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Hodgkin Lymphoma

Introductory Notes The current staging classification for Hodgkin Lymphoma is a modification of the Ann Arbor classification first adopted in 1971. Over the past 45 years the practice has changed, making the previously used staging laparotomy and the resulting pathological staging classification obsolete. The recent consensus conference that took place in 2012 in Lugano suggested even more simplified system putting together stage I and II as Limited Stage and stage III and IV as Advanced Stage lymphoma. The Lugano Classification, a modification of the Ann Arbor classification, has been published and accepted by the UICC.1

Clinical Staging (cS) It is determined by history, clinical examination, imaging, blood analysis, and the initial biopsy report. Bone marrow biopsy must be taken from a clinically or radiologically non‐involved area of bone.

Spleen Involvement Clinical evidence of spleen involvement is accepted if there is palpable enlargement of the spleen confirmed by imaging.

Lymphatic and Extralymphatic Disease The lymphatic structures are as follows: ▪▪ Lymph nodes ▪▪ Waldeyer ring TNM Classification of Malignant Tumours, Eighth Edition. Edited by James D. Brierley, Mary K. Gospodarowicz and Christian Wittekind. © 2017 UICC. Published 2017 by John Wiley & Sons, Ltd.

Hodgkin

Liver Involvement Clinical evidence of liver involvement must include either enlargement of the liver and at least an abnormal serum alkaline phosphatase level and two different liver function test abnormalities, or an abnormal liver demonstrated by imaging and one abnormal liver function test.

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Hodgkin Lymphoma ▪▪ ▪▪ ▪▪ ▪▪

Spleen Appendix Thymus Peyer patches

The lymph nodes are grouped into regions and one or more (2, 3, etc.) may be involved. The spleen is designated S and extralymphatic organs or sites E. Lung Involvement Lung involvement limited to one lobe, or perihilar extension associated with ipsilateral lymphadenopathy, or unilateral pleural effusion with or without lung involvement but with hilar lymphadenopathy is considered as localized extralymphatic disease.

Liver Involvement Liver involvement is always considered as diffuse extralymphatic disease.

Clinical Stages (cS) Limited Stage Stage I Involvement of a single lymph node region (I), or localized involvement of a single extralymphatic organ or site (IE).

Stage II Involvement of two or more lymph node regions on the same side of the diaphragm (II), or localized involvement of a single extralymphatic organ or site and its regional lymph node(s) with or without involvement of other contiguous lymph node regions on the same side of the diaphragm (IIE).

Bulky Stage II Stage II disease with a single nodal mass greater than 10 cm in maximum dimension or greater than a third of the thoracic diameter as assessed on CT.

Advanced Stage Stage III Involvement of lymph node regions on both sides of the diaphragm (III), which may also be accompanied by involvement of the spleen (IIIS).

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Stage IV Disseminated (multifocal) involvement of one or more extralymphatic organs, with or without associated lymph node involvement; or non‐­ contiguous extralymphatic organ involvement with involvement of lymph node regions on the same or both sides of the diaphragm.

A and B Classification (Symptoms) Each stage should be divided into A and B according to the absence or ­presence of defined general symptoms. These are: 1. Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to first attendance 2. Unexplained fever with temperature above 38 °C 3. Night sweats Note Pruritus alone does not qualify for B classification nor does a short, febrile illness associated with a known infection.

Reference

Hodgkin

1 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; 32: 3059–3068.