Hodgkin Lymphoma Flashcards
If female pt is diagnosed with hodgkin lymphoma what should you do?
referral to reproductive endocrinologist to discuss fertility preservation options
Is Hodgkin lymphoma curable?
up to 75% but there can be recurrence or relapse after initial treatment.
Pts will undergo gonadotoxic chemo and radiation therapy may be unavoidable.
Why do we refer to reproductive endocrinologist right away?
takes time to arrange for fertility preserving procedures that can potentially delay cancer tx and so some people w/ advanced dx may not get fertility preservation.
antracycline therapy can cause
cardiomyopathy and so need baseline TTE.
treatment of refractory Hodgkin lymphoma
allogeneic stem cell transplnat.
long term survivors of hodgkin lymphoma have to be monitored for:
psychosocial issues (congitive function, motivation, chronic fatigue)
what causes hodgkin lymphoma?
from post germinal B cells. Affects patients in their 30 ‘s and 60’s
Two subtypes
Hodgkin’s lymphoma has what tumor markers
CD 15 and CD 30 positive lymphocytes Reed Sternberg Cells.
people who received chest radiation for treatment of Hodgkin’s lymphoma should get
annual screening mammograms starting 8-10 years after radiation therapy. or at age 40yrs whichever happens first.
also need annual TSH level
what are the long term complications of non Hodgkin lymphoma survivors after they get radiation treatment?
second malignancies,
cardiovascular dx,
endocrine problems
and neuropsychiatric
why do we care about long term complications of non Hodgkin Lymphoma pts?
because dx recurrence drops after 5 years of treatment and so Heme/Onc stops following after remission and so care will be done by PCP
What increases risk for secondary breast cancer after treatment for Hodgkin Lymphoma?
age of pt - younger the pt, the higher the risk
mean length of time between exposure to radiation therapy and breast cancer –about 15 years.
what is not recommended for surveillance for secondary cancer at this point if someone got treated with chest radiation for Hodgkin lymphoma
no need for PFTs
no need for annual CXR or screening colonoscopy.
Only time for these things are if there’s clinical or laboratory evidence of relapse.
Hodgkin lymphoma is seen in
pts in 30 and 60’s
subtypes of Hodgkin lymphoma (there are two) classical and nodular lymphocyte
- classic hodgkin lymphoma - has several subtypes - nodular sclerosis, lymphocyte rich, mixed cellularity, and lymphocyte depleted
all will have owl eye appearance and stain for CD15 and CD30 and has better prognosis
- nodular lymphocyte predominant
Treatment of hodgkin lymphoma is
radiation and chemo with ABVD (adriamycin (doxorubicin)), bleomycein, vinblastine and dacarbazine)
Diagnosis of Hodgkin lymphoma requires
initially may get a fine needle aspiration of a LAD
but needs excisional biopsy
Will eventually need bone marrow biopsy to make diagnosis.
classic symptom in history for Hodgkin’s lymphoma?
pain after drinking ETOH
highly specific for Hodgkin lymphoma.
lab testing for recurrence and for diagnosis?
ESR
LDH
what would we see on imaging with Hodgkin lymphoma?
may see mediastinal mass.
side effects of Hodgkin’s Treatments
cardiomyopathy AML myelodysplastic syndrome invasive aspergillous infertility amenorrhea
radiation therapy side effects of Hodgkin’s dx
- constrictive pericarditis
- accelerated CAD, irrespective of age (so can see at age 30)
- solid tumors (breast cancer, lung cancer, thyroid cancer)
- radiation pneumonitis
- thyroid dx
after radiation therapy for Hodgkin’s lymphoma need to get annual
TSH.
