Hodgkin's lymphoma

Question 1

what is a lymphoma?

Answer 1

haematological malignancy arising from lymphoid tissue

Question 2

what characterises Hodgkin’s lymphoma?

Answer 2

Reed sternberg cells

Question 3

what are the types?

Answer 3

classical

nodular lymphocyte-predominant

Question 4

types of classical Hodgkin lymphoma

Answer 4

nodular sclerosis
mixed cellularity
lymphocyte rich
lymphocyte depleted

Question 5

risk factors

Answer 5

EBV
smoking
HIV immunosuppression

Question 6

who is it most common in?

Answer 6

men

Question 7

characteristics of Reed sternberg cells

Answer 7

large
multinucleated
malignant cells
owl like appearance

Question 8

what are hodgkin cells?

Answer 8

mononuclear variant of reed sternberg cells

Question 9

what is nodular lymphocyte-predominant characterised by?

Answer 9

lymphohistiocytic reed-sternberg variant

Question 10

which is the most common type of classical?

Answer 10

nodular sclerosis

Question 11

which classical type has best prognosis?

Answer 11

lymphocyte rich

Question 12

which classical type has worst prognosis?

Answer 12

lymphocyte depleted

Question 13

who is nodular lymphocyte-predominant Hodgkin lymphoma most common in?

Answer 13

rare
males most at risk
more common in black ethnicity

Question 14

clinical features

Answer 14

gradual lymphadenopathy 
malaise
fatigue 
B symptoms
mediastinal mass 
pruritus 
hepatosplenomegaly

Question 15

gradual lymphadenopathy

Answer 15

painless
firm
enlarged lymph nodes - most commonly of the neck

Question 16

B symptoms

Answer 16

fever
night sweats
weight loss

Question 17

mediastinal mass

Answer 17

may present with SOB, cough, pain or superior vena cava obstruction

Question 18

diagnosis

Answer 18

excision biopsy of affected lymph nodes - preferred to fine needle aspiration or core biopsy 
immunophenotyping 
PET/CT for staging 
Bloods
Imaging 
additional tests

Question 19

bloods

Answer 19

FBC
U&Es
LFTs
bone profile
LDH
uric acid
ESR
HIV
Hep B 
Hep C
HTLV-1

Question 20

Imaging

Answer 20

chest x-ray
PET CT
CT neck, chest, abdomen and pelvis
MRI of brain and liver

Question 21

additional tests

Answer 21

lumbar puncture 
CSF analysis 
echo 
pulmonary function tests 
bone marrow biopsy

Question 22

what is an echo needed for?

Answer 22

assess cardiac function if considering doxorubicin chemotherapy

Question 23

what are pulmonary function tests used for?

Answer 23

if considering bleomycin chemotherapy

Question 24

what is the staging?

Answer 24

Lugano staging

Question 25

Lugano staging

Answer 25

describes anatomical distribution of disease important for prognostic and therapeutic importance modified by presence/absence of B symptoms, extranodal involvement and bulky disease

Question 26

what is bulky disease?

Answer 26

disease >10cm

Question 27

what are the stage categories?

Answer 27

limited stage II bulky advanced

Question 28

what are the stages of limited disease?

Answer 28

stage I and II

Question 29

what is stage II bulky disease?

Answer 29

stage II with bulky disease

Question 30

what are the stages of advanced disease?

Answer 30

stage III and IV

Question 31

stage I

Answer 31

1 node or group of adjacent nodes | single extranodal lesion without nodal involvement

Question 32

stage II

Answer 32

2 or more nodal groups on same side of diaphragm - limited contiguous extra-nodal involvement

Question 33

stage III

Answer 33

nodes on both side of diaphragm are affected | or nodes above the diaphragm with spleen involvement

Question 34

stage IV

Answer 34

additional non-continguous extra-lymphatic involvement

Question 35

what determines management?

Answer 35

``` Lugano staging ESR age number of regions involved presence of bulky mediastinal disease ```

Question 36

management options

Answer 36

chemotherapy - ABVD | radiotherapy

Question 37

treatment for early stage disease

Answer 37

AVBD 3-4 cycles + or - radiotherapy after

Question 38

treatment for advanced stage disease

Answer 38

ABVD or BEACOPP or stanford V | radiotherapy as adjunct

Question 39

BEACOPP

Answer 39

``` bleomycin etoposide doxorubicin cyclophosphamide vincristine procarbazine prednisolone ```

Question 40

Standford V

Answer 40

``` doxorubicin vinblastine mechlorethamine vincristine bleomycin etoposide prednisolone ```

Question 41

can relapses be treated?

Answer 41

depends on prognostic indicators, timing and number of relapses

Question 42

what is treatment for relapse?

Answer 42

salvage chemotherapy radiotherapy autologous haematopoietic cell transplant

Question 43

blood transfusions

Answer 43

must be irradiated blood to reduce risk of transfusion-associated graft versus host disease for all adults and children with Hodgkin's lymphoma

Question 44

prognosis

Answer 44

reasonably good

Question 45

cure rate

Answer 45

>75% but depends on stage

Question 46

limited disease 5-year survival rate

Answer 46

90%

Question 47

advanced disease 5-year survival rate

Answer 47

75-90%