Hematology and Oncology Book

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Hodgkin's LymphomaAka: Hodgkin's Disease

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  1. See Also
    1. Lymphoma
  2. Epidemiology
    1. Second most common solid hematologic malignancy
      1. Most common is Non-Hodgkin's Lymphoma
    2. Incidence: 7500 new cases per year in United States
  3. Symptoms
    1. Painless lymph node enlargement
    2. Pruritus
    3. Abdominal Pain
    4. Periodic fever
    5. Cachexia
  4. Signs
    1. Lymphadenopathy
      1. Firm, discrete, nontender nodes
      2. Nonsuppurative
    2. Hepatomegaly
    3. Splenomegaly
  5. Staging (Ann Arbor classification)
    1. Stage I
      1. Single Lymph Node or intralymphatic organ
    2. Stage II
      1. Two or more lymph nodes on same side of diaphragm
    3. Stage III
      1. Lymph nodes involve both sides diaphragm or
      2. Localized spleen or extralymphatic involved
    4. Stage IV
      1. Diffuse or disseminated disease
      2. Liver or Bone Marrow involvement
    5. Modifier
      1. A: Asymptomatic
      2. B: Fever, Night sweat, weight loss (>10% in 6 months)
  6. Labs (for staging)
    1. Complete Blood Count
      1. Normocytic normochromic Anemia
      2. Leukocytosis with lymphopenia
    2. Bone Marrow Aspiration and biopsy
    3. Liver Function Tests
      1. Alkaline Phosphatase
      2. 5' Nucleotidase
    4. Erythrocyte Sedimentation Rate (ESR)
  7. Radiology (for staging)
    1. Chest XRay
      1. Anterior mediastinal or hilar Lymphadenopathy
      2. Osteosclerotic or osteoporotic lesions
    2. Ultrasound Liver and spleen
    3. CT scan of abdomen
    4. Bipedal lower extremity lymphangiography
  8. Diagnosis: Lymph node Excisional Biopsy
    1. Reed-Sternberg Cells
      1. Pathognomonic for Hodgkin's Lymphoma
      2. Large binucleate cells with single distinct nucleoli
      3. Appearance: "Owl's Eye"
  9. Pathology (Histologic Types)
    1. Nodular Sclerosis
      1. Most common type in North America, Western Europe
    2. Mixed cellularity
      1. Second most common histologic type in North America
      2. More frequent in poorer parts of world and in elderly
    3. Lymphocytic predominance
      1. Abundance of Reed-Sternberg Cells
      2. Prognosis Favorable
    4. Lymphocyte depletion
      1. Paucity of cellular elements
      2. Rarest histologic type
      3. Associated features
        1. Advanced age
        2. Systemic symptoms
        3. Retroperitoneal nodes
        4. Extranodal involvement
      4. Worst prognosis
  10. Management: Localized disease - Stages I-III
    1. Combination Chemotherapy
      1. Six cycles at 28 day intervals
      2. Medications (ABVD Regimen)
        1. Adriamycin
        2. Bleomycin
        3. Vinblastine
        4. Dacarbazine
    2. Involved Region Radiation therapy
  11. Prognosis
    1. Prior to Chemotherapy had been uniformly fatal
    2. Large majority are now cured with Chemotherapy
  12. Complications
    1. Secondary tumors
      1. Breast Cancer in women
      2. Lung Cancer
      3. Colorectal Cancer
      4. Bone Cancer
      5. Thyroid Cancer
    2. Other adverse effects
      1. Hypothyroidism
      2. Premature Ovarian Failure
      3. CardioMyopathy due to Anthracycline
      4. Osteoporosis

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