Staging & Risk Stratification

Question 1

What are the nodal regions that are considered supradiaphragmatic regions?

Answer 1

Waldeyer ring
Cervical, supraclavicular, occipital, preauricular, infraclavicular nodes
Axillary, pectoral, mediastinal nodes
Hilar
Epitrochoidal, brachial nodes

Question 2

What are the nodal regions that are considered infradiaphragmatic regions?

Answer 2

Spleen, mesenteric, para-aortic, L/R iliac, L/R inguinal/femoral, L/R popliteal

Question 3

What staging systems do we use for Hodgkin lymphoma?

Answer 3

Ann Arbor Staging (Lugano Modification)

Question 4

Stage 1

Answer 4

single lymph node region or group of adjacent nodes

Question 5

Stage 2

Answer 5

> = 2 node regions on same side of the diagpharm

Question 6

Stage 3

Answer 6

Nodes on both sides of the diaphragm or nodes above diaphragm with splenic involvement

Question 7

Stage 4

Answer 7

Noncontiguous extranodal involvement

Question 8

What are the 3 B symptoms?

Answer 8

Unexplained weight loss > 10% over 6 months
Drenching night sweat
Fever ( > 38 C)

Question 9

Stage IE

Answer 9

Stage I with one extra-nodal site

Question 10

Stage IIE

Answer 10

> = 2 extra-nodal sites on same side of diaphragm

Question 11

Stage III SE (1)

Answer 11

Stage III with splenic involvement

Question 12

What are the unfavorable risk factors for Hodgkin lymphoma per NCCN?

Answer 12

ESR > 50, or any B symptoms
Mediastinal mass ratio > 0.33
Lymph nodal areas > 4
Bulky > 10 cm