Hodgkins lymphoma Flashcards
Who does it affect most?
Young adults
What is though to cause about half of cases?
EBV
What are RFs?
FHx
HIV/AIDS
What are the clinical feature?
- painless LN enlargement - rubbery consistency
- Hepatosplenomegaly
- Systemic: fever, night sweats, WL
- Constitutional sx: pruritus, fatigue, anorexia, alcohol induced pain at LN
What are the most common LN to be affected?
cervical
What is the most common presentation?
LN enlargement
What are the investigations?
- FBC - normal, or normochromic normocytic anaemia
- Raised ESR
- Abnormal LFTs
- Serum lactate dehydrogenase may be raised
- CXR - mediastinal widening from enlarged LNs
What confirms the diagnosis
LN biopsy + histological examination: Reed Sternberg cells seen - bi/multinucleate malignant B lymphocytes in background rich in benign small lymphocytes and histiocytes
What is used to stage/
CT/PET
What are the differentials?
localised - infection e.g. tonsillitis, TB, lymphoma
generalised - infection (EBV, CMV, toxoplasma, TB, HIV), lymphoma, leukaemia, systemic disease (SLE, sarcoid, RA) Drug reaction (phenytoin)
What does treatment depend on ?
stage
involved sites
bulk of LN involvement
presence of B sx
wHat is the treatment in early stage disease?
- brief chemo - ABVD, Doxorubicin + Bleomycin + Vinblastine + Dacarbazine
- field irradiation
What is the treatment of advanced diseasE?
Cyclical combo chemo w irradiation at sites of bulk disease
PET/CT used to detect disease activity after rx and distinguish between active tumour and necrosis or fibrosis in residual masses
When is irradiation omitted in rx?
PET -ve masses after chemo
What indicates a worse prognosis?
B sx
