
• Axillary: 62.5%
• Inguinal: 38.5% – Lowest Yield

Staging (Lugano Classification)

• Stage I – Involvement of a Single Lymph Node Region
  • IE – Involvement of a Single Extralymphatic Organ/Site without Nodal Involvement
• Stage II – Involvement of ≥ 2 Lymph Node Regions on the Same Side of the Diaphragm
  • IIE – Also Involves Limited Contiguous Extralymphatic Organs/Tissue
• Stage III – Involvement of Lymph Node Regions on Both Sides of the Diaphragm
• Stage IV – Diffuse/Disseminated Disease which Involves Noncontiguous Extralymphatic Organs/Tissue (Bone Marrow/Liver/Lung)
  • May or May Not Involve Lymph Nodes

Treatment

• Primary Treatment: Chemotherapy