Hodgkin's Lymphoma Quiz
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Questions and Answers

Which of the following statements is TRUE about follicular lymphoma?

  • It is the most common indolent type of lymphoma, but it's uncommon among people older than 60.
  • It is the most common indolent lymphoma, with a higher prevalence in females. (correct)
  • It is the most common indolent lymphoma, with a higher prevalence in males.
  • Follicular lymphoma is a type of lymphoma where overexpression of BCL6 protein is a common feature.

    • Which of the following statements is TRUE about Burkitt lymphoma?

  • Burkitt lymphoma is primarily a nodal lymphoma, with extranodal involvement being uncommon.
  • It is the most common type of non-Hodgkin's lymphoma in children, but it is rarely associated with Epstein-Barr virus.
  • It is often associated with translocation of the C-MYC gene, a feature that makes it a very aggressive lymphoma. (correct)
  • It is a highly aggressive type of lymphoma with curable potential but only when diagnosed in its early stages.

    • Which of the following statements is TRUE about the prognosis of lymphomas?

  • The prognosis of lymphoma is largely dependent on the specific subtype, with aggressive types often being curable and indolent types having a long-term survival possibility. (correct)
  • Both aggressive and indolent lymphomas have poor prognosis, with the indolent ones usually developing into their aggressive counterparts later on.
  • All types of lymphoma have a predictable long-term survival rate, regardless of the subtype or its aggressiveness.
  • Aggressive lymphoma subtypes have a favorable prognosis, while indolent subtypes are generally incurable.

    • Which of the following statements is TRUE about MALT lymphoma?

    <p>It is a type of lymphoma that is mainly associated with the lungs and may require surgical intervention on the pylorus. (A)</p> Signup and view all the answers

    Which of the following is a characteristic of Reed-Sternberg cells?

    <p>They are positive for CD15 and CD30 markers (A)</p> Signup and view all the answers

    What is the most common presentation of Hodgkin's lymphoma in terms of lymphadenopathy?

    <p>Mediastinal nodes (C)</p> Signup and view all the answers

    Which of the following factors contribute to the prognosis of Hodgkin's lymphoma?

    <p>The patient's age (A)</p> Signup and view all the answers

    Which of the following is a treatment option for advanced stage Hodgkin's lymphoma?

    <p>Chemotherapy combined with radiation therapy (C)</p> Signup and view all the answers

    What is the most common subtype of Hodgkin's lymphoma?

    <p>Nodular sclerosis (A)</p> Signup and view all the answers

    Which of the following is a characteristic of non-classic subtypes of Hodgkin's lymphoma?

    <p>Presence of B-cell markers like CD20 (B)</p> Signup and view all the answers

    What is the most frequent site of spread of Hodgkin's lymphoma, following mediastinal involvement?

    <p>Cervical nodes (A)</p> Signup and view all the answers

    What is a possible treatment option for a relapse of Hodgkin's lymphoma?

    <p>High-dose chemotherapy followed by autologous stem cell transplant (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the Ann Arbor staging system for Hodgkin's lymphoma?

    <p>It is based on the extent of extranodal involvement (C)</p> Signup and view all the answers

    Which of the following is a potential complication leading to death in patients with Hodgkin's lymphoma?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the most common genetic syndrome associated with osteosarcoma?

    <p>Li-Fraumeni syndrome (B)</p> Signup and view all the answers

    Which of the following is NOT a typical characteristic of localized cervical lymph node involvement in cancer?

    <p>Extranodal spread is common (A)</p> Signup and view all the answers

    Which of these cancers is NOT associated with a TP53 mutation?

    <p>Medulloblastoma (B)</p> Signup and view all the answers

    What is the most common subtype of brain tumor in young children?

    <p>Pilocytic astrocytoma (D)</p> Signup and view all the answers

    Which of these statements is TRUE regarding the treatment of medulloblastoma in children?

    <p>The majority of children with medulloblastoma are diagnosed with the mixed cellularity subtype. (D)</p> Signup and view all the answers

    Which type of rhabdomyosarcoma is associated with the best prognosis?

    <p>Botryoid (A)</p> Signup and view all the answers

    What percentage of lung cancer cases are Small Cell Lung Cancer (SCLC)?

    <p>15% (C)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for pleural mesothelioma?

