Hodgkin Lymphoma
A highly curable lymphatic cancer marked by painless swollen lymph nodes and the presence of unique Reed-Sternberg cells.
Emergency Management: Superior Vena Cava (SVC) Syndrome from large mediastinal mass. Treat with steroids/radiation.
Hodgkin Lymphoma (HL) is a B-cell malignancy characterized by sparse, multinucleated Reed-Sternberg (RS) cells embedded in a dense background of reactive inflammatory cells.
Detailed Overview
HL classically spreads contiguously through lymph node chains. It has a bimodal age distribution (20-30s and >65). It is highly curable with multi-agent chemotherapy (ABVD) and involved-site radiation, though treatment is associated with significant long-term toxicities like secondary cancers and cardiotoxicity.
Epidemiology & Demographics
Incidence of 2.5 per 100,000. Nodular sclerosis is the most common subtype in young adults.
Etiological Mechanism
EBV infection is implicated in 40-50% of classical HL cases.
Primary Causes
Malignant transformation of germinal center B-cells
Malignant RS cells secrete cytokines (IL-5, TARC) recruiting benign lymphocytes and eosinophils, which make up 98% of the tumor. RS cells express PD-L1, exhausting host T-cells and enabling immune evasion.
Diagnostic Criteria & Guidelines
Excisional lymph node biopsy showing Reed-Sternberg cells with appropriate IHC.
Advanced stage: ABVD (Doxorubicin 25 mg/m2, Bleomycin 10 U/m2, Vinblastine 6 mg/m2, Dacarbazine 375 mg/m2) for 6 cycles. Often adapted based on interim PET/CT (dropping Bleomycin).
Second-Line & Adjunctive Therapy
Salvage chemotherapy (ICE) followed by Autologous Stem Cell Transplant.
Surgical & Procedural Management
Excisional biopsy for diagnosis. No therapeutic surgery.
Patient Counseling & Advice
Discuss high cure rates. Instruct to report fever >38.3°C immediately due to neutropenia. Warn of temporary hair loss.
Follow-Up & Monitoring Schedule
H&P every 3-6 months. Annual TSH if neck radiated. Mammogram/MRI at age 40 or 8 years post-chest radiation.
Preventive Strategies
No primary prevention.
Excellent. 5-year survival is ~89%.