Hodgkin Lymphoma Diagnosis And Treatment

Hodgkin Lymphoma Diagnosis And Treatment

Question. Write Hodgkin’s lymphoma under following headings:

• Hodgkin’s lymphoma Clinical Features
• Hodgkin’s lymphoma Investigations
• Hodgkin’s lymphoma Staging
• Hodgkin’s lymphoma Treatment

Answer. Hodgkin’s disease is a clinically and histologically distinct chronic lymphoproliferative disorder of unknown etiology.

Hodgkin’s lymphoma Clinical Features

Hodgkin’s lymphoma Local Signs

• Lymphadenopathy: Superfiial lymph nodes in neck are fist to enlarge at fist one side and then other. On palpation, lymph nodes are painless, leathery and discrete. In advanced cases there is a pyramidal swelling with base at clavicle and apex at angle of the jaw.
• Splenomegaly: Moderate enlargement is present.
• Hepatomegaly: Moderate and non­tender

Hodgkin Lymphoma Diagnosis and Treatment

Hodgkin’s lymphoma Systemic Symptoms

• Presence of cachexia and loss of weight
• Fever is present. It can be of mild grade or undulant for several days or can be continuous.
• Night sweats are present
• Anemia can be present
• Generalized or refractory pruritus

Hodgkin’s lymphoma Features due to Metastatic Growth

• In skin: pruritus, erythema, herpes zoster
• In bones: localized pain and tenderness
• Nervous system: Paresthesia and pain
• Respiratory tract: Paralysis of larynx, Collapse of lung,pleural effsion
• Gastrointestinal: Jaundice and ascites
• Genitourinary: Hematuria, retention of urine and pain in back

Symptoms and Diagnosis of Hodgkin Lymphoma

Due to Immunologic changes

• Lowering of resistance to infection
• Homolytic anemia

Hodgkin’s lymphoma Investigations

1. Blood test:

• Non-specifi anemia of chronic disease is common
• Lymphopenia is present.
• ESR is elevated

2. Lymph node biopsy:

• Show presence of reed­sternberg cells.

3. Imaging:

• Chest X­ray to look for mediastinal lymph nodes and pleural effsion.
• CT is valuable in detecting intra­thoracic and abdominal lymphadenopathy. It can also detect presence or absence of bone marrow involvement after chemotherapy.
• Bone marrow: Aspiration biopsy is indicated in stage II disease and higher staging.

Hodgkin Lymphoma Staging and Diagnosis

Hodgkin’s lymphoma Staging

Ann Arbor Staging Classifiation of Hodgkin’s Disease

Hodgkin’s lymphoma Treatment

Hodgkin’s lymphoma Treatment stage I and II

• Mainly radiotherapy is given, i.e. external high cobalt radiotherapy
• Above the diaphragm, Y fild therapy is given.
• Below the diaphragm, mantle or inverted Y fild therapy is given
• Chemotherapy should also be given.
• Involved fild radiation therapy is given to all sites ofbulky disease post­ABVD

Hodgkin’s lymphoma Treatment Stage III And Iv

• Mainly chemotherapy is given
• Drugs used are MOPP combination, i.e.
• Mustine—6 mg/m2 IV daily on days 1 and 8
• Oncovine—1.4 mg/m2 IV daily on days 1 and 8
• Procarbazine—100 mg/m2 orally on days 1–14
• Prednisolone—40 mg/m2 orally on days 1–14
• Give 6 courses with 2 weeks rest between the end of one course and beginning of next.
• ABVD combination is popular these days, i.e.
• Adriamycin: 25 mg/m2 IV on days 1 and 15
• Bleomycin: 10 mg/m2 IV on days 1 and 15
• Vinblastine: 6 g/m2 IV on days 1 and 15
• Dacarbazine: 150 mg/m2 I.V. on days 1 to 5
• Alternating MOPP with ABVD gives excellent response.