Hodgkin Lymphoma Quiz

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Questions and Answers

What cell type is characteristic of Hodgkin lymphoma?

T-lymphocytes

Reed-Sternberg cells (correct)

Plasma cells

B-lymphocytes

Which symptom is NOT typically associated with Hodgkin lymphoma?

Painful lymph nodes (correct)

Night sweats

Weight loss

Fever

What is the primary diagnostic method for Hodgkin lymphoma?

Lymph node biopsy (correct)

Blood test

CT scan

MRI

Which of the following is a risk factor for developing Hodgkin lymphoma?

Epstein–Barr virus Signup and view all the answers

Which treatment is commonly used for Hodgkin lymphoma?

Immunotherapy Signup and view all the answers

Non-Hodgkin lymphoma includes which of the following?

All types of lymphoma except Hodgkin's lymphomas Signup and view all the answers

Burkitt lymphoma is best described as which of the following?

An aggressive non-Hodgkin B cell lymphoma Signup and view all the answers

What is a primary complication for leukemic patients during dental procedures?

Serious bleeding problems Signup and view all the answers

What condition is highly suggestive of malignancy in a dental examination?

Enlarged supraclavicular node Signup and view all the answers

Which phase of medical therapy focuses on oral health care during treatment?

Oral health care during medical therapy Signup and view all the answers

What aspect should the dentist assess before starting chemotherapy?

Severity of the disorder Signup and view all the answers

Which oral condition may become a source of systemic infection during chemotherapy?

Mucositis Signup and view all the answers

When should the extraction of teeth be scheduled before chemotherapy?

At least 3 weeks prior Signup and view all the answers

What is a characteristic of leukemia?

Increase in immature leukocytes Signup and view all the answers

Which type of leukemia is more common among individuals younger than 19 years?

Acute lymphoblastic leukemia Signup and view all the answers

What should be removed or treated before chemotherapy according to the pre-treatment assessment?

Mucosal and periodontal disease Signup and view all the answers

What is a significant risk factor for mucositis during chemotherapy?

High replication rates of epithelial cells Signup and view all the answers

Which environmental factor is identified as a risk for developing leukemia?

High doses of ionizing radiation Signup and view all the answers

At what platelet count should invasive procedures be avoided before chemotherapy?

50,000/micro L Signup and view all the answers

What classification is used for lymphomas based on their clinical behavior?

Growth rate Signup and view all the answers

Intraoral lymphomas most commonly affect which area of the mouth?

Waldeyer's ring Signup and view all the answers

What is a common symptom of intraoral lymphomas?

Rapidly expanding swellings Signup and view all the answers

Which type of leukemia is characterized by mature neoplastic malignancies of lymphoid cells?

Chronic lymphocytic leukemia Signup and view all the answers

What is the typical age demographic for the majority of leukemia cases?

Adults over 65 Signup and view all the answers

What percentage of the total blood volume do white blood cells (WBCs) make up in a healthy adult?

Approximately 1% Signup and view all the answers

What is the normal range of circulating WBCs per micro L in adults?

4400 to 11,000/micro L Signup and view all the answers

Which type of white blood cell primarily defends the body against bacteria?

Neutrophils Signup and view all the answers

What is leukocytosis defined as?

An increase in WBCs to more than 11,000/micro L Signup and view all the answers

Which of the following conditions is NOT a cause of leukopenia?

Physical exercise Signup and view all the answers

What is a common treatment for acute pseudomembranous candidiasis?

Systemic antifungal medications Signup and view all the answers

What is pancytopenia characterized by?

Reduction in all blood elements Signup and view all the answers

How does chronic neutropenia affect oral health?

It contributes to severe periodontium destruction. Signup and view all the answers

Which type of infections is associated with increased numbers of eosinophils?

Allergic reactions and parasitic infections Signup and view all the answers

Which of the following describes a unique characteristic of infections in leukemic patients?

Infections can occur with minimal clinical signs. Signup and view all the answers

Which antibiotic is often used in treating herpes simplex infections in chemotherapy patients?

