Hodgkin's lymphoma is a type of lymphoma characterized by the presence of Reed-Sternberg cells. It represents 20% of lymphomas and is a B-cell cancer that commonly involves lymph nodes in the neck. Signs and symptoms include painless swollen lymph nodes and B symptoms such as weight loss, fever, and night sweats. Staging involves imaging tests and determines prognosis and treatment, which typically consists of chemotherapy and radiation therapy. Complications can include infection, superior vena cava obstruction, and secondary cancers from treatment. With treatment, 5-year survival rates are 90% for early stage disease and 75% for later stages.

1. HODGKIN'S
LYMPHOMA
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2. DEFINITION
• Lymphoma is a malignant proliferation of mature lymphocytes that
accumulate in lymph nodes ± other tissue, often as a solid tumour.
Differs from leukaemia, which arises in the bone marrow and is present
in the blood.
• Hodgkin's lymphoma represents 20% of all lymphomas, and is
characterised by the presence of 'mirror-image' binucleated Reed-
Sternberg cells on light microscopy.
• Hodgkin's lymphoma is a B-cell cancer.

3. SUB-TYPES
• Common: nodular sclerosis (70%), usually in young patients, and
mixed cellularity (25%), usually in old patients. Both have a good
prognosis.
• Rare (5%): lymphocyte-rich (excellent prognosis) or lymphocyte-
depleted (bad prognosis).

4. EPIDEMIOLOGY
• Lifetime risk: 1/400.
• Occurs any age but peaks at 15-30 and 75-80.
• Commoner in men.

5. HODGKIN LYMPHOMA STAGING | LEUKEMIA AND
LYMPHOMA SOCIETY

6. SIGNS AND SYMPTOMS
• Lymphadenopathy:
• Painless, rubbery, nodes, usually cervical (⅔), axillary, or inguinal.
• May be adherent to each other and move together ('matted').
• Increase and decrease spontaneously.
• Painful on alcohol consumption.
• Mediastinal lymph nodes can cause SOB, dry cough, and SVC
obstruction.

7. SIGNS AND SYMPTOMS
• B symptoms (present in 25%):
• Weight loss.
• Fever. The classical Pel-Ebstein cyclical fever every 2-4 weeks is rare.
• Night sweats.
• Lethargy
• Pruritus
• Other features:
• Anaemia of chronic disease.
• Hepatosplenomegaly in advanced disease.

8. RISK FACTORS
• Family history.
• EBV infection.
• ↑Socioeconomic status.

9. INVESTIGATIONS
• Bloods:
• FBC: pancytopaenia if there is bone marrow infiltration.
• Blood film
• ↑ESR
• LFT, U+E.
• Protein electrophoresis may show paraproteins, though these are commoner in
myeloma.
•

10. INVESTIGATIONS
• Biopsy for diagnosis:
• Lymph node excision.
• Bone marrow aspirate and biopsy only if there is altered FBC or B
symptoms.
• Analysis: microscopy (Reed-Sternberg cells), immunohistochemistry
(CD30 ± CD15 +ve, EBV in 50% of malignant cells), flow cytometry
(CD30 ± CD15 +ve), cytogenetics.

11. INVESTIGATIONS
• Imaging for staging:
• CXR for mediastinal disease (widening).
• Staging: contrast CT head-neck-abdo or PET-CT.

12. HODGKIN'S LYMPHOMA

13. ANN ARBOR STAGING SYSTEM
• Used for both Hodgkin's and non-Hodgkin's. Comprises 2 components.
• By location:
1.1 lymph node (LN) area.
2.≥2 LN areas on 1 side of the diaphragm.
3.LN areas on 2 sides of the diaphragm.
4.Beyond LN e.g. liver, bone marrow.

14. ANN ARBOR STAGING SYSTEM
• By presence of systemic symptoms:
• A: no systemic symptoms, except pruritus.
• B: systemic symptoms.

15. MANAGEMENT
• Chemotherapy plus radiotherapy.
• Consider chemo alone if not bulky, or radiotherapy alone for early lymphocyte-rich disease.
• Common chemo regimens: ABVD (doxorubicin [Adriamycin], Bleomycin, Vinablastine, Dacarbazine),
BEACOPP (Bleomycin, Etoposide, doxorubicin
[Adriamycin], Cyclophosphamide, Vinicristine, Procarbazine, Prednisolone).
• Sperm bank pre-chemo for men.
• Autologous stem cell transplantation – in which the patient's bone marrow is removed, chemo given,
then the marrow returned – is used in resistant and relapsed disease.
• Pneumococcal and flu vaccine.
•

16. COMPLICATIONS AND PROGNOSIS
• Treatment complications:
• Radio- or chemo-therapy: AML, NHL, infertility.
• Radiotherapy damage to neighbouring tissue: secondary cancer
(especially lung, breast), IHD, hypothyroidism, pulmonary fibrosis.
• Chemotherapy-specific: all the usual chemo side effects, including
immunosuppression, nausea, and hair loss, plus pulmonary fibrosis
from bleomycin.

17. COMPLICATIONS AND PROGNOSIS
• Oncological emergencies:
• Infection
• SVC obstruction.
• Prognosis:
• 5 year survival: stage 1-2 90%, stage 3-4 75%.
• Poor prognosis: B symptoms, ↑ESR, lymphocyte-depleted type.

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