Hodgkins Lymphoma

Question 1

What is Hodgkins lymphoma?

Answer 1

Lymphoproliferative malignancy of suspected B cell origin
First cancer cured by chemotherapy
Affects young people
Age of diagnosis is bimodal
Causes are unknown but has strong association to EBV

Question 2

What are the types of Hodgkinslymphoma?

Answer 2

Nodular sclerosis- most common, only one that affects more women than men
Mixed cellularity (20-25%)
Lymphocyte rich (5%)
Lymphocyte depleted(<1%)

Question 3

What are the most common lymph nodes involved?

Answer 3

Left cervical or supraclavicular-70%
Right cervical or supraclaviculat-62%
Mediastinum-60%

Question 4

What is involved in the staging studies?

Answer 4

History and physical
Imaging: CT of chest, abdomen and pelvis, PET scan- required for staging
Lymph node biopsy for diagnosis
Lab data for baseline

Question 5

What are the characteristics of the Ann Arbor staging system?

Answer 5

Staging based on lymph node involvement and presence or absence of symptoms.
Ranges from 1-4
1- single node or region
2- 2 or more nodal regions on one side of the diaphragm
3- nodal involvement on both sides of the diaphragm
4- diffuse involvement of an extranodal organ
A- no symptoms
B- fever, soaking night sweats, weight loss>10%
E- localized involvement of an extranodal site not including liver or bone marrow

Question 6

When is radiation used as a treatment option?

Answer 6

Used in early stages
Used in asymptomatic patients
Very radio sensitive

Question 7

What are the types of radiation used?

Answer 7

Mantle- upper body
Para aortic
Inverted Y- abdomen and pelvis
Total nodal- sum of previous 3

Question 8

What are the chemotherapy combinations used?

Answer 8

MOPP- nitrogen mustard, vincristine,procarbazine, prednisone
ABVD- adriamycin (doxyrubicin),bleomycin, vinblastine,dacarbazine

Question 9

What are the late effects related to radiation?

Answer 9

Hypothyroidism
Radiation pneumonitis
Second malignancies ( breast, lung, stomach cancer)

Question 10

What are the late effects related to chemotherapy ?

Answer 10

Sterility
Premature CHF- adriamycin
Pulmonary fibrosis - bleomycin
Second malignancies (AML, NHL)