Hodgkin’s Lymphoma Flashcards
What type of cells are primarily involved in Hodgkin’s Lymphomas?
B lymphocytes are most often involved.
What are the two types of lymphocytes involved in Hodgkin’s Lymphomas?
T Cells and B lymphocytes.
Where do lymphocytes develop and mature?
Lymphocytes develop in the bone marrow and mature in the lymphatic organs.
How is Hodgkin’s Lymphomas distinct from other lymphoma types?
HL is distinct due to the presence of Reed-Sternberg cells.
What are Reed-Sternberg cells?
Reed-Sternberg cells are large lymphoid cells that contain multiple nuclei.
How does Hodgkin’s Lymphomas spread?
HL spreads in a systematic manner from one lymph node group to the next in a predictable pattern.
What is the prevalence of HL in males?
More prevalent in males, regardless of race.
What is the age range with the greatest occurrence of HL?
Greatest in the age range from 20-34 years.
What viruses may increase the risk of developing HL?
Infection with Epstein-Barr virus (EBV), infectious mononucleosis, or HIV may increase the risk of developing HL.
Components of EBV have been found in the DNA of the Reed-Sternberg cells of some patients with HL.
How does a weakened immune system affect the risk of HL?
Having a weakened immune system may increase the risk of developing HL.
What age groups are most commonly affected by HL?
HL is most common among teens and adults aged 15 to 24 and adults aged 55 and older.
How does family history influence the risk of HL?
Family members, especially siblings, of a person with HL may have an increased risk of developing the disease.
What is the most common symptom of HL?
Painless swollen lymph nodes are the most common symptom of HL.
Where are swollen lymph nodes most often discovered in HL?
Swollen lymph nodes are most often discovered in lymph node areas above the diaphragm.
What are the B symptoms associated with HL?
B symptoms include weight loss, fevers, night sweats, and itchy skin.
What constitutes weight loss as a symptom of HL?
Weight loss is defined as 10% of body weight in 6 months prior to diagnosis.
What fever temperature is considered a symptom of HL?
Fever higher than 100.4 Fahrenheit is considered a symptom of HL.
What are other symptoms of HL?
Other symptoms include pain with alcohol ingestion, coughing, chest pain, fatigue, and splenomegaly with advanced disease.
What are signs of advanced HL?
Advanced disease may present with a tender abdomen, achy bones, and pleural effusion.
What does a physician check for during the history and physical exam in HL?
A physician checks for swollen lymph nodes in the neck, underarms, and groin, and checks for a swollen spleen or liver.
What lab tests are conducted to check for HL?
The lab does a CBC to check the number of white blood cells, including platelet count, liver, and renal function tests.
What lab results may indicate bone marrow involvement in HL?
Anemia, leukopenia, thrombocytosis, and lymphopenia can indicate bone marrow involvement.
When are bone marrow biopsies reserved for HL patients?
Bone marrow biopsies are reserved for those with later-stage disease and subdiaphragmatic disease.
When should a liver biopsy be performed in HL?
A liver biopsy should be done if splenic involvement is found.
What are the two subcategories of Hodgkin Lymphoma (HL)?
Classic Hodgkin Lymphoma (CHL) and Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL).
What percentage of Hodgkin Lymphoma cases are Classic Hodgkin Lymphoma (CHL)?
95%.
What is the most common subtype of Classic Hodgkin Lymphoma?
Nodular Sclerosing HL.
Where does Nodular Sclerosing HL typically involve?
Nodes in the chest and neck.
At what age is Nodular Sclerosing HL typically diagnosed?
Usually diagnosed at an early stage, most common among people in their 20s and 30s.
What is the average age of diagnosis for Mixed Cellularity HL?
38 years old.
In which population is Mixed Cellularity HL more commonly seen?
Those affected by HIV.
What percentage of cases does Lymphocytic Rich HL account for?
Found only in 5% of cases.
Where is Lymphocytic Rich HL usually found?
Usually in the upper body.
In which demographic is Lymphocytic Rich HL more common?
More common in men.
What is the prognosis of Lymphocytic Depleted HL?
Carries the worst prognosis, usually presents with more advanced disease.
What age group is usually affected by Lymphocytic Depleted HL?
Usually affects people in their 30s with HIV.