Acyclovir Signup and view all the answers

Which of the following statements about leukemia and lymphoma is true?

Patients may be gravely ill if not properly identified. Signup and view all the answers

What layer is used to protect oral ulcers from surface trauma?

Orabase Signup and view all the answers

What is the relationship between splenectomy and infection risk in patients?

It may increase the risk of infection. Signup and view all the answers

What type of infection is referred to as opportunistic in leukemic patients?

Bacterial, fungal, and viral infections Signup and view all the answers

What might be found in leukemic patients due to minor trauma?

Submucosal hemorrhage Signup and view all the answers

What is a common complication after splenectomy in patients with Hodgkin lymphoma?

Increased risk of bacterial infections Signup and view all the answers

What dental treatment option is advised for leukemic patients experiencing severe gingival bleeding?

Gelatin sponge with thrombin Signup and view all the answers

What dental issue can result from chemotherapy during childhood?

Microdontia and malocclusion Signup and view all the answers

Which of the following is a typical adverse effect associated with long-term use of intravenous bisphosphonates?

Osteonecrosis of the jaws Signup and view all the answers

What is the priority treatment for patients with advanced leukemia and a limited prognosis?

Emergency care only Signup and view all the answers

What is a common presentation of osteonecrosis of the jaws?

Nonhealing extraction socket Signup and view all the answers

What covers the minimum platelet count required before performing certain dental procedures on leukemic patients?

50,000/microliter Signup and view all the answers

What is a common manifestation of dental issues due to chemotherapy in children?

Blunted roots Signup and view all the answers

Study Notes

WBC Disorders

White blood cells (WBCs) are the primary defense against microbial infections and vital to the immune response.
Defects in WBCs can cause delayed healing, infection, and mucosal ulceration.
WBCs make up approximately 1% of the total blood volume in healthy adults.
Only 5% of WBCs circulate in the peripheral blood.

White Blood Cell Count (WBC 1)

Normal circulating WBC count ranges from 4400 to 11,000/microL in adults.
Normal differential count consists of:
- Neutrophils: 50% to 60%
- Eosinophils: 1% to 3%
- Basophils: less than 1%
- Lymphocytes: 20% to 34% (T lymphocytes, B lymphocytes, Natural killer cells)
- Monocytes: 3% to 7%

White Blood Cell Function (WBC 3)

Neutrophils defend the body primarily against bacteria through phagocytosis and enzymatic destruction.
Eosinophils and basophils are involved in inflammatory and allergic reactions.
Eosinophils combat parasitic infections.

Leukocytosis

Leukocytosis is an increase in circulating WBCs to more than 11,000/microL.
Physiologic leukocytosis is caused by exercise, pregnancy, and emotional stress.
Pathologic leukocytosis is caused by infection, neoplasia, and necrosis.
Pyogenic infections increase neutrophils.
Tuberculosis, syphilis, and viral infections increase lymphocytes.
Protozoal infections increase monocytes.
Allergies and parasitic infections increase eosinophils.

Leukopenia

Leukopenia is a reduction in circulating WBCs (less than 4400/microL).
Leukopenia can result from infection (viral), drugs, and chemotherapy.

Pancytopenia

Pancytopenia is a reduction in all blood elements (WBC, RBC, platelets).
Pancytopenia is caused by bone marrow suppression, such as aplastic anemia and chemotherapy.

Leukemia and Lymphoma

Patients with leukemia or lymphoma are severely ill if not properly identified and treated.
Patients are immunosuppressed, increasing risk of serious infections.
Patients often bleed easily due to thrombocytopenia.

Leukemia (1)

Leukemia (cancer of the WBCs) is characterized by a significant increase in immature leukocytes.
Leukemia affects bone marrow and circulating blood.
Exists in acute and chronic forms.

