Hodgkin Lymphoma

Question 1

If female pt is diagnosed with hodgkin lymphoma what should you do?

Answer 1

referral to reproductive endocrinologist to discuss fertility preservation options

Question 2

Is Hodgkin lymphoma curable?

Answer 2

up to 75% but there can be recurrence or relapse after initial treatment.

Pts will undergo gonadotoxic chemo and radiation therapy may be unavoidable.

Question 3

Why do we refer to reproductive endocrinologist right away?

Answer 3

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.

Question 4

antracycline therapy can cause

Answer 4

cardiomyopathy and so need baseline TTE.

Question 5

treatment of refractory Hodgkin lymphoma

Answer 5

allogeneic stem cell transplnat.

Question 6

long term survivors of hodgkin lymphoma have to be monitored for:

Answer 6

psychosocial issues (congitive function, motivation, chronic fatigue)

Question 7

what causes hodgkin lymphoma?

Answer 7

from post germinal B cells. Affects patients in their 30 ‘s and 60’s
Two subtypes

Question 8

Hodgkin’s lymphoma has what tumor markers

Answer 8

CD 15 and CD 30 positive lymphocytes Reed Sternberg Cells.

Question 9

people who received chest radiation for treatment of Hodgkin’s lymphoma should get

Answer 9

annual screening mammograms starting 8-10 years after radiation therapy. or at age 40yrs whichever happens first.

also need annual TSH level

Question 10

what are the long term complications of non Hodgkin lymphoma survivors after they get radiation treatment?

Answer 10

second malignancies,
cardiovascular dx,
endocrine problems
and neuropsychiatric

Question 11

why do we care about long term complications of non Hodgkin Lymphoma pts?

Answer 11

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

Question 12

What increases risk for secondary breast cancer after treatment for Hodgkin Lymphoma?

Answer 12

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.

Question 13

what is not recommended for surveillance for secondary cancer at this point if someone got treated with chest radiation for Hodgkin lymphoma

Answer 13

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.

Question 14

Hodgkin lymphoma is seen in

Answer 14

pts in 30 and 60’s

Question 15

subtypes of Hodgkin lymphoma (there are two) classical and nodular lymphocyte

Answer 15

1. 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

2. nodular lymphocyte predominant

Question 16

Treatment of hodgkin lymphoma is

Answer 16

radiation and chemo with ABVD (adriamycin (doxorubicin)), bleomycein, vinblastine and dacarbazine)

Question 17

Diagnosis of Hodgkin lymphoma requires

Answer 17

initially may get a fine needle aspiration of a LAD
but needs excisional biopsy

Will eventually need bone marrow biopsy to make diagnosis.

Question 18

classic symptom in history for Hodgkin’s lymphoma?

Answer 18

pain after drinking ETOH

highly specific for Hodgkin lymphoma.

Question 19

lab testing for recurrence and for diagnosis?

Answer 19

ESR

LDH

Question 20

what would we see on imaging with Hodgkin lymphoma?

Answer 20

may see mediastinal mass.

Question 21

side effects of Hodgkin’s Treatments

Answer 21

cardiomyopathy
AML
myelodysplastic syndrome
invasive aspergillous
infertility
amenorrhea

Question 22

radiation therapy side effects of Hodgkin’s dx

Answer 22

• 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

Question 23

after radiation therapy for Hodgkin’s lymphoma need to get annual

Answer 23

TSH.