Hodgkin's Lymphoma

Question 1

What is a lymphoma?

Answer 1

Malignancy of the lymphocytes (not just in the blood)

Question 2

What is Hodgkin’s lymphoma?

Answer 2

This is where Reed-Sternberg cells are found.

Question 3

What is characteristic of a Reed-Sternberg cell?

Answer 3

Mirror image nuclei

Question 4

What are the risk factors for HL?

Answer 4

15-24yrs
Elderly
Women 2:1
An affected sibling
EBV
SLE
Post transplantation

Question 5

In which age range is HL the commonest malignancy?

Answer 5

15-24

Question 6

What are the symptoms of HL?

Answer 6

Non-tender, rubbery lymphadenopathy
60-70% cervical however some can be axillary and inguinal
25% have generalised symptoms such as fever, weight loss, night sweats, pruritus and lethargy

Question 7

What can make the lymph pain worse in HL?

Answer 7

Alcohol

Question 8

How could one get SVC obstruction/pleural effusion?

Answer 8

Mediastinal lymph nodes can enlarge in HL, pressing on SVC and causing pleural effusion

Question 9

What is pruritus?

Answer 9

Severe itching of the skin

Question 10

Aside from lymphadenopathy, what signs can you get from HL?

Answer 10

Anorexia
Cachectic
Splenomegaly
Hepatomegaly

Question 11

What tests are required with suspected HL?

Answer 11

Bloods:
FBC to check haemoglobin
Film to look at the cells
ESR for inflammation
LFTs 
LDH increased in cell turnover
Urate elevated in HL
Ca, vit D is secreted by HL

Biopsy

Question 12

What is the Ann Arbor system of staging?

Answer 12

This is the staging of HL.
I - confined to one single lymph node region
II - involves two or more nodal areas on one side of the diaphragm
III - involves nodes on both sides of the diaphragm
IV - has spread to other organs e.g. spleen, liver, bone, blood

This number is then followed by A or B depending on whether or not B symptoms are present.
An E is added on the end if there is extranodal extension.

Question 13

What are ‘B’ symptoms?

Answer 13

systemic symptoms of weight loss, night sweats, fever and lethargy

Question 14

What is extranodal extension?

Answer 14

Where the tumour has breached the node into the perinodal surroundings.

Question 15

How do we treat HL?

Answer 15

Depending on the stage. If <3 nodal areas are involved then can just give radio with short course of chemo.

If more than three areas (IIB - IVB) then give ABVD chemo treatment which will cure 80% patients.

If worse prognosis or relapse, can include stem cell transplant

Question 16

What is ABVD chemotreatment?

Answer 16

Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine

Question 17

What are the complications of treating HL?

Answer 17

Radiotherapy increases risk of other malignancies (breast, lung, melanoma, sarcoma, gastric and thyroid), IHD, hypothyroidism and lung fibrosis

Question 18

What are the survival rates of HL?

Answer 18

95% 5 year if I-A

40% if IV-B

Question 19

What things indicate a worse prognosis that aren’t staging?

Answer 19

B symptoms
Low Hb
Raised ESR
Raised LDH
Lymphocyte depleted
HIV positive

Question 20

What are ways in which HL can present as an emergency?

Answer 20

Infection
SVC obstruction
Fullness of head
Dyspnoea
Blackouts
Facial oedema