Leukemia (2)

Myeloproliferative disorders include acute myeloid leukemia (immature myeloid cell malignancy) and chronic myeloid leukemia (mature myeloid cell malignancy).
Lymphoproliferative disorders include acute lymphoblastic leukemia (immature lymphoid cell malignancy) and chronic lymphocytic leukemia (mature lymphoid cell malignancy).

Leukemia (3)

Leukemia occurs in all races and at any age, but is more common in men.
Leukemia is more common in adults than in children, and more than half of cases occur after age 65.
Acute myeloid leukemia is a common type of leukemia in adults.
Acute lymphoblastic leukemia is a common type in those younger than 19.

Risk of Leukemia

Risk factors include family history, high doses of ionizing radiation, infections with specific viruses (e.g., Epstein-Barr virus), cigarette smoking, and exposure to electromagnetic fields.

Lymphomas (1)

Lymphoma is a cancer of the lymphoid organs and tissues.
Lymphomas are classified by cell type (B cell, T cell, plasma cell) and appearance (small cell, large cell).
Classified by clinical behavior (low, intermediate, high grade).

Lymphomas (2)

Initial signs of these diseases often occur in the mouth and head/neck region.
Intraoral lymphoma most often involves Waldeyer's Ring (soft palate, oropharynx), but salivary glands and mandible can also be affected.
Intraoral lymphomas present as rapidly expanding or chronic, unexplained swellings in the head/neck, palate, gingiva, buccal sulcus, or floor of the mouth.
Prompt evaluation with biopsy is needed for diagnosis.

Lymphomas (3)

Common lymphoma types include Hodgkin lymphoma, Non-Hodgkin lymphoma, Burkitt lymphoma and multiple myeloma.

Hodgkin Lymphoma (1)

Hodgkin lymphoma is a malignant neoplasm of B-lymphocytes, mainly in lymph nodes, characterized by Reed-Sternberg cells.
Micrograph(Field stain) can show the cells.
Diagnosis includes,hematology,oncology, symptoms such as fever, night sweats, weight loss, enlarged non painful lymph nodes
Risk factors include Epstein-Barr virus, family history, and HIV/AIDS.
Treatment involves chemotherapy, radiation therapy, stem-cell transplant, and immunotherapy.
Five-year survival rate is around 88% (US).

Non-Hodgkin Lymphoma

Includes all lymphomas except Hodgkin's lymphoma.
Often a B-cell origin.
Are malignant neoplasms of lymphoid cells.
Occur in many kinds and places.

Burkitt Lymphoma

Aggressive non-Hodgkin B-cell lymphoma involving bone and lymph nodes.

Multiple Myeloma

Characterized by overproduction of malignant plasma cells, creating multiple tumor masses throughout the skeletal system.

Dental Management in Leukemia

Leukemic patients, especially those with undiagnosed disease, may experience serious bleeding problems after surgery, healing problems, and postoperative infection.
Dentists should identify these patients before treatment.

Diagnosis/Questions

Questions on family history of blood disorders and cancer
Evaluate weight loss, fever, enlarged lymph nodes, and bleeding tendencies
Complete clinical examination needed, including inspection of head, neck, mouth, oropharynx, cervical, and supraclavicular lymph nodes.
Awareness of supraclavicular lymph node enlargement as a possible sign of malignancy.
Evaluate cranial nerves to check for possible invasive neoplasms.
Radiographic studies like panoramic films are needed to check for oral conditions.
Blood tests to obtain WBC count, hemoglobin, and platelet count.

Treatment Planning Modifications

Three main phases:
- Pre-treatment assessment and preparation
- Oral health care during medical therapy
- Post-treatment management

Pre-treatment Assessment (1)

Minimize or eliminate oral diseases prior to chemotherapy.
Dentist needs to know specific diagnosis, severity of disorder, and type of medical treatment.

Pre-treatment Assessment (2)

Oral hygiene instructions (fluoride gels) and non-cariogenic diet.
Eliminating sources of mucosal/periodontal disease.
Caries elimination.
Root canal therapy or tooth extraction for pulpal disease.
Radiographic review/Inspection/identification of potential/undiagnosed disease, impacted teeth to clear oral cavities.

