| ID | 157 |
|---|---|
| Name | HODGKIN’S DISEASE |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations:1-2 1. Full blood count- normochromic, normocytic anemia, eosinophilia, thrombocytopenia. 2. Bone marrow- involvement is uncommon at the onset of the disease but may be found later. 3. Lymph node biopsy- diagnosis can be established by tissue biopsy. 4. Clinical staging investigations include- a. Inspection of Waldeyer’s ring b. Chest X-ray c. Liver and spleen isotope scan d. C.T scan of thorax and abdomen e. MRI- this is not more sensitive then C.T scan for detecting enlarged nodes, f. A staging laparotomy includes splenectomy, liver biopsy, multiple nodes biopsy. |
| Management | Management: Treatment depends on the stage of the disease. There are two main modalities of treatment, radiotherapy and chemotherapy. A. Treatment of early-stage HL (Stages IA & HA): Chemotherapy with ABVD (Adriamycin i.e doxorubicin, Bleomycin, Vinblastine, Dacarbazine) rgimen 4 courses; followed by- Radiotherapy (adjunctive) to the involved lymph nodes. Treatment response should be assessed clinically and by repeated CT or PET (positron emission tomography- a newer scanning modality). Dosage: (as bellow or see the text) Adriamycin (doxorubicin)- 75mg/m2) as single dose every 3 weeks by slow i.v injection. Bleomycin- 15mg once or twice a week to a total dose of 225mg by slow i.v or in infusion. Chlorambucil- 6mg/m2 upto 10mg daily for days 1-14 orally. Decarbazine- this is now often replced by VP16 on account of its toxicity. Vinblastine- 6mg/m2 upto 10mg daily for days 1 & 8 by slow i.v injection. B. Treatment of advanced-stage HL (Stages IB, IIB, III & IV): Chemotherapy with ABVD (Adriamycin i.e doxorubicin, Bleomycin, Vinblastine, Decarbazine) rgimen 6-8 courses; followed by-assessment of response with CT or PET Radiotherapy is not recommended for advanced-stage HL. Dosage: (as above or see the text) C. Treatment ofHL resistant to chemotherapy & radiotherapy: The choice of treatment is autologous bone marrow transplantation. |
| Introduction | Hodgkin’s lymphoma also known as Hodgkin’s disease- is characterised by progressive painless enlargement of lymphoid tissues throughout the body. The pathological hallmark of this disease is the Reed-Stemberg cell. It occurs in both sexes but more commonly in men, with bimodal age distribution, one peak around the 20s and second peak over the age 50 years |
| History | |
| Etiology | |
| Clinical Features | Clinical features:123 1. Nontender (occasionaly tender), rubbery, discrete lymphadenopathy (commonly cervical). 2. The enlarged nodes compress adjacent structures & may produce dysphagia, dyspnoea, stridor, superior venacaval obstruction, (perticularly in the mediastinum) paraplegia, nerve root compression, & jaundice. 3. General features include- progressive weakness, intermittent low grade pyrexia, pruritus, weight loss, night sweating and lethergy. Staging of Hodgkin’s lymphoma:1-2-3 (Ann Arbor) Staging of lymphoma is necessary to determine the extent of disease & to determine whether localized treatment (radiotherapy) is indicated or if systemic chemotherapy is to be given. Stage I: Single lymph node region or one extralymphatic site involvement. Stage II: Two or more lymph node regions involvement on one side of the diaphragm or one lymphnode region plus one extralymphatic site on the same side of the diaphragm Stage III: Lymph node regions on both sides of diaphragm ± extralymphatic or splenic involvement. Stage IV: Diffuse involvement of one or more extralymphatic tissues (such as bone marrow or liver) involvement. In addition each stage is subclassified as- Stage A: No systemic symptoms and Stage B: Significant weight loss, fever or night sweats are present. |
| Preventions | |
| Treatment | |
| Complications | |
| Prognosis | |
| Types | |
| Classification | WHO Pathological classification:2 1. Nodular lymphocyte-predominant HL- 5% 2. Classical HL a. Nodular sclerosing- 70% b. Mixed cellularity- 20% c. Lymphocyte-rich- 5% d. Lymphocyte depleted- rare |
| Observation | |
| Pathology |
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