Hodgkin’s Lymphoma

Question 1

Definition of Hodgkin’s lymphoma

Answer 1

Lymphomas are disorders caused by haematological malignant proliferations of lymphocytes (mature B cells). These would accumulate in the lymph nodes causing lymphadenopathy
• Lymphomas as histologically divided into Hodgkin’s and non-Hodgkin’s

• Characterised by the presence of Hodgkin’s cells and Reed-Sternberg cells (binucleate lymphocytes)

Question 2

Aetiology of Hodgkin’s lymphoma

Answer 2

• Unknown aetiology
• Likely to be multifactorial with genetic and environmental influence
• Suggest infectious cause due to fever, night sweats and lymphadenopathy symptoms
• 20-40% have detectable EBV antigens in the Reed-Sternberg cells

Question 3

Risk factors for Hodgkin’s lymphoma

Answer 3

• Affected sibling
• 20-34 year old
• EBV
• Male
• FHx
• SLE
• Post-transplantation

Is the most common malignancy in 15-24 year olds

Question 4

History and Examination of Hodgkin’s lymphoma

Answer 4

• Lymphadenopathy:
‣ Often presents with enlarged, non-tender, ‘rubbery’ superficial lymph nodes (commonly the cervical and/or supraclavicular nodal chain)
‣ Most commonly seen in the neck
‣ Can be seen in axilla and inguinal area, but uncommon

• B SYMPTOMS of lymphoma:
‣ Unexplained fevers:
◦ History of recurrent, unexplained fevers (>38)
‣ Night sweats:
‣ History of drenching night sweats needing clothes change
‣ Weight loss:
‣ Unexplained weight loss of >10% of baseline in last 6 months

• Dyspnoea and/or cough: can be caused by extensive mediastinal lymphadenopathy
• Alcohol induced pain at lymph nodes: rare but associated symptom of Hodgkin’s lymphoma
• Hepatomegaly and/or splenomegaly

Question 5

Investigations for Hodgkin’s lymphoma

Answer 5

• FBC: would show low Hb (anaemia of chronic disease) and platelets
• LFTs, U&Es: normal in most patients, but low albumin is an adverse prognostic factor
• ESR: elevated
• CXR: can show bulky mediastinal lymphadenopathy (widened)
• Excisional lymph node biopsy or core biopsy: REQUIRED to confirm diagnosis of Hodgkin’s lymphoma and essential before treatment can start. Never use fine needle aspiration. Would see Reed Sternberg cell (mirror image nuclei)
• Contrast CT and PET/CT: for staging. Staged using the Ann Arbor system

Question 6

Treatment for Hodgkin’s lymphoma

Answer 6

1) ABVD + radiotherapy + interim PET/CT:
◦ ABVD= Combination chemotherapy ( Doxorubicin [Adriamycin], Bleomycin, Vinblastine, Dacarbazine)
◦ Combined with radiotherapy gives the best results
◦ Interim PET/CT to assess metabolic response to treatment and inform on next steps

Question 7

Complications and prognosis of Hodgkin’s lymphoma

Answer 7

• Radiotherapy related thyroid abnormalities
• Radiotherapy related secondary malignancies
• Immunosuppression: due to Hodgkin’s lymphoma and then subsequent chemo and radio treatment

Depends on stage and grade. Can have a high 5 year survival if a low stage
80% of people treated with combined modality therapy (chemo and radio)