Hodgkin's Lymphoma

Question 1

When does incidence peak in Hodgkin’s lymphoma?

Answer 1

3rd & 6th decades

Question 2

A history of what disease is associated with Hodgkin’s?

Answer 2

Glandular fever

Question 3

How does Hodgkin’s present?

Answer 3

Asymmetrical painless lymphadenopathy
- single rubbery node in cervical, axillary, or inguinal region which may become painful after alcohol ingestion

‘B’ symptoms (present in 20% patients, worse prognosis)

• weight loss
• sweating
• fever
• pruritis
• general lethargy

Question 4

What are 2 rarer symptoms of Hodgkin’s?

Answer 4

Dyspnoea + superior vena cava obstruction (chest pain + other rare collection of symptoms)
- caused by spread of Lymphoma to mediastinal nodes

Question 5

How is Hodgkin’s diagnosed?

Answer 5

Lymph node biopsy

- shows large malignant B-cells (pathognomonic Reed-Sternberg cells)

Question 6

How is spread and staging assessed/categorised?

Answer 6

CT scan for spread
Ann Arbor (city in NA) system for staging
- I - one node region involved
- II - 2+ ipsilateral regions involved
- III - Bilateral node involvement
- IV - extranodal disease
A/B is added depending on absence/presence of ‘B’ symptoms
e.g. IIA = 2+ node regions involved on one side of the body with no “B” symptoms present

Question 7

Treatment for Hodgkin’s?

Answer 7

Early stages = radiotherapy only

Advanced/bulky stages = radiotherapy + chemotherapy

Question 8

Prognosis of Hodgkin’s?

Answer 8

70% chance of cure, even in late stage

- worsens with increasing age