Hodgkin’s lymphoma

Hodgkin’s lymphoma (HL) is a rare but curable malignancy. It is associated with Epstein Barr virus (EBV) infection in 40–50% of cases, and this virus is likely to play an aetiological role. Patients commonly present with isolated painless cervical adenopathy, but formal staging by computed tomography scan (and increasingly positron emission tomography scanning) is mandatory as therapy is based on anatomical stage. Localized disease can be cured with an abbreviated course of chemotherapy and radiotherapy, whereas advanced stage disease requires more protracted chemotherapy, which may be escalated in intensity for patients with poor risk disease. Even in relapse, many patients can be cured with standard chemotherapy or by autologous or allogeneic stem cell transplantation. Disease-free survival is high in HL, and therefore monitoring closely for long-term side effects of chemo-irradiation is paramount. Particular emphasis should be placed on detecting treatment-related breast and lung carcinomas, and acute myeloid leukaemia. Trials are ongoing to establish prognostic scoring systems and tools to risk-stratify patients with HL, with the aim of avoiding more intensive (and hence more toxic) treatment strategies in those with good risk disease. We review the aetiology and pathology of HL, its clinical features, diagnosis, prognosis, management and late effects of treatment.