Hodgkin's lymphoma

  • 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%)

Hodgkin's lymphoma

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 șC
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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