Hodgkin’s disease (HD)

Overview:

• Is one of 2 groups of lymphoma (HD and non-Hodgkin’s lymphoma)
• Represents abnormal proliferation of B or T cells
• Is now curable in the majority of patients
• All stages are subclassified as A (asymptomatic) or B

Clinical features:

Symptoms:

• Lymph node enlargement (most often of the cervical nodes)
• ‘B’ symptoms:
• Fever
• Drenching night sweats
• Weight loss of >10% of bodyweight

• Other constitutional symptoms:
• Pruritus
• Fatigue
• Anorexia
• Alcohol-induced pain at the site of enlarged lymph nodes
• Symptoms due to involvement of other organs (e.g. bone, lungs, liver)

Signs:

• Peripheral lymph node enlargement
• Hepatosplenomegaly

Differential diagnosis of cervical lymph node enlargement:

Acute infections

Chronic infections:

• TB
• Sarcoidosis
• Syphilis
• HIV

Connective tissue disorders:

• RA

Drugs:

• Phenytoin

Primary lymph node malignancies:

• HD
• NHL
• CLL
• ALL

Secondary malignancies:

• Nasopharyngeal
• Thyroid
• Lung
• Breast
• Stomach

Investigations:

FBC:

• May be a normocytic normochromic anaemia

ESR:

• Usually raised

LFTs:

• Abnormal if the liver is involved

CXR:

• May show mediastinal widening, with or without lung involvement

CT scans:

• May show involvement of intrathoracic, abdominal or pelvic lymph nodes

Bone marrow aspirate:

• May show involvement in patients with advanced disease

Lymph node biopsy:

• Is required for definitive diagnosis
• Classically, Sternberg-Reed cells are present

Treatment:

• Treatment is nearly always given with curative intent
• Consists of chemotherapy, radiotherapy or both
• Treatment for HD can usually be given on an outpatient basis and most people are able to lead a reasonably normal life whilst having treatment

Prognosis at recurrence:

• Failure to achieve an initial or almost complete response, and recurrence within 1 year, are both associated with a very poor prognosis
• Similarly, patients who develop recurrent HD more than once will almost certainly die of HD