Hodgkin's lymphoma
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2008-07-17T05:25:42Z
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{{DiseaseDisorder infobox |
Name = Hodgkin's lymphoma |
ICD10 = {{ICD10|C|81||c|81}} |
ICD9 = {{ICD9|201}} |
ICDO = 9650/3-9667/3 |
Image = Hodgkin_lymphoma_(1)_mixed_cellulary_type.jpg|
Width = 325|
Caption = Lymph node biopsy showing Hodgkin's lymphoma.|
OMIM = |
MedlinePlus = 000580 |
eMedicineSubj = med |
eMedicineTopic = 1022 |
DiseasesDB = 5973 |
MeshID = D006689 |
}}
'''Hodgkin's lymphoma''', also known as Hodgkin's disease, is a type of [[lymphoma]] first described by [[Thomas Hodgkin]] in 1832. Hodgkin's lymphoma is characterized clinically by the orderly spread of disease from one [[lymph node]] group to another and by the development of [[B symptoms|systemic symptoms]] with advanced disease. Pathologically, the disease is characterized by the presence of [[Reed-Sternberg cell]]s (RS cells). Hodgkin's lymphoma was one of the first [[cancer]]s to be cured by radiation. Later it was one of the first to be cured by [[history of cancer chemotherapy#combination chemotherapy|combination chemotherapy]]. The survival rate is generally around 90% when the disease is detected relatively early, making it one of the most curable forms of cancer. Later-stage cancers show a significantly worse prognosis <ref>Stein, RS.; Morgan, D (2003). Handbook of Cancer Chemotherapy, Sixth Edition. [[Lippincott Williams & Wilkins]], 493, Table 21.2: "Hodgkin's Disease: Incidence of stages and results of therapy." ISBN 0-7817-3629-3.</ref>. The ''Handbook of Cancer Chemotherapy, Sixth Edition'' states that "the potential for cure should not lead clinicians and patients to lose sight of the fact that [Hodgkin's lymphoma] is a malignancy and that approximately 20% to 25% of patients die of the disease."<ref>Ibid., 489. ISBN 0-7817-3629-3.</ref> Nevertheless, recent trials are showing much higher 5-year survival rates than have previously been seen, often on the order of 98% for many patients. <ref> Edelson, Ed; Nov. 8, 2007. Doctors Report High Survival Rates for Hodgkin's Disease. MedicineNet.com.http://www.medicinenet.com/script/main/art.asp?articlekey=85095 </ref>
== Epidemiology ==
Unlike some [[non-Hodgkin lymphoma|other lymphomas]], whose [[incidence (epidemiology)|incidence]] increases with age, Hodgkin's lymphoma has a [[Bimodal distribution|bimodal]] incidence curve; that is, it occurs most frequently in two separate age groups, the first being young adulthood (age 15–35) and the second being in those over 55 years old although these peaks may vary slightly with nationality.<ref> {{cite book | last=Mauch | first=Peter | coauthors=James Armitage, Volker Diehl, Richard Hoppe, Laurence Weiss | title=Hodgkin's Disease | publisher=[[Lippincott Williams & Wilkins]] | date=1999 | pages=62-64 | isbn=0-7817-1502-4}} </ref> Overall, it is more common in males, except for the ''[[nodular sclerosis]]'' variant (see below), which is more common in females.
The annual incidence of Hodgkin's lymphoma is about one in 25,000 people, and the disease accounts for slightly less than 1% of all cancers worldwide.
The incidence of Hodgkin's lymphoma is increased in patients with HIV infection.<ref>{{cite journal |author=Biggar RJ, Jaffe ES, Goedert JJ, Chaturvedi A, Pfeiffer R, Engels EA |title=Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS |journal=Blood |volume=108 |issue=12 |pages=3786–91 |year=2006 |pmid=16917006 |doi=10.1182/blood-2006-05-024109}}</ref> In contrast to many other lymphomas associated with HIV infection it occurs most commonly in patients with higher CD4 T cell counts.
== Symptoms ==
Patients with Hodgkin's lymphoma may present with the following symptoms:
*[[Lymph nodes]]: the most common symptom of Hodgkin's is the painless enlargement of one or more lymph nodes. The nodes may also feel rubbery and swollen when examined by a physician. The nodes of the neck and shoulders ([[cervical]] and [[supraclavicular]]) are most frequently involved (80-90% of the time, on average). The lymph nodes of the chest are often affected and these may be noticed on a [[chest radiograph]].
