Summary
Definition
History and exam
Other diagnostic factors
- unexplained fevers
- night sweats
- weight loss
- dyspnoea
- cough
- chest pain
- superior vena cava syndrome (SVCS)
- abdominal pain
- pruritus
- alcohol-induced pain at involved sites
- hepatomegaly and/or splenomegaly
- tonsillar enlargement
Risk factors
- age 20-34 years and >55 years
- history of Epstein-Barr virus (EBV) infection
- family history of Hodgkin's lymphoma
- young adults from higher socio-economic class
- human leukocyte antigen (HLA) types
- Jewish ancestry
Diagnostic investigations
1st investigations to order
- FBC with differential
- comprehensive metabolic panel
- erythrocyte sedimentation rate (ESR)
- thyroid function tests
- screening for HIV, hepatitis B, hepatitis C
- CXR
- PET/CT scan
- gallium scan
- contrast-enhanced CT (neck, chest, abdomen, pelvis)
- excisional lymph node biopsy or core biopsy
- immunohistochemical studies
Investigations to consider
- bone marrow biopsy
- echocardiogram or multi-gated acquisition (MUGA) scan
- pulmonary function tests
Treatment algorithm
Contributors
Authors
Alison Moskowitz, MD
Associate Attending
Lymphoma Service
Memorial Sloan-Kettering Cancer Center
New York City
NY
Disclosures
AM has received research support from miRagen (Viridian) Therapeutics, Seattle Genetics, Merck, Bristol Myers Squibb, and Incyte; and honoraria from Imbrium Therapeutics, Merck, and Seattle Genetics. AM is an author of several articles cited in the topic.
Acknowledgements
Dr Alison Moskowitz would like to gratefully acknowledge Dr Chris R. Kelsey, Dr Leonard R. Prosnitz, and Dr Timothy M. Zagar, the previous contributors to this topic.
Disclosures
CRK, LRP, and TMZ declare that they have no competing interests.
Peer reviewers
Joachim Yahalom, MD
Radiation Oncologist
Director of Postgraduate Education
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York
NY
Disclosures
JY declares that he has no competing interests.
Rebecca Connor, MD
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Disclosures
RC declares that she has no competing interests.
Kirit Ardeshna, MD, MA (Cantab), MB, BChir, FRCP, FRCPath
Consultant Haematologist
University College London Hospitals
London
UK
Disclosures
KA declares that he has no competing interests.
References
Key articles
Eichenauer DA, Aleman BM, André M, et al. Hodgkin lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29(4 suppl):iv19-29.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Hodgkin lymphoma [internet publication].Full text
Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014 Sep 20;32(27):3059-68.Full text Abstract
Follows GA, Barrington SF, Bhuller KS, et al. Guideline for the first-line management of classical Hodgkin lymphoma - a British Society for Haematology guideline. Br J Haematol. 2022 Jun;197(5):558-72.Full text Abstract
McKay P, Fielding P, Gallop-Evans E, et al. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol. 2016 Jan;172(1):32-43.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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