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For further information, see CMDT Part 13-33: Hodgkin Lymphoma
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Essentials of Diagnosis
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Lymphadenopathy, often painless
Constitutional symptoms may or may not be present
Pathologic diagnosis by lymph node biopsy
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General Considerations
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Group of cancers characterized by lymph node biopsy showing Reed-Sternberg cells in an appropriately reactive cellular background
Malignant cell is a B lymphocyte
Divided into pathologic subtypes
Classic Hodgkin lymphoma (nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted)
Non-classic Hodgkin lymphoma (nodular lymphocyte predominant)
Tendency to arise within single lymph node areas and spread in orderly fashion to contiguous lymph nodes
Widespread hematogenous dissemination occurs only late in course
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Painless lymphadenopathy (mass), commonly in neck
Constitutional symptoms, eg, fever, weight loss, or night sweats, or generalized pruritus
Pain in involved lymph node after alcohol ingestion is an unusual symptom
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Differential Diagnosis
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Diagnostic Procedures
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Serum chemistries, whole body PET/CT scan, and bone marrow biopsy
Staging nomenclature (Ann Arbor)
Stage I, one lymph node region involved
Stage II, involvement of two or more lymph node regions on one side of diaphragm
Stage III, lymph node regions involved on both sides of diaphragm
Stage IV, disseminated disease with extranodal involvement
In addition, designated as stage A if there is a lack of constitutional symptoms and stage B if there is a 10% weight loss over 6 months, fever, or night sweats ("B symptoms")
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Chemotherapy is the mainstay of treatment and ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) remains the standard first-line regimen
Even though others such as escalated BEACOPP may improve response rates, it is usually associated with increased toxicity and lacks a definitive overall survival advantage
Stage I and II disease: combination of short-course chemotherapy with involved-node radiotherapy (INRT), but INRT can be eliminated for those with an early negative PET/CT scan without a significant change in outcomes (Table 39–3)
Stage II disease and a large mediastinal or other bulky mass: full course of ABVD for six cycles with involved-node radiotherapy
Stage III or IV disease: full course of ABVD (no radiotherapy)
Pulmonary toxicity can unfortunately occur following either chemotherapy or radiation and should be treated aggressively, since it can lead to permanent fibrosis and death
When disease relapses,