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20 Cards in this Set
- Front
- Back
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What kind of biopsy is preferred for Dx of HL and why?
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Excisional Biopsy. because it shows lymph node architecture
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What imaging studies are typically ordered as part of the workup?
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PET/CT
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What lab work is required as part of the workup of HL?
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the following labs have prognostic implications: ESR, CBC, albumin, LDH. Labs necessary for treatment planning: BUN, Cr, and pregnancy test in women of childbearing age.
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What are common indications for a BM biopsy in the workup of HD?
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1. B symptoms
2. Stages III-IV 3. Bulky disease 4. > 2 sites 5. recurrent disease |
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How is HL staged?
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Ann Arbor System
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What is stage I HL?
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involvement of 1 LN region
OR localized involvement of a single extralymphatic organ or site (stage IE) |
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What is stage II HL?
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involvement of two or more LN regions on same side of diaphragm
OR localized involvement of a single associated extralymphatic organ or site and its regional LN (with or without involvement of other LN regions on same side of diaphragm) (stage IIE) |
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What is stage III HL?
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involvement of LN regions on both sides of thee diaphragm that may also be accompanied by localized involvement of an associated extralymphatic organ or site (stage IIIE)
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What is stage IV HL?
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multifocal involvement of one or more extralymphatic organ (with or without associated LN involvement)
OR isolated extralymphatic organ involvement with distant nodal involvement. |
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Patients with splenic involvement are characterized with what?
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S
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Involvement of what sites is considered Stage IV?
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bone marrow
liver pleura CSF |
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What are the 14 distinct LN regions as part of the Rye classification?
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1. Waldeyer ring
2. Occipital, cervical, preauricular, and supraclavicular 3. infraclavicular 4. axillary 5. epitrochlear 6. mediastinum 7. right hilum 8. left hilum 9. para-aortic 10. spleen 11. mesenteric 12. iliac 13. inguinofemoral 14. popliteal |
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Is involvement of the Waldeyer ring and spleen considered extranodal?
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No. Per the AJCC (7th edition), the waldeyer ring and spleen are not considered extranodal sites.
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What does the waldeyer ring include?
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1. pharyngeal tonsil (adenoids)
2. Palatine tonsil 3. lingual tonsil (base of tongue) |
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What are unfavorable factors for early HD?
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Risk factors used to stratify early-stage HD in clinical trials vary.
Unfavorable factors for early HD: 1. age 50 or greater 2. bulky disease 3. 4 or more sites 4. ESR >50 if no B symptoms 5. ESR >30 if B symptoms 6. presence of extranodal sites 7. mixed cellularity or lymphocyte-depleted histology |
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What are unfavorable factors for advanced HL used in the International Prognostic Score (IPS)?
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WALSH AM:
WBC > 15,000 Albumin <4 Lymphocytes <600 Stage IV Hgb <10.5g/dL Age 45 or more Male |
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What percentage of patients with favorable early stage HL have occult splenic involvement?
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~30% (Carde P et al., JCO 1993)
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Historically what was included in a staging laparotomy for HL?
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1. liver biopsy
2. splenectomy 3. abdominal LN sampling |
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What study showed that staging laparotomy was unnecessary given treatment with subtotal nodal irradiation or CRT?
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EORTC H6F showed that a staging laparotomy was unnecessary given Tx with STNI or CRT (Carde P et al. JCO 1993).
The study randomized favorable stage I-II pts with supradiaphragmatic HL to laparotomy and Tx based on laparotomy results vs. clinical staging only and STNI. Freedom from progression (78-83%) and OS (89-93%) were similar at 6 years. |
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How many times are HL patients staged with PET/CT?
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at least twice. once as part of the workup and then again after initial chemo to assess response.
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