*[[Splenomegaly]]: enlargement of the [[spleen]] occurs in about 30% of people with Hodgkin's lymphoma. The enlargement, however, is seldom massive and the size of the spleen may fluctuate during the course of treatment.<ref>Howard Terebelo, DO, FACP: discussion with patient, July 5, 2007.</ref>
*[[Hepatomegaly]]: enlargement of the [[liver]], due to liver involvement, is present in about five percent of cases.
*[[Hepatosplenomegaly]]: the enargement of both the liver and spleen caused by the same disease.
*[[Pain]]:
**Pain following alcohol consumption: classically, involved nodes are painful after alcohol consumption, though this phenomenon is rare<ref>[Anonymous]. Symptoms & Signs. The Lymphomas. 2006: 11.</ref>.
**[[Back pain]]: nonspecific back pain (pain that cannot be localized or its cause determined by examination or scanning techniques) has been reported in some cases of Hodgkin's lymphoma.
*Systemic symptoms: about one-third (⅓) of patients with Hodgkin's disease may also present with systemic symptoms, including low-grade [[fever]]; [[night sweats]]; unexplained weight loss of at least 10% of the patient's total body mass in six months or less, itchy skin ([[itch|pruritus]]) due to increased levels of [[eosinophils]] in the bloodstream; or [[fatigue (physical)|fatigue]] (lassitude). Systemic symptoms such as fever, night sweats, and weight loss are known as [[B symptoms]]; thus, presence of fever, weight loss, and night sweats indicate that the patient's stage is, for example, 2B instead of 2A<ref>Ibid., 13,14.</ref>.
*Cyclical fever: patients may also present with a cyclical high-grade fever known as the [[Pel-Ebstein fever]]<ref>RK Gupta, MB, PhD, FRCP; MK Gospodarowicz, MD, FRCPC; T. Andrew Lister, MD. Clinical Evaluation and Staging of Hodgkin's Disease. Hodgkin's Disease: 1999; 230-1. ISBN 0-7187-150204</ref>, or more simply "P-E fever". However, there is debate as to whether or not the P-E fever truly exists<ref> {{cite journal | last=Asher | first=Richard | title=Making Sense | journal=The New England Journal of Medicine | volume=333 | date=[[July 6]], [[1995]] | pages=66–67 | doi=10.1056/NEJM199507063330118 | pmid=7777006 }}</ref>.
== Diagnosis ==
Hodgkin's lymphoma must be distinguished from non-cancerous causes of lymph node swelling (such as various infections) and from other types of cancer. Definitive diagnosis is by lymph node [[biopsy]] (Usually excisional biopsy with microscopic examination). [[Blood test]]s are also performed to assess function of major organs and to assess safety for [[chemotherapy]]. [[Positron emission tomography]] (PET) is used to detect small deposits that do not show on CT scanning. In some cases a [[Gallium imaging|Gallium Scan]] may be used instead of a PET scan.
==Pathology==
===Macroscopy===
Affected lymph nodes (most often, laterocervical lymph nodes) are enlarged, but their shape is preserved because the capsule is not invaded. Usually, the cut surface is white-grey and uniform; in some histological subtypes (e.g. [[nodular sclerosis]]) a nodular aspect may appear.
===Microscopy===
Microscopic examination of the lymph node biopsy reveals complete or partial effacement of the lymph node architecture by scattered large malignant cells known as Reed-Sternberg cells (typical and variants) admixed within a reactive cell infiltrate composed of variable proportions of lymphocytes, histiocytes, eosinophils, and plasma cells. The Reed-Sternberg cells are identified as large often bi-nucleated cells with prominent nucleoli and an unusual [[CD45]]-, [[CD30]]+, [[CD15]]+/- immunophenotype. In approximately 50% of cases, the Reed-Sternberg cells are infected by the [[Epstein-Barr]] [[virus]].
Characteristics of classic Reed-Sternberg cells include large size (20–50 micrometres), abundant, amphophilic, finely granular/homogeneous cytoplasm; two mirror-image nuclei (owl eyes) each with an eosinophilic nucleolus and a thick nuclear membrane ([[chromatin]] is distributed at the cell periphery).
Variants:
* [[Hodgkin's cell]] (atypical mononuclear RSC) is a variant of RS cell, which has the same characteristics, but is mononucleated.
* Lacunar RSC is large, with a single hyperlobated nucleus, multiple, small nucleoli and eosinophilic cytoplasm which is retracted around the nucleus, creating an empty space ("lacunae").