    <p>Smoking (C)</p> Signup and view all the answers

    Which of the following is NOT a typical location for rhabdomyosarcoma in children?

    <p>Liver (C)</p> Signup and view all the answers

    Which genetic syndrome is associated with an increased risk of colon cancer and glioma?

    <p>HNPCC (A)</p> Signup and view all the answers

    What is the most common subtype of Non-Hodgkin's Lymphoma (NHL)?

    <p>Diffuse Large B-Cell Lymphoma (DLBCL) (A)</p> Signup and view all the answers

    What is the estimated long-term survival rate for patients with osteosarcoma?

    <p>75% (A)</p> Signup and view all the answers

    Which of the following is a common symptom of Ewing sarcoma in children?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary method of diagnosis for Non-Hodgkin's Lymphoma (NHL)?

    <p>Excisional biopsy (B)</p> Signup and view all the answers

    Which of these is a paraneoplastic syndrome associated with Small Cell Lung Cancer (SCLC)?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the most common presenting symptom of pleural mesothelioma?

    <p>Chest pain (D)</p> Signup and view all the answers

    In which stage of lung cancer is radiation therapy (RT) considered most effective?

    <p>Stage IIIB (B)</p> Signup and view all the answers

    Which of these is a complication frequently seen on imaging in patients with lung cancer?

    <p>Pleural effusions (C)</p> Signup and view all the answers

    What is the most common presenting symptom of lung cancer?

    <p>Chronic cough (B)</p> Signup and view all the answers

    Which type of lung cancer is most commonly centrally located?

    <p>Squamous cell carcinoma (B)</p> Signup and view all the answers

    What is the recommended treatment for inoperable stage III N+ NSCLC?

    <p>Radical concurrent chemo-radiotherapy (D)</p> Signup and view all the answers

    What is the average age of diagnosis for pleural mesothelioma?

    <p>60 years old (B)</p> Signup and view all the answers

    Which of these is a common complication associated with Pancoast tumors?

    <p>Horner syndrome (D)</p> Signup and view all the answers

    Which of these is NOT a common site of metastasis for lung cancer?

    <p>Kidney (A)</p> Signup and view all the answers

    What is the most common cause of death in patients with lung cancer?

    <p>The cancer itself (D)</p> Signup and view all the answers

    Which of these syndromes is associated with a mutation in the NF1 gene?

    <p>Neurofibromatosis 1 (D)</p> Signup and view all the answers

    Which of these tumors is commonly associated with Neurofibromatosis 1?

    <p>Astrocytoma (A)</p> Signup and view all the answers

    Which of the following statements about Wilms tumor treatment is TRUE?

    <p>Radical surgery is typically the first line of treatment. (A)</p> Signup and view all the answers

    Which of these conditions is commonly diagnosed around 1-2 years of age?

    <p>Neuroblastoma (D)</p> Signup and view all the answers

    Which of these conditions is characterized by a mutation in the ATM gene?

    <p>Ataxia-telangiectasia (B)</p> Signup and view all the answers

    Which of the following mutations is associated with Fanconi anemia?

    <p>FANCA (A)</p> Signup and view all the answers

    Which of the following tumors is NOT associated with Beckwith-Wiedemann syndrome?

    <p>Osteosarcoma (B)</p> Signup and view all the answers

    What is the most common location for a retroperitoneal tumor?

    <p>Mediastinum (B)</p> Signup and view all the answers

    Which of the following is a characteristic sign of metastasis to the skin in neuroblastoma?

    <p>Blueberry muffin sign (D)</p> Signup and view all the answers

    What is the most common finding in the urine of children with neuroblastoma?

    <p>Elevated catecholamines (A)</p> Signup and view all the answers

    Flashcards

    BCL6 Overexpression

    A genetic alteration noted in some lymphomas, indicating aggressive behavior.

    Follicular Lymphoma

    Most common indolent lymphoma, usually affects those over age 60, more common in females.

    Burkitt Lymphoma

    An aggressive and curable type of non-Hodgkin lymphoma, associated with C-MYC translocation.

    CNS Lymphoma

    Lymphoma that typically occurs in the central nervous system, characterized by deep infiltration without calcification.

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    MALT Lymphoma

    A type of lymphoma often linked to chronic inflammation, particularly in the stomach related to H. pylori.

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    Gorlin Syndrome

    Genetic condition with PTCH mutation causing basal cell carcinomas and medulloblastoma.

