Hodgkin's Lymphoma.
Lymphomas are malignant proliferation of the lymphoid system. They are divided into Hodgkin's and non-Hodgkin's types by histology. In Hodgkin's lymphoma characteristic cells with mirror image nuclei are found (Reed-Sternberg cells).
Classification: Nodular sclerosing, Mixed cellularity, lymphocyte predominance and lymphocyte depletion (bad prognosis).
Clinical features: Enlarged painless lymph nodes, usually in the neck or axilla. Rarely there may be alcohol-induced pain or features due to the mass effect of the nodes. Constitutional symptoms such as fever, weight loss, night sweats, pruritus and loss of energy.
Signs: lymphadenopathy (note position, consistency, mobility and tenderness). Look for anaemia, weight loss and hepatosplenomegaly.
Tests: lymph node biopsy for diagnosis. FBC, Film, ESR, LFT, uric acid, Ca²+, CXR, bone marrow biopsy, abdominal CT or lymphangiography.
Staging: 1- 4. Each stage is subdivided into A (no systemic symptoms) or B- with weight loss, fever and night sweats.
Treatment: Radiotherapy for stages: la and lla.
Chemotherapy for lla-lVb, usually a MOPP type regime.
Complications of treatment: Radiation lung fibrosis and hypothyroidism. Chemotherapy- nausea, alopecia, infertility in men, infection and secondary malignancies especially AML.
Prognosis: 5y-survival rate 80%, depending on stage and grade.
Emergency presentations: Infection, marrow failure and SVC obstruction (presenting with raised JVP, sensation of fullness in the head, dyspnoea, blackouts and facial oedema).