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• First described by Sir Thomas Hodgkin in 1832
• Can present at any age but most commonly seen in young adults
• Male : Female ratio 2:1
• Usually presents as painless lymphadenopathy in superficial lymph nodes involving
  • Cervical nodes (60-70%)
  • Axillary nodes (10-15%)
  • Inguinal nodes (6-12%)

Picture provided by Mr M H Raja, Armed Forces Hospital, Jubail, Saudia Arabia

• Splenomegaly occurs in 50% patients
• Cutaneous involvement occurs as a late complication in 10%
• Constitutional symptoms include fever (Pel-Ebstein), pruritus, alcohol-induced pain and occurs in those with widespread disease
• Diagnosis confirmed by histological examination of involved node
• Reed-Sternberg cells are diagnostic of the disease

Histological type

• Lymphocyte predominant (7%) - best prognosis
• Nodular sclerosing (64%) - worst prognosis
• Mixed cellularity (25%)
• Lymphocyte depleted (4%)

Staging investigations

• Chest X-ray
• Bone marrow trephine biopsy
• Abdominal and chest CT scan
• Staging laparotomy - often not required

Staging of Hodgkin's disease

Stage I	Confined to one lymph node region
Stage II	Disease confined to 2 or more nodal regions on one side of diaphragm
Stage III	Disease involving node on both sides of diaphragm
Stage IV	Extra-nodal disease - usually liver or bone marrow
At any stage of the disease
A	Absence of constitutional symptoms
B	Presence of constitutional symptoms
	Unexplained fever above 38 ºC
	Night sweats
	Loss of >10% body weight in 6 months

Treatment

• Stage I & II is radiotherapy
• Stage III & IV is chemotherapy and radiotherapy

Survival

• Stage I is 90% at 5 years
• Stage IV is 60% at 5 years

Bibliography

Mendenhall N P.  The role of radiation in the management of Hodgkin's disease: an update.  Cancer Invest 1999;  17:  47-55.

Potter R.  Paediatric Hodgkin's disease. Eur J Cancer 1999;  35:  1466-1477.

Wirth A,  Wolf M,  Prince H M.  Current trends in the management of early stage Hodgkin's disease.  Aust NZ J Med 1999;  29:  535-544.

Last updated: 05 January 2008

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