* Pleomorphic RSC has multiple irregular nuclei.
* "Popcorn" RSC (lympho-histiocytic variant) is a small cell, with a very lobulated nucleus, small nucleoli.
* "Mummy" RSC has a compact nucleus, no nucleolus and basophilic cytoplasm. <ref>[http://www.pathologyatlas.ro/Reed%20Sternberg%20Cell%20Hodgkin%20Lymphoma.html Reed-Sternberg cell - Hodgkin lymphoma<!-- Bot generated title -->]</ref>
Hodgkin's lymphoma can be sub-classified by histological type. The cell histology in Hodgkin's lymphoma is not as important as it is in [[non-Hodgkin's lymphoma]]: the treatment and prognosis in Hodgkin's lymphoma depend on the stage of disease rather than the [[histotype]].
== Types ==
Classical Hodgkin's lymphoma (excluding nodular lymphocyte predominant Hodgkin's) can be subclassified into 4 pathologic subtypes based upon Reed-Sternberg cell morphology and the composition of the reactive cell infiltrate seen in the lymph node biopsy specimen. ({{ICDO|9650|3}})
{| class="wikitable"
| '''Family''' || '''Name''' || '''Description''' || '''[[ICD-10]]''' || '''[[ICD-O]]'''
|-
| Classical || Nodular sclerosing CHL || Is the most common subtype and is composed of large [[tumor]] nodules with lacunar RS cells subtype composed of numerous classic often pleomorphic RS cells with only few reactive lymphocytes which may easily be confused with diffuse large cell lymphoma. || {{ICD10|C|81|1|c|81}} || {{ICDO|9663|3}}
|-
| Classical || Mixed-cellularity subtype || Is a common subtype and is composed of numerous classic RS cells admixed with numerous inflammatory cells including lymphocytes, histiocytes, eosinophils, and plasma cells. || {{ICD10|C|81|2|c|81}} || {{ICDO|9652|3}}
|-
| Classical || [[Lymphocyte]]-rich || Is a rare subtype. || {{ICD10|C|81|0|c|81}} || {{ICDO|9651|3}}
|-
| Classical || Lymphocyte depleted || Is a rare subtype. || {{ICD10|C|81|3|c|81}} || {{ICDO|9653|3}}
|-
| Non-classical || Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) || Is no longer classified as a form of classic Hodgkin's lymphoma. This is due to the fact that the RSC variants (popcorn cells) that characterize this form of the disease invariably express B lymphocyte markers such as CD20 (thus making NLPHL an unusual form of B cell lymphoma), and that (unlike classic HL) NLPHL may progress to [[B-cell lymphoma|diffuse large B cell lymphoma]]. There are small but clear differences in prognosis between the various forms. Lymphocyte predominant HL is an uncommon subtype composed of vague nodules of numerous reactive lymphocytes admixed with large popcorn-shaped RSC. Unlike classic RSC, the non-classic popcorn-shaped RS cells of NLPHL are [[CD15]] and [[CD30]] negative while positive for the B cell marker [[CD20]]. || {{ICD10|C|81|7|c|81}} || {{ICDO|9659|3}}
|}
== Staging ==
After Hodgkin's lymphoma is diagnosed, a patient will be ''[[Cancer staging|staged]]'': that is, they will undergo a series of tests and procedures which will determine what areas of the body are affected. These procedures will include documentation of their histology, a physical examination, blood tests, chest [[X-ray]] radiographs, [[computed tomography]] (CT) scans or [[magnetic resonance imaging]] (MRI) scans of the chest, abdomen and pelvis, and a bone marrow biopsy. [[Positron emission tomography]] (PET) scan is now used instead of the [[gallium scan]] for staging. In the past, a [[lymphangiogram]] or surgical [[laparotomy]] (which involves opening the abdominal cavity and visually inspecting for tumors) were performed. Lymphangiograms or laparotomies are very rarely performed, having been supplanted by improvements in imaging with the CT scan and PET scan
On the basis of this staging, the patient will be classified according to a staging classification (the [[Ann Arbor staging classification]] scheme is a common one):
* Stage I is involvement of a single lymph node region (I) or single extralymphatic site (Ie);
* Stage II is involvement of two or more lymph node regions on the same side of the [[diaphragm (anatomy)|diaphragm]] (II) or of one lymph node region and a contiguous extralymphatic site (IIe);
* Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the [[spleen]] (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes);
* Stage IV is disseminated involvement of one or more extralymphatic organs.
