Hodgkin’s Disease (HD) A disease of lymph nodes with a predictable pattern of spread.
Hodgkin’s Disease (HD)
description
Transcript of Hodgkin’s Disease (HD)
Hodgkin’s Di sease (HD)
A disease of lymp h nodes with a pr
edictable pattern of spread
Epidemiology• Age: bimodal peak age– Third decade– After 50
• Gender: male to female 13 10= . to .
Etiology and R isk Factors
•Unknown• Possible etiologic factor– 1) Familial factor– - 2) Viruses EBV
Signs and Symptoms
• - HD is a lymph node based malignancy• Common = asymptomatic lymphadenopathy• Systemic symptoms• Extranodal involvement
Location of Lymphadenopathy
• 80% LN above the diaphragm–AAAAAAAA AAAAAAAAAAA– AAAAAAAA, ,
Systemic Symptoms
• - 40% of patients > sAAAAAAA AAAAAAAA– - B symptom => Fever, N
ight sweat, Weight loss– Chronic pruritus
Extranodal Involvement
•“ E” lesion by direct invasion• Hematogenous metasta
sis (Stage IV): spleen, lu ngs, liver, bone marrow
Diagnosis•Biopsy• - Pathology : “Reed Sternberg Cell”– Diagnostic tumor cell– Must be identified– Large size, binucleated, large eo
sinophilic nucleoli
Histology• 1. Lymphocyte predominant (LP)
AA AAAAAA AAAA AAAAAAAAA= ,• 2. ( ) =Nodular sclerosis NS the mos
tcommon, young adul t , f emal e• 3. ( ) =Mixed cellularity MC generali
AAA AAAAAAAAAAAAAAA• 4. ( ) =Lymphocyte depletion LD nu
AA AAAAAA AAAA AAAAAAAAA,
Staging : The Coltswold s Classification for HD• I: A single LN region or a lymphoid structure (eg., spleen
, thymus, Waldeyer’s ring)• II: Two or more LN regions on the same side of the diaphragm
• III: LN regions or structures on both sides of the diaphragm– 1: with/without involement of splenic, hilar, celiac, or portal
AAAAA– 2: , ,with involvement of paraaortic iliac or mesenteric nodes
• IV: Extranodal site(s) beyond that designated E ( a singl e extranodal site, contiguous or proximal to a known no
dal site)
Designations applicable to any disease stage
• A: No symptoms• B: Fever, drenching sweats, weight loss• X: Bulky disease– 13> / the width of the mediastinum– 10> cmmaximal dimension of nodal mass
• E: Involvement of a single extranodal site, contiguous or proximal to a know nodal sit
e
Prognostic Factors• Stage of disease: the most importa
nt prognostic factor• Number of sites of involvement• Bulky disease ( particularly in themediastinum)
• B symptoms•Age
Investigations• 1. Imaging : CT scan of the chest/ abd
AAAA• 2. : , ,Lab tests CBC ESR LDH• -3. :Bone marrow biopsy B symptoms• 4. :Staging laparotomy consist of– Splenectomy– LN sampling: celiac/splenic/hilar/paraaorti
c/paracaval/iliac nodes– Wedge/needle biopsy of the liver– open iliac crest Bone Marrow Biopsy– Oophoropexy
Treatment• - StageI I I = Radi ot her apy• - Stage III IV = Chemotherapy
Radiotherapy• Subtotal lymphoid irradiation =
Mantle + Paraaortic field• Mantle field = base of mandible
to diaphragm– - CoverLNabovediaphragm>submandibular, cervical, supr acl avi cul ar , i nf r ac
lavicular, axillary, mediastinum, hi l ar
• Dose = 3,600 cGy
Side Effects of Radiotherapy•Acute
– N/V, Dermatitis, Fatigue•Delay– Pneumonitis– Herpes zoster infection– Subclinical hypothyroidism– Infertility– Secondary malignancies
• secondary solid tumors ( lung, breast)• - chemotherapy > most common = leukemia
- Non Hodgkin’s Lymphoma
Heterogeneous grou p of lymphoprolifera
tive malignancies
Epidemiology
• The incidence has been increasing worldwide.
• This increase is more m arked for older persons.
Etiology and Ca usative Factors
• The origin is UNCERTAIN.• Causative factors with a predisposition–Immunosuppression– Infectious agents (EBV, HTL
- V 1, Herpes type 8, H.pylori)
NHL• Usually originates in lymphoidtissues• Can spread to other organs• Prognosis depends on the hist
ologic type, stage and extent o f disease, age, and treatment
Clinical Manifestations• Asymptomatic LN enlargement (most common
presentation)• 1) Location of lymphadenopathy– most common = neck, inguinal, and abdominal LNs
• 2) Systemic symptoms– fever, weight loss, night sweats ( usually heralding
more advanced disease)
• 3) Primary extranodal lymphoma– depend on the site of origin
Staging Evaluation• Pathologic diagnosed by an experie
nced hematopathologist.• Staging Evaluation includes:– History + Physical Exam– Lab : CBC, LDH– Bone marrow biopsy– -Chest X Ray– CT abdomen and pelvis/chest– Gallium scan
2Histology: prognooooo oooooo
• Indolent lymphoma• Aggressive lymphoma
Staging: Ann Arbor Sys tem (commonly used)
• I: A single nodal region (I) or single extralymp hatic site (IE)
• II: 2 or more nodal regions on the same side of diaphragm(II) or a single localized extralymph
atic site and its regional nodes on the same si de of diaphragm (IIE)
• III: Nodal regions on both sides of the diaphragm
• IV: Diffuse or disseminated involvement of 1 o r more extralymphatic organs with/without as
sociated nodal involvement
Designations applic able to any stage
• A: No symptoms• B: Weight loss, unexplained
fever, night sweats• E: Localized involvement of
extralymphatic tissue• S: Spleen involvement
Treatment• I ndol ent Lymphoma– Stage I + II = RT– Stage III + IV = Chemotherapy + RT
• Aggr essi ve Lymphoma– Stage I + II = combined modality (
Chemotherapy + RT)– Stage III + IV = Chemotherapy ( Do
xorubicin based)
oooooooooooo• - Involve field RT:– -Involved region + first ech
elon adjacent LN region
• Extended field RT:– -involve field + second ech
elon adjacent LN region
Example
Radiation Dose:
• Indolent: 2 ,5 0 0- 3,500cGy• Aggressive: 3 ,5 0
- AA A04500
Late effects of t reatment
• Normal tissue toxicity• Secondary cancers