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    Neurofibromatosis 1

    Condition with NF1 mutation linked to multiple tumors like gliomas and neurofibromas.

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    Wilms Tumor

    Kidney cancer in children, often treated with chemo and surgery.

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    Ataxia-telangiectasia

    Condition caused by ATM mutation, increasing risk of lymphoma and leukemia.

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    Neuroblastoma

    Common pediatric cancer, often presenting in early childhood, with a high survival rate if diagnosed early.

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    Bad Prognostic Factors

    Age >60, poor performance status, elevated LDH, involvement of >2 nodal regions.

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    Presentation of Hodgkin's Lymphoma

    Common symptoms include lymphadenopathy, B-symptoms, pruritus, and superior vena cava syndrome.

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    Excisional Biopsy

    Procedure to confirm Hodgkin's Lymphoma by removing a whole lymph node.

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    Ann-Arbor Staging System

    A system used to stage Hodgkin's Lymphoma based on the extent of disease.

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    B-symptoms

    Symptoms of Hodgkin’s Lymphoma: fever, night sweats, and weight loss (>10% in 6 months).

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    Classic Subtypes of Hodgkin’s Lymphoma

    Includes nodular sclerosis, mixed cellularity, and lymphocyte predominant types.

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    Poor Prognostic Indicators

    Features like bulky mediastinum, extranodal involvement, or elevated ESR.

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    Lymphocyte-Depleted HL

    A classic subtype known for having the worst prognosis.

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    Treatment for Early Stage HL

    Managed by Radiation Therapy or chemotherapy (2-4x ABVD regimen).

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    Non-Classic Subtype

    Nodular lymphocyte predominant HL, typically in younger males with B-cell markers.

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    Osteosarcoma

    A type of bone cancer often affecting adolescents and young adults.

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    Fanconi Anemia

    A genetic disorder caused by mutations in FANCA, associated with increased cancer risk.

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    Metastasis

    The spread of cancer cells from the original tumor to other parts of the body.

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    Blueberry Muffin Sign

    A dermal manifestation indicating metastasis, often found in neuroblastoma.

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    Cervical MC Nodes

    Localized cancer spread primarily to cervical lymph nodes; rare extranodal spread.

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    Childhood Cancer Epidemiology

    Second leading cause of death in children, with accidents being the first.

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    Bimodal Peak

    Age distribution showing two peaks in incidence; significant at around 15 years.

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    Acute Lymphoblastic Leukemia (ALL)

    The most common type of leukemia in children, except for specific age groups.

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    Medulloblastoma

    A common brain tumor in children, typically treated with chemotherapy and radiation.

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    Familial Retinoblastoma

    Genetic syndrome linked to retinoblastoma, often with Rb1 mutation.

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    Li-Fraumeni Syndrome

    Genetic condition associated with multiple cancers, including adrenocortical carcinoma.

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    Ewing Sarcoma

    A type of bone cancer in children, often showing inflammation symptoms.

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    Rhabdomyosarcoma (RMS)

    Most common soft tissue sarcoma in children, with variable prognosis based on subtype.

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    Adenocarcinoma

    A type of lung cancer, constituting 40%, linked to atypical adenomatous hyperplasia.

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    SCC (Squamous Cell Carcinoma)

    30% of lung cancers, originating from squamous metaplasia.

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    SCLC (Small Cell Lung Cancer)

    A rapidly growing lung cancer making up 15% of cases, sensitive to chemotherapy.

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    Stage I-IIIA surgery

    Surgical intervention is most effective in early lung cancer stages.

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    Radiotherapy (RT)

    Most beneficial in higher stages of lung cancer, especially T3.

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    Targeted therapy for AC

    Targets specific mutations like EGFR and ALK in adenocarcinoma.

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    Pancoast tumor

    A lung cancer at the top of the lung causing shoulder pain and Horner syndrome.

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    Malignant Pleural Mesothelioma

    Rare but increasing, primarily due to asbestos exposure.

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    Asbestos exposure

    Main risk factor for pleural mesothelioma and contributes to lung cancer.

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    Symptoms of Pleural Cancer

    Common symptoms include chest pain, dyspnea, and recurrent pleural effusion.

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    Non-Hodgkin's Lymphoma (NHL)

    The 7th most common cancer, more prevalent than Hodgkin's Lymphoma.