The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage.
==Prognosis==
Treatment of Hodgkin's disease has been improving over the past few decades. Recent trial that have made use of new types of chemotherapy have indicated higher survival rates than have previously been seen. In one recent European trial, the 5-year survival rate for those patients with a favorable prognosis was 98%, while that for patients with worse outlooks was at least 85%. <ref>Edelson, Ed; Nov. 8, 2007. Doctors Report High Survival Rates for Hodgkin's Disease. MedicineNet.com.http://www.medicinenet.com/script/main/art.asp?articlekey=85095 </ref>
In 1998, an international effort<ref> {{cite journal |author=Hasenclever D, Diehl V | title=A Prognostic Score for Advanced Hodgkin's Disease | journal=New England Journal of Medicine | volume=339 | issue=21 | date=[[1998-11-19]] |pages=1506–14 |year=1998 |pmid=9819449 |doi=10.1056/NEJM199811193392104}} </ref> identified seven prognostic factors that accurately predict the success rate of conventional treatment in patients with locally extensive or advanced stage Hodgkin's lymphoma. Freedom from progression (FFP) at 5 years was directly related to the number of factors present in a patient. The 5-year FFP for patients with zero factors is 84%. Each additional factor lowers the 5-year FFP rate by 7%, such that the 5-year FFP for a patient with 5 or more factors is 42%.
The adverse prognostic factors identified in the international study are:
* Age >= 45 years
* Stage IV disease
* Hemoglobin < 10.5 g/dl
* Lymphocyte count < 600/µl or < 8%
* Male
* Albumin < 4.0 g/dl
* White blood count >= 15,000/µl
Other studies have reported the following to be the most important adverse prognostic factors: mixed-cellularity or lymphocyte-depleted histologies, male sex, large number of involved nodal sites, advanced stage, age of 40 years or more, the presence of B symptoms, high [[erythrocyte sedimentation rate]], and bulky disease (widening of the [[mediastinum]] by more than one third, or the presence of a nodal mass measuring more than 10 cm in any dimension.)
== Treatment ==
{{see also | ABVD}}
Patients with early stage disease (IA or IIA) are effectively treated with [[radiation therapy]] or chemotherapy. The choice of treatment depends on the age, sex, bulk and the histological subtype of the disease. Patients with later disease (III, IVA, or IVB) are treated with combination chemotherapy alone. Patients of any stage with a large mass in the chest are usually treated with combined chemotherapy and radiation therapy.
Currently, the ''[[ABVD]]'' [[chemotherapy regimen]] is the gold standard for treatment of Hodgkin's disease. The abbreviation stands for the four drugs [[Adriamycin]], [[bleomycin]], [[vinblastine]], and [[dacarbazine]]. Developed in Italy in the 1970s, the ABVD treatment typically takes between six and eight months, although longer treatments may be required. Another form of treatment is the newer [[Stanford V]] regimen, which is typically only half as long as the ABVD but which involves a more intensive chemotherapy schedule and incorporates radiation therapy. However, in a randomized controlled study, Stanford V was inferior.<ref name="pmid16172458">{{cite journal |author=Gobbi PG, Levis A, Chisesi T, ''et al'' |title=ABVD versus modified stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin's lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi |journal=J. Clin. Oncol. |volume=23 |issue=36 |pages=9198–207 |year=2005 |pmid=16172458 |doi=10.1200/JCO.2005.02.907}}</ref>
Another form of treatment, mainly in Europe for stages > II is [[BEACOPP]]. The cure rate with the BEACOPP esc. regimen is approximately 10-15% higher than with standard ABVD in advanced stages. Although this was shown in a landmark paper in The New England Journal of Medicine (Diehl et al.), the US physicians still favor ABVD. Probably because some physicians think that BEACOPP induces more secondary leukemia. However, this seems negligible compared to the higher cure rates. Also, BEACOPP is more expensive because of the requirement for concurrent treatment with [[GCSF]] to increase production of white blood cells. Currently, the German Hodgkin Study Group tests 8 cycles (8x) BEACOPP esc vs. 6x BEACOPP esc vs. 8x BEACOPP-14 baseline (HD15-trial).<ref>http://ghsg.org/en/</ref>
The high cure rates and long survival of many patients with Hodgkin's lymphoma has led to a high concern with late adverse effects of treatment, including cardiovascular disease and second malignancies such as acute [[leukemia]]s, lymphomas, and solid tumors within the radiation therapy field. Most patients with early stage disease are now treated with abbreviated chemotherapy and involved-field radiation therapy rather than with radiation therapy alone. Clinical research strategies are exploring reduction of the duration of chemotherapy and dose and volume of radiation therapy in an attempt to reduce late morbidity and mortality of treatment while maintaining high cure rates. Hospitals are also treating those who respond quickly to chemotherapy with no radiation.
