Non Hodgkin's lymphoma & Hodgkin's disease

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The Lymphomas are a heterogeneous group of neoplasms that arise in the lympho-reticular system. The incidence of Hodgkin’s Disease in the UK is 3/100,000, approximately half that of NHL currently standing at 6/100,000 but rising. In Hodgkin’s Disease the neoplastic cell takes the form of mononuclear Hodgkin’s cells and the characteristic multinucleate Reed-Sternberg cell, which must be identified for histological diagnosis. The histological classification of Non Hodgkin’s Lymphoma is more diverse and subject to a degree of controversy. The most widely accepted classification is the Working Formulation but more recently the Revised European-American Lymphoma (REAL) Classification has been devised. It has the advantage of incorporating all nodal and extranodal lymphoid tumour, including Hodgkin’s disease and it incorporates newer categories of lymphoma. The ‘aggressiveness’ and response to treatment vary widely within the sub types of these neoplasms.

Symptoms of a lymphoma

Isolated or generalised lymphadenopathy (glands) in the absence of local or systemic infection. Particularly if associated with weight loss, sweating excessively at night or unexplained temperatures. 

What to do: 

Patients should present to their GP's and unless another explanation can be found sent for urgent biopsy to a surgeon. or if a high suspicion of lymphoma directly to the Oncologist/Haematologist with an interest in lymphoma who may organise an ultrasound guided biopsy in consultation with the radiologist. If the lymphadenopathy is above the clavicles it is best to refer to an ENT or oro-maxillary surgeon. If there are risk factors for HIV infection these are best mentioned to the doctor at this stage.

Other investigation 

The following investigations are often required at this time:-

1. Full history and clinical examination, with particular reference to clinically assessable disease, e.g. lymph nodes, spleen, liver, Waldeyer’s ring etc.

2. Baseline bloods - FBC, U+E, LFT, LDH, ESR. Consider HIV test, with appropriate counselling and consent, if patient in high risk category.

3. Baseline imaging, CXR, other imaging as indicated usually CT scan chest, abdomen & pelvis

4. Bone marrow aspirate and trephine:

All patients with NHL

Evidence of bone marrow impairment on FBC with Hodgkin's.

5. Lumbar puncture (see section - management of the CNS in lymphoma) for patients with:-

6. Histology review at Cambridge, all newly diagnosed patients - send to Dr Arno.

7. If chemotherapy is likely, offer sperm banking if required by the patient and if delay is acceptable .


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