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    DLBCL

    Diffuse Large B-cell Lymphoma, the most common subtype of NHL.

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    Ann Arbor Staging

    Staging system for lymphoma based on nodal involvement.

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    Thoracentesis

    Procedure to analyze pleural effusion for cancer cells.

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    Prognosis of SCLC

    5-year survival rate is low (5-8%), but better in limited cases.

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    Study Notes

    Lung Cancer

    • Epidemiology: Most deadly cancer, causing one-third of cancer deaths; more than breast, prostate, and colon cancers combined. Increasing incidence in women.
    • Risk Factors & Etiology: Smoking is responsible for 90% of cases, including passive smoking (15% increased risk). One pack per day increases the risk by 25 times. Risk normalizes after 15 years of quitting. Occupational carcinogens, radon, and air pollution also contribute.
    • Subtypes: NSCLC (85%): slower, more contained growth, low-moderate chemo sensitivity, better for surgery. Adenocarcinoma (40%) arises from atypical adenomatous hyperplasia to carcinoma in situ (CIS), usually peripherally located, least associated with smoking (10%). Squamous cell carcinoma (SCC, 30%) arises via squamous metaplasia to dysplasia to CIS, usually centrally located. Large cell carcinoma (10%) usually centrally located and grows quickly, high chemo sensitivity. SCLC (15%): rapid growth, high chemo sensitivity; usually centrally located.
    • Diagnosis: Peripheral tumors diagnosed via transthoracic fine needle biopsy or fiberoscopy/transbronchial biopsy/thoracotomy. Central tumors diagnosed via fiberoscopy (bronchoscopy) +/- transbronchial biopsy, transthoracic biopsy or thoracotomy. Step 2: determine limited (one hemithorax) or extensive (beyond one hemithorax) spread. Uses CT scans of abdomen and chest, esophageal endoscopy, mediastinoscopy, bone scintigraphy, EBUS/EUS biopsy, pleural/pericardial biopsy, and PET/CT scans during therapy.
    • Treatment: NSCLC treatment depends on stage and spread. Surgery is often the go-to for localized disease. Radiation therapy (RT) is useful for localized disease in stage I-IIIB cases and is more effective for higher stages. Chemotherapy (chemo) is used in stages II-IV for more advanced cases. In inoperable stage III N+ NSCLC, radical concurrent chemo-radiotherapy with Durvalumab is recommended. Targeted therapies targeting EGFR-I, ALK-I are also used. SCLC treatment includes chemo (Cisplatin + Etoposide) + thoracic RT + prophylactic cranial irradiation.
    • Presentation: Associated with local symptoms such as persistent cough, hemoptysis, dyspnea, wheezing, and chest pain. Can also have systemic effects like weight loss, fatigue, and weakness and pain in the back or shoulder, bone pain. Paraneoplastic syndromes associated include Cushing's syndrome, hypercalcemia (SCC!), SIADH, carcinoid syndrome and more.

    Pleural Cancer (Malignant Pleural Mesothelioma)

    • Epidemiology: Rare but increasing incidence; most common primary pleural malignancy (despite metastasis being more common overall). Average age of diagnosis is 60; more common in men (70-80%).
    • Risk Factors & Etiology: Asbestos exposure is the primary cause. Increased risk in families with asbestos exposure.
    • Diagnosis: History of asbestos exposure. X-ray, CT scans to examine for pleural thickening and/or fluid. PET scans for metastasis. Thoracentesis to examine the pleural fluid for cancer cells if effusion is present. Biopsy for definite diagnosis.
    • Presentation: Common symptoms incl. chest pain (70%), shortness of breath (60%), fever/sweating/fatigue (33% each), loss of appetite (24%) and recurring pleural effusion.
    • Treatment: Early disease may involve surgery and/or radiation therapy. Disseminated disease usually receives palliative chemotherapy. Symptomatic treatment is often necessary.
    • Progression & Prognosis: Long latency period (20-40 years) between exposure and diagnosis. Usually diagnosed to late for effective treatment. Low curability.

