Hodgkin’s Lymphoma

Question 1

What type of cells are primarily involved in Hodgkin’s Lymphomas?

Answer 1

B lymphocytes are most often involved.

Question 2

What are the two types of lymphocytes involved in Hodgkin’s Lymphomas?

Answer 2

T Cells and B lymphocytes.

Question 3

Where do lymphocytes develop and mature?

Answer 3

Lymphocytes develop in the bone marrow and mature in the lymphatic organs.

Question 4

How is Hodgkin’s Lymphomas distinct from other lymphoma types?

Answer 4

HL is distinct due to the presence of Reed-Sternberg cells.

Question 5

What are Reed-Sternberg cells?

Answer 5

Reed-Sternberg cells are large lymphoid cells that contain multiple nuclei.

Question 6

How does Hodgkin’s Lymphomas spread?

Answer 6

HL spreads in a systematic manner from one lymph node group to the next in a predictable pattern.

Question 7

What is the prevalence of HL in males?

Answer 7

More prevalent in males, regardless of race.

Question 8

What is the age range with the greatest occurrence of HL?

Answer 8

Greatest in the age range from 20-34 years.

Question 9

What viruses may increase the risk of developing HL?

Answer 9

Infection with Epstein-Barr virus (EBV), infectious mononucleosis, or HIV may increase the risk of developing HL.

Components of EBV have been found in the DNA of the Reed-Sternberg cells of some patients with HL.

Question 10

How does a weakened immune system affect the risk of HL?

Answer 10

Having a weakened immune system may increase the risk of developing HL.

Question 11

What age groups are most commonly affected by HL?

Answer 11

HL is most common among teens and adults aged 15 to 24 and adults aged 55 and older.

Question 12

How does family history influence the risk of HL?

Answer 12

Family members, especially siblings, of a person with HL may have an increased risk of developing the disease.

Question 13

What is the most common symptom of HL?

Answer 13

Painless swollen lymph nodes are the most common symptom of HL.

Question 14

Where are swollen lymph nodes most often discovered in HL?

Answer 14

Swollen lymph nodes are most often discovered in lymph node areas above the diaphragm.

Question 15

What are the B symptoms associated with HL?

Answer 15

B symptoms include weight loss, fevers, night sweats, and itchy skin.

Question 16

What constitutes weight loss as a symptom of HL?

Answer 16

Weight loss is defined as 10% of body weight in 6 months prior to diagnosis.

Question 17

What fever temperature is considered a symptom of HL?

Answer 17

Fever higher than 100.4 Fahrenheit is considered a symptom of HL.

Question 18

What are other symptoms of HL?

Answer 18

Other symptoms include pain with alcohol ingestion, coughing, chest pain, fatigue, and splenomegaly with advanced disease.

Question 19

What are signs of advanced HL?

Answer 19

Advanced disease may present with a tender abdomen, achy bones, and pleural effusion.

Question 20

What does a physician check for during the history and physical exam in HL?

Answer 20

A physician checks for swollen lymph nodes in the neck, underarms, and groin, and checks for a swollen spleen or liver.

Question 21

What lab tests are conducted to check for HL?

Answer 21

The lab does a CBC to check the number of white blood cells, including platelet count, liver, and renal function tests.

Question 22

What lab results may indicate bone marrow involvement in HL?

Answer 22

Anemia, leukopenia, thrombocytosis, and lymphopenia can indicate bone marrow involvement.

Question 23

When are bone marrow biopsies reserved for HL patients?

Answer 23

Bone marrow biopsies are reserved for those with later-stage disease and subdiaphragmatic disease.

Question 24

When should a liver biopsy be performed in HL?

Answer 24

A liver biopsy should be done if splenic involvement is found.

Question 25

What are the two subcategories of Hodgkin Lymphoma (HL)?

Answer 25

Classic Hodgkin Lymphoma (CHL) and Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL).

Question 26

What percentage of Hodgkin Lymphoma cases are Classic Hodgkin Lymphoma (CHL)?

Answer 26

95%.

Question 27

What is the most common subtype of Classic Hodgkin Lymphoma?

Answer 27

Nodular Sclerosing HL.

Question 28

Where does Nodular Sclerosing HL typically involve?

Answer 28

Nodes in the chest and neck.

Question 29

At what age is Nodular Sclerosing HL typically diagnosed?

Answer 29

Usually diagnosed at an early stage, most common among people in their 20s and 30s.

Question 30

What is the average age of diagnosis for Mixed Cellularity HL?

Answer 30

38 years old.

Question 31

In which population is Mixed Cellularity HL more commonly seen?

Answer 31

Those affected by HIV.

Question 32

What percentage of cases does Lymphocytic Rich HL account for?

Answer 32

Found only in 5% of cases.

Question 33

Where is Lymphocytic Rich HL usually found?

Answer 33

Usually in the upper body.

Question 34

In which demographic is Lymphocytic Rich HL more common?

Answer 34

More common in men.

Question 35

What is the prognosis of Lymphocytic Depleted HL?

Answer 35

Carries the worst prognosis, usually presents with more advanced disease.

Question 36

What age group is usually affected by Lymphocytic Depleted HL?

