Hodgkin Lymphoma

Question 1

what is the definition of hodgkin lymphoma?

Answer 1

B cell lymphoma, presence of Reed-Sternberg cells.

Question 2

what is the epidemiology of hodgkin lymphoma?

Answer 2

Male predominance 
Majority teenagers (13-19yrs), and elderly (over 65)

Question 3

what is the aetiology of hodgkin lymphoma?

Answer 3

Epstein-barr virus? - ‘hide’ in white blood cells and can result in malignancy

Question 4

what are the risk factors for hodgkin lymphoma?

Answer 4

history of Epstein-Barr virus (EBV) infection
family history of Hodgkin’s lymphoma
young adults from higher socio-economic class
HLA types
Lupus
Obese
Post transplant

Question 5

what is the pathophysiology of hodgkin lymphoma?

Answer 5

Classical Hodgkin’s lymphoma (cHL):
- The hallmark of which is the REED-STERNBERG CELL with mirror-image nuclei
- Accounts for 90-95% of cases
Nodular lymphocyte predominant Hodgkin’s Lymphoma (NLPHL):
- Characterised by the Reed-Sternberg VARIANT, the ‘POPCORN CELL’
Hodgkin lymphoma (HL) is an unusual malignancy in that the tumour cells, the Hodgkin and Reed-Sternberg (HRS) cells, are a minor component of the tumour mass, the bulk of which is a mixed cellular infiltrate. There is compelling evidence that HRS cells are clonal B cells that have lost their B cell phenotype

Question 6

what are the key presentations for hodgkin lymphoma?

Answer 6

presence of risk factors
Lymphadenopathy - painless, cervical, rubbery
Young women - cough?

Question 7

what are the signs of hodgkin lymphoma?

Answer 7

Infection

Superior vena cava obstruction, JVP increased

Question 8

what are the symptoms of hodgkin lymphoma?

Answer 8

Generalised B symptoms:
unexplained fevers
night sweats
weight loss
dyspnoea

Question 9

what are the first line investigations for hodgkin lymphomas?

Answer 9

FBC with differential - high ESR, low Hb = worse prognosis

metabolic panel

Question 10

what are the gold standard investigations for hodgkin lymphoma?

Answer 10

bone marrow biopsy (needed to confirm diagnosis) - to see RS cells or popcorn cells
thyroid function tests
echocardiogram or multi-gated acquisition (MUGA) scan
pulmonary function tests
CXR - ann arbor staging:
- I - Confined to single lymph node region
- II - Involvement of two or more nodes areas on the same side of the diaphragm
- III - Involvement of nodes on both sides of the diaphragm
- IV - Spread beyond the lymph nodes e.g. liver or bone marrow
- Each stage is either A or B
• A: no systemic symptoms other than pruritus (severe itching of skin)
• B: presence of B symptoms such as fever, weight loss and night sweats

Question 11

what are the differential diagnoses for hodgkins lymphoma?

Answer 11

Non-Hodgkin’s lymphoma (NHL)
Lymphadenopathy from other malignancies
Infectious mononucleosis

Question 12

how is hodgkin lymphoma managed?

Answer 12

Preferred treatment for stage I or stage II Hodgkin lymphoma (HL) is chemotherapy plus radiotherapy.
Stages I-A to II-A (with less than 3 areas involved):
• Short course of ABVD followed by radiotherapy
Stages II-A to IV-B (with more than 3 areas involved):
• Longer course of ABVD
Combination chemotherapy - ABVD:
• A - ADRIAMYCIN
• B - BLEOMYCIN
• V - VINBLASTINE
• D - DACARBAZINE

Question 13

how is hodgkin lymphoma monitored?

Answer 13

Monitor for evidence of second malignancies

Question 14

what are the complications of hodgkins lymphoma?

Answer 14

Complications of treatment include secondary malignancies, heart disease, and decreased pulmonary function, hypothyroidism, infertility, alopecia, infection

Question 15

what is the prognosis of hodgkin lymphoma?

Answer 15

5-year relative survival rates for Hodgkin lymphoma ; Localised. 91% ; Regional. 94% ; Distant. 81% ; All SEER stages combined. 87%