JCO Classification Highlights

Question 1

Staging

Answer 1

Defines disease location and extent
Suggests prognostic information
Allows comparison among studies
Provides a baseline against which response or disease progression can be compared

Question 2

Diagnosis

Answer 2

Depends on:
morphology
immunohistochemistry
flow cytometry
molecular studies to categorize

Question 3

Biopsy

Answer 3

Fine-needle aspirate is inadequate
incisional or excisional biopsy is preferred
Core-needle biopsy can be considered when excisional biopsy is not possible

Question 4

Patient evaluation

Answer 4

age
sex
absence/presence of fevers >101F, chills, drenching night sweats, or unexplained weight loss more than 10% of body mass over 6 months
history of malignancy
Fatigue, pruritus, and alcohol-induced pain in HL should also be notes

Question 5

Physical Examination

Answer 5

measurement of accessible nodal groups
size of the spleen and liver in cm below their costal margins in the midclavicular line
organomegaly formally defined by CT imaging

Question 6

Anatomic Staging

Answer 6

PET-CT scanning (fluorodeoxyglucose FDG PET)
improves staging ensuring that fewer patients are over or undertreated
important for staging before consideration of RT

Question 7

PET-CT

Answer 7

Critical as a baseline measurement before therapy to increase the accuracy of subsequent response assessment

Question 8

Tumor Bulk

Answer 8

A single nodal mass of 10cm or greater than a third of the transthoracic diameter at any level of thoracic vertabrae as determined by CT is the definition of bulky disease for HL

Question 9

Spleen Involvement

Answer 9

may be of normal size and still contain lymphoma
may be enlarged as a result of variations in blood volume, use of growth factors, or lymphoma-unrelated causes
splenomegaly cutoff >13cm

Question 10

Liver involvement

Answer 10

liver size is not a reliable measure of hepatic involvement by lymphoma

diffusely increased or focal uptake, with or without focal or disseminated nodules, supports liver involvement

Question 11

Bone Marrow Involvement

Answer 11

If a PET-CT is performed, a BMB is no longer required for the routine evaluation of patients with HL

Question 12

Stage I Limited

Answer 12

1 node or a group of adjacent nodes

single extranodal lesions without nodal involvement

Question 13

Stage II Limited

Answer 13

2 or more nodal groups on the same side of the diaphragm

stage I or II by nodal extent with limited contiguous extranodal involvement

Question 14

Stage II bulky

Answer 14

as above with “bulky” disease

Question 15

Stage III Advanced

Answer 15

Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement

Question 16

Stage IV Advanced

Answer 16

Additional noncontiguous extralymphatic involvement

Question 17

Ann Arbor classification

Answer 17

subdivides patients according to the absence or presence of disease-related symptoms (A or B; only in HL patients)

Question 18

Assessment of response

Answer 18

5-point scale:
score of 1-2 represents complete metabolic response
score of 3 inadequate response (to avoid undertreatment)
score of 4-5 suggests chemotherapy-sensitive disease, represents partial metabolic response; at end of tx, 4-5 represents tx failure