Answer 36

Usually affects people in their 30s with HIV.

Question 37

What percentage of Hodgkin Lymphoma cases are Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)?

Answer 37

5%.

Question 38

What is the most common site of metastasis?

Answer 38

The most common site of metastasis is to adjacent lymph nodes.

Question 39

What is the most common visceral involvement in metastasis?

Answer 39

The most common visceral involvement is the spleen, liver, and bone marrow.

Question 40

Where else can metastasis occur in late stages?

Answer 40

Metastasis can also occur in the lungs and skeletal system in late stages.

Question 41

Which staging system is used for patients with Hodgkin Lymphoma (HL)?

Answer 41

Ann Arbor Staging System

Question 42

How are patients designated in addition to their stage?

Answer 42

Patients are designated as having favorable or unfavorable HL based on the presence or absence of adverse risk factors.

Question 43

What defines early favorable HL?

Answer 43

Early favorable HL is designated when patients have clinical stage I or II disease without B symptoms, less than 3 sites of nodal involvement, and no markedly abnormal lab results.

Question 44

What constitutes early unfavorable HL?

Answer 44

Early unfavorable HL is designated when patients have one or more adverse risk factors.

Question 45

Can advanced HL be considered favorable?

Answer 45

Yes, advanced HL (stage III or IV) can still be considered favorable if there are 3 or fewer risk factors.

Question 46

What defines advanced unfavorable HL?

Answer 46

Advanced unfavorable HL is defined as stage III or IV with 4 or more risk factors.

Question 47

Is HL treatable?

Answer 47

HL is one of the most treatable types of cancer.

Question 48

What is the primary treatment modality for HL?

Answer 48

The primary treatment modality is chemotherapy.

Question 49

What does the chemotherapy regimen for HL consist of?

Answer 49

4 cycles of ABVD (Adriamycin, bleomycin, Vincristine, and Dacarbazine).

Question 50

What is the purpose of adjuvant radiation in HL treatment?

Answer 50

To treat subclinical or residual disease.

Question 51

What is the treatment for patients diagnosed with stage III or IV with bulky disease or B symptoms?

Answer 51

They are treated with a chemotherapy regimen and adjuvant radiation therapy.

Question 52

What is salvage therapy?

Answer 52

Chemotherapy may also be used after the disease has reoccurred in an area already treated with radiation therapy, which is termed salvage therapy.

Question 53

What is the primary area for radiation therapy treatment?

Answer 53

Radiation therapy treatment is most often delivered to the neck, chest, axilla, or paraaortic lymph nodes and spleen. Some patients also receive treatment to the pelvic lymph nodes.

Question 54

What is Total Nodal Irradiation (TNI)?

Answer 54

Total nodal irradiation includes radiation to the upper nodes and lower nodes.

Question 55

How are upper nodes irradiated?

Answer 55

Upper nodes are irradiated via a mantle field AP/PA.

Question 56

What treatment fields are used for the neck, chest, and axilla?

Answer 56

Treatment fields to the neck, chest, and axilla are indicated by nodes in a blue wire frame.

Question 57

What areas are blocked in the TLI case?

Answer 57

In the TLI case, the lungs, occipital, and head of humerus are blocked.

Question 58

How are lower nodes irradiated?

Answer 58

Lower nodes are irradiated via an inverted 'Y' field AP/PA.

Question 59

What is the initial tumor dose for radiation therapy of the AP/PA field?

Answer 59

Initial tumor dose is 20-30 Gy to the mantle field at 1.8 to 2.0 Gy/fraction.

Question 60

What is the boost dose for radiation therapy?

Answer 60

Boost dose is a total of 35-44 Gy at 1.8 to 2.0 Gy/fraction.

Question 61

What recent findings have been shown regarding chemotherapy and radiation doses?

Answer 61

Recent studies have shown that patients receiving chemotherapy and radiation may be treated to a lesser dose up to 20 Gy with the same results and less toxicity.

Question 62

How does the treatment procedure for pediatric cases differ from adults?

Answer 62

The treatment procedure for pediatric cases is similar to that for adults, but more emphasis is placed on minimizing lower doses for chemotherapy and radiation therapy to prevent toxicities and interruption in the growth process.

Question 63

What factors may decrease a patient's survival in HL?

Answer 63

Factors include stage at diagnosis, B symptoms, age, gender, and lab results. ## Footnote B symptoms refer to weight loss, night sweats, and fever.

Question 64

How does age affect treatment results in HL?

Answer 64

Younger patients (teens to adults in their 20s) tend to have better treatment results than older adults aged 45 or older.

Question 65

What is the overall survival rate of HL?

Answer 65

The overall survival rate of HL is 86.6% according to the National Cancer Institute's SEER Program.

Question 66

How does HL respond to treatment?

Answer 66

HL is one of the most curable types of cancer and responds well to chemotherapy and radiation therapy at lower doses than other tumors.

Question 67

Which gender has a poorer prognosis in HL?

Answer 67

Males tend to have a poorer prognosis in HL.

Question 68

What are B symptoms in HL?

Answer 68

B symptoms include weight loss, night sweats, and fever, and are known to have a poorer prognosis.