    Hematologic Cancer - Non-Hodgkin's Lymphoma

    • Epidemiology: 7th most common cancer; more common than Hodgkin's lymphoma. Primarily affects older adults.
    • Risk Factors/Etiology: Depends on subtype.
    • Subtypes: DLBCL (aggressive), follicular lymphoma (indolent), Burkitt lymphoma, Mantle cell lymphoma, Cutaneous T-cell lymphoma, and others.
    • Diagnosis: Excisional biopsy of lymph nodes. Imaging (CT, X-ray, PET). Bone marrow biopsy. Cerebrospinal fluid (CSF) examination. Further imaging for staging.
    • Treatment: Aggressive lymphomas often respond to aggressive chemotherapy. Advanced low-to-intermediate grade lymphomas may be incurable, but chemo, radiation, or immunotherapy can prolong lifespan.
    • Progression & Prognosis: Depends on subtype; aggressive lymphomas have better prognoses than indolent ones; often incurable, but treatment can extend life.

    Hematologic Cancer - Hodgkin's Lymphoma

    • Epidemiology: Less common than Non-Hodgkin's lymphoma. Bimodal distribution; young adults and older adults.
    • Risk Factors/Etiology: Depends on subtype.
    • Subtypes: Classic subtypes: nodular sclerosis, mixed cellularity, lymphocyte-predominant; Non-classic subtypes.
    • Diagnosis: Excisional biopsy (whole node). Staged using the Ann Arbor system.
    • Treatment: Early stages: Radiation therapy or chemotherapy. Advanced stages: High-dose chemotherapy + autologous stem cell transplant.
    • Progression & Prognosis: Better prognosis than Non-Hodgkin's lymphomas. Spread: mediastinal ➔ cervical → para-aortic nodes.

    Cancer in Children

    • Epidemiology: Second leading cause of death (after accidents), bimodal peak in children (<5 and >15 years); ALL most common, except in very young.
    • Diagnosis: History, physical exam, lab tests (biochemical, hormonal, immunological, genetic testing). Imaging.
    • CNS Tumors (Children): Mostly low-grade glial tumors, supratentorial (40%) and infratentorial (50%) tumors.
    • Soft Tissue Sarcomas: Rhabdomyosarcoma most common (70%), various locations and aggressiveness. Orbital type has the worst prognosis.
    • Other Sarcomas: Neurogenic sarcomas (10%), Ewing sarcoma (extraosseous & PNET) (5%), and fibrosarcoma (5%).
    • Lymphoma: High-grade lymphomas are more chemosensitive, compared to others.
    • Leukemia: Most common leukemia is Acute Lymphoblastic Leukemia (ALL) (80%).
    • Treatment: Tailored to tumor type, stage, and individual needs
    • Importance of Early Diagnosis: Early diagnosis significantly improves outcomes.

    Genetic Syndromes Associated with Childhood Cancers

    • Familial retinoblastoma: Rb1 gene mutation.
    • Li-Fraumeni syndrome: TP53 gene mutation.
    • HNPCC (Hereditary Non-polyposis Colorectal Cancer): MSH2/MLH1/PMS2 mutations.
    • FAP (Familial Adenomatous Polyposis): APC gene mutation.
    • Gorlin Syndrome: PTCH gene mutation.
    • Neurofibromatosis 1 & 2: NF1 & NF2 gene mutations.
    • Ataxia-telangiectasia: ATM gene mutation.
    • Wiskott Aldrich Syndrome: WAS gene mutation.
    • Bloom Syndrome: BLM gene mutation.
    • Fanconi anemia: FANCA gene mutation.
    • Familial Wilms Tumor: WT1/2 gene mutations.
    • Denys-Drash Syndrome: WT1 gene mutation.
    • Beckwith-Wiedemann Syndrome: Multiple genes.
    • Tuberous Sclerosis: TSC1/2 gene mutation.

    Bone Sarcomas

    • Osteosarcoma: Most common type, close to knee. 70% prevalence.
    • Ewing Sarcoma: ~40%, inflammatory symptoms common during disease onset, chemotherapy, surgery, and radiation treatment.
    • Treatment: Chemotherapy, surgery, radiation.

    Wilms Tumor

    • AA: 3-4 years old (mostly <7).
    • Treatment: Chemotherapy, surgery.

    Neuroblastoma

    • AA: 1-2 years old (mostly <5).
    • Location: Retroperitoneal (most common) mediastinum, pelvis.
    • Diagnosis Elevated catecholamine levels in urine, and/or presence of metastasis at diagnosis.
    • Treatment: Surgery, chemotherapy, radiation.

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