Hodgkin Lymphoma

Question 1

What are the different types of Lymphoma? (2 things)

Answer 1

1. Hodgkin Lymphoma (HL)
2. Non-Hodgkin Lymphoma (NHL)

Question 2

What is specific about Hodgkin Lymphoma (HL)?

Answer 2

Characterised by presence of Hodgkin / Reed-Sternberg cells (2 different types of cell)

Question 3

What is HL?

Answer 3

Haematological malignancy arising from B lymphocytes in lymphatic system

Question 4

How many people are diagnosed with HL in UK / year?

Answer 4

2,100

Question 5

What is the peak age for HL?

Answer 5

20-34 years old

Question 6

What is the prognosis of HL?

Answer 6

Good, 75% survive 10+ years

Question 7

What is the pathophysiology of HL?

Answer 7

B lymphocytes mutate into 2 types of cell:
1. Hodgkin cells (large mono-nucleated cells)
2. Reed-Sternberg cells (large multi-nucleated cells)

Question 8

How is HL classified? (2 things)

Answer 8

1. Classical HL (95%)
2. Nodular lymphocyte-predominant HL (5%)

Question 9

How is Classical HL further classified? (4 things)

Answer 9

1. Nodular sclerosis (70%)
2. Mixed cellularity
3. Lymphocyte-rich (best prognosis)
4. Lymphocyte-depleted (rare) (worst prognosis)

Question 10

What are the RF for HL? (4 things)

Answer 10

1. HIV
2. EBV
3. AI conditions (e.g RA / sarcoidosis)
4. FHx

Question 11

What are the CF of HL? (7 things)

Answer 11

1. Lymphadenopathy (most common)
2. “B” symptoms (Fever + Night sweats + WL)
3. Malaise
4. Fatigue
5. Mediastinal mass
6. Pruritis
7. Hepatosplenomegaly

Question 12

What are the lymph nodes like in Lymphadenopathy in HL? (3 things)

Answer 12

1. Painless
2. Firm
3. Enlarged

Question 13

Where is the Lymphadenopathy most commonly found in HL?

Answer 13

Neck

Question 14

What are the complications of Mediastinal mass (enlarged lymph nodes in mediastinum) in HL?

Answer 14

Compress airway –> SOB + Chest pain

Question 15

What investigations should you do for sus HL? (2 things)

Answer 15

1. Lymph node biopsy (GOLD)
2. Bloods

Question 16

What bloods should you do for sus HL? (4 things)

Answer 16

1. FBC
2. ESR (raised)
3. LDH (raised)
4. Viral screen (Hep B/C, HIV)

Question 17

What signs of HL are you looking for in FBC? (4 things)

Answer 17

1. Anaemia
2. Lymphopenia
3. Thrombocytopaenia
4. Neutropenia (poor prognosis)

Question 18

What level of ESR indicates a poor prognosis of HL?

Answer 18

50+

Question 19

What investigations help with Staging HL? (3 things)

Answer 19

1. PET
2. CT
3. MRI

Question 20

What is the staging system used for HL?

Answer 20

Ann Arbor staging system
(used for non-HL a well)

Question 21

What are the stages of the Ann Arbor staging system for HL? (4 stages)

Answer 21

• Stage 1: Confined to 1 region of lymph nodes
• Stage 2: In 2+ regions but on same side of diaphragm (above / below)
• Stage 3: In regions above AND below diaphragm
• Stage 4: Spread to NON-lymphatic organs e.g liver / lungs

Question 22

What is the main Mx options for HL?

Answer 22

Chemo + Radio

Question 23

Is Chemo + Radio usually successful in Tx of HL?

Answer 23

Yes

Question 24

What are the risks after treating HL? (3 things)

Answer 24

1. Relapse
2. Other haematological cancers
3. Meds side fx

Question 25

What are the possible Side Fx of the Chemo used for HL? (2 things)

Answer 25

1. Leukaemia
2. Infertility (50%)

Question 26

What are the possible Side Fx of Radio? (3 things)

Answer 26

1. Cancer
2. Tissue damage
3. Hypothyroidism (50%)