What percentage of Hodgkin Lymphoma cases are Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)?
5%.
What is the most common site of metastasis?
The most common site of metastasis is to adjacent lymph nodes.
What is the most common visceral involvement in metastasis?
The most common visceral involvement is the spleen, liver, and bone marrow.
Where else can metastasis occur in late stages?
Metastasis can also occur in the lungs and skeletal system in late stages.
Which staging system is used for patients with Hodgkin Lymphoma (HL)?
Ann Arbor Staging System
How are patients designated in addition to their stage?
Patients are designated as having favorable or unfavorable HL based on the presence or absence of adverse risk factors.
What defines early favorable HL?
Early favorable HL is designated when patients have clinical stage I or II disease without B symptoms, less than 3 sites of nodal involvement, and no markedly abnormal lab results.
What constitutes early unfavorable HL?
Early unfavorable HL is designated when patients have one or more adverse risk factors.
Can advanced HL be considered favorable?
Yes, advanced HL (stage III or IV) can still be considered favorable if there are 3 or fewer risk factors.
What defines advanced unfavorable HL?
Advanced unfavorable HL is defined as stage III or IV with 4 or more risk factors.
Is HL treatable?
HL is one of the most treatable types of cancer.
What is the primary treatment modality for HL?
The primary treatment modality is chemotherapy.
What does the chemotherapy regimen for HL consist of?
4 cycles of ABVD (Adriamycin, bleomycin, Vincristine, and Dacarbazine).
What is the purpose of adjuvant radiation in HL treatment?
To treat subclinical or residual disease.
What is the treatment for patients diagnosed with stage III or IV with bulky disease or B symptoms?
They are treated with a chemotherapy regimen and adjuvant radiation therapy.
What is salvage therapy?
Chemotherapy may also be used after the disease has reoccurred in an area already treated with radiation therapy, which is termed salvage therapy.
What is the primary area for radiation therapy treatment?
Radiation therapy treatment is most often delivered to the neck, chest, axilla, or paraaortic lymph nodes and spleen. Some patients also receive treatment to the pelvic lymph nodes.
What is Total Nodal Irradiation (TNI)?
Total nodal irradiation includes radiation to the upper nodes and lower nodes.
How are upper nodes irradiated?
Upper nodes are irradiated via a mantle field AP/PA.
What treatment fields are used for the neck, chest, and axilla?
Treatment fields to the neck, chest, and axilla are indicated by nodes in a blue wire frame.
What areas are blocked in the TLI case?
In the TLI case, the lungs, occipital, and head of humerus are blocked.
How are lower nodes irradiated?
Lower nodes are irradiated via an inverted ‘Y’ field AP/PA.
What is the initial tumor dose for radiation therapy of the AP/PA field?
Initial tumor dose is 20-30 Gy to the mantle field at 1.8 to 2.0 Gy/fraction.
What is the boost dose for radiation therapy?
Boost dose is a total of 35-44 Gy at 1.8 to 2.0 Gy/fraction.
What recent findings have been shown regarding chemotherapy and radiation doses?
Recent studies have shown that patients receiving chemotherapy and radiation may be treated to a lesser dose up to 20 Gy with the same results and less toxicity.
How does the treatment procedure for pediatric cases differ from adults?
The treatment procedure for pediatric cases is similar to that for adults, but more emphasis is placed on minimizing lower doses for chemotherapy and radiation therapy to prevent toxicities and interruption in the growth process.
What factors may decrease a patient’s survival in HL?
Factors include stage at diagnosis, B symptoms, age, gender, and lab results.
B symptoms refer to weight loss, night sweats, and fever.
How does age affect treatment results in HL?
Younger patients (teens to adults in their 20s) tend to have better treatment results than older adults aged 45 or older.
What is the overall survival rate of HL?
The overall survival rate of HL is 86.6% according to the National Cancer Institute’s SEER Program.
How does HL respond to treatment?
HL is one of the most curable types of cancer and responds well to chemotherapy and radiation therapy at lower doses than other tumors.
Which gender has a poorer prognosis in HL?
Males tend to have a poorer prognosis in HL.
What are B symptoms in HL?
B symptoms include weight loss, night sweats, and fever, and are known to have a poorer prognosis.