Extraction

Extraction consideration in patients on chemotherapy :
- Periodontal pocket depth > 5mm
- Periapical Inflammation
- Non-functional tooth
- Partially erupted tooth
Scheduling considerations regarding extraction and start of chemotherapy : A 3-week wait between extraction and chemo-radio-therapy initiation
Platelet count should be at least 50,000/microL before performing invasive procedures.

Oral Complications during Medical Therapy (1)

Mucositis: Inflammation of oral mucosa, especially in young patients undergoing chemotherapy.
Affects replication-active epithelial cells and usually begins 7-10 days after chemo, resolving after chemo ceases.

Oral Complications during Medical Therapy (2)

Breakdown of epithelial barrier leading to oral ulcerations
Potentially secondarily infected
Use antiseptic rinses (chlorhexidine) and oral topical/systemic analgesics.
Using Orabase to protect ulcers from surface irritation

Neutropenia and Infection

Patients with neutropenia can develop acute gingival inflammation and mucosal ulcerations, leading to periodontal destruction when oral hygiene is poor.
Periodontal therapy, oral hygiene instructions, frequent scaling, and antimicrobial therapy are beneficial.

Oral Infection

Oral infection is less common in patients with chronic leukemia because of healthier cells.
Still, in later stages, infection can become problematic.
Severe cases include opportunistic bacterial, fungal and viral infections.
Splenectomy further increases risk of bacterial infection.

Opportunistic Infections

Infections like acute pseudomembranous candidiasis are usually treated by antifungal medications.
Unusual fungal infections like mucormycosis are treated with potent antifungal agents.
Herpes Simplex Virus infections might have prolonged healing compared to other populations. Acyclovir may be used for prevention.

Bleeding

Submucosal hemorrhage could occur in small or large areas.
Bleeding can be from minor trauma (e.g., tongue biting) and thrombocytopenia.
Severe gingival bleeding is exacerbated by poor oral hygiene management.
Efforts to improve oral hygiene and/or topical measures (like gelatin sponge with thrombin) are recommended to reduce/manage bleeding.
Platelet count of at least 50,000/microL is needed before dental procedures.

Growth and Development

Chemotherapy affects growing and developing teeth, jaws, and facial bones – this is especially pronounced during childhood but less so in adults.
Results of such therapy can be micrognathia, retrognathia, malocclusion, or altered teeth-roots (e.g., shorten or blunted roots, dilacerations, calicification abnormalities, pulp enlargement, microdontia).

Post-treatment Management (1)

Patients in remission can receive indicated dental treatment, although emergencies are often handled separately.
Patients with advanced disease or certain conditions (like Hodgkin lymphoma or splenectomy and bacterial infection after) receive only emergency dental care.
Antibiotic prophylaxis is recommended for invasive procedures for at least the first 6 months after splenectomy.

Post-treatment Management (2)

Typical presentation includes severely painful non-healing extraction socket/bone exposure.
Necrotic bone can be asymptomatic for weeks so requires routine observation.
Treatment focuses on managing symptoms with local debridement (bone and wound irrigation with antiseptics) and suitable antibiotics.

Treatment Planning Development

Early intervention is key- Treat infections and related complications promptly.
Non-surgical options are preferred over surgery.
Limit extractions to a single quadrant or limited procedures to one quadrant.
Two-month wait period recommended between surgical interventions.
Antibiotic coverage should be present during extraction and the healing period.

Additional Notes

Bisphosphonates, a type of drug, can result in osteonecrosis of the jaw, which is a serious complication.
This risk is higher in patients receiving intravenous bisphosphonates for a year or more, particularly after tooth extractions.

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Description

Test your knowledge on Hodgkin lymphoma and its characteristics with this quiz. It covers diagnostic methods, symptoms, treatment options, and related types of lymphoma. Enhance your understanding of this condition and the implications for dental health.