== Notable cases ==
* [[Luke Menard]], American Idol Season 7 contestant. Diagnosed with Hodgkin's lymphoma in 2008.
* [[Mark Fields]] Former [[NFL]] player forced to retire in 2004 from the disease.
* [[Paul Allen]], Microsoft co-founder, was diagnosed and treated for Hodgkin's lymphoma in 1983.
* The actor [[Richard Harris]] died of Hodgkin's lymphoma in 2002 after filming ''[[Harry Potter and the Chamber of Secrets]]'' as main character [[Albus Dumbledore]].
* Former [[NHL]] star [[Mario Lemieux]] was diagnosed with Hodgkin's lymphoma in January 1993. Even after taking 2 months off, Lemieux ended up winning the [[Art Ross Trophy|scoring title]] that year.
* [[Lynden David Hall]] died of Hodgkin's lymphoma in 2006.
* [[Barry Watson (actor)|Barry Watson]], an actor who gained fame in the television series ''[[7th Heaven]]'', had successfully treated Hodgkin's lymphoma.
* [[Delta Goodrem]], Australian singer, was diagnosed with Hodgkin's lymphoma in July 2003.
* Former head of [[NBC]] Entertainment, [[Brandon Tartikoff]], died in 1997 after a 25 year battle with Hodgkin's disease.
* U.S. Senator [[Arlen Specter]] (R-PA) was diagnosed with Phase IVB Hodgkin's Disease in 2005, underwent 5 months of chemotherapy, and received a clean bill of health. On [[April 15]] [[2008]], he announced that his Hodgkin's had returned.
* British actor [[Roger Tonge]] who played the disabled Sandy Richardson in the cult British soap opera ''[[Crossroads (TV series)|Crossroads]]'' in the 1960s and 1970s died of Hodgkin's Disease in 1981 at the age of 35.
* Alese Coco [http://www.fight2win.org]One of the most notable non-celebrities to have Hodgkin's disease. Known worldwide as a torch bearer for Hodgkin's research. Died at 23 years old.
*[[WWE]] wrestler [[Rowdy Roddy Piper]] was announced to have been diagnosed with Hodgkin's lymphoma on [[November 27]] [[2006]].
*[[John Millington Synge]], the Irish author best known for the play ''The Playboy of the Western World'', died in 1909 from the disease.
*[[Dinu Lipatti]], the Romanian pianist, died of Hodgkin's disease in 1950, 33 years old.
*[[Wayne Shelford]], aka 'Buck' Shelford, former All Black rugby player for New Zealand.
*[[Elizabeth Madox Roberts]], a noted Kentucky poet and novelist, died from Hodgkin's in 1941.
*[[Joy Hester]], a noted Australian artist, died from Hodgkin's in 1960.
*[[Emma Lazarus]], Jewish American poetess, writer of the New Colossus, died of Hodgkin's disease on [[19 November]] [[1887]].
*[[Martin Fry]], vocalist with [[ABC (band)|ABC]], was treated for Hodgkin's Disease in 1985/86.
*Journalist [[Giles Smith]] describes his bout with Hodgkin's in his memoir ''Lost in Music''; he refers to the fact that Martin Fry (above) had the same condition.
*[[James Whitham]], motorcycle racer, was treated for Hodgkin's Disease in 1995/96.
*[[Glen Goins]], singer and guitarist for [[Parliament Funkadelic]] died from Hodgkin's Disease in 1978.
*[[Venya Drkin|Alexander Litvinov]], a Russian rock poet and musician, died from Hodgkin's Disease in 1999.
*[[Jamie Tape]] AFL Footballer
*[[Freida Riley]], an American schoolteacher who inspired the Rocket Boys, died of Hodgkin's Disease in 1969 at the age of 31. The movie October Sky was made in honor of her and the Rocket boys.
*[[Jane Austen]], one of the most famous authors of English literature, died in 1817 aged 41. The cause of death was officially recorded as [[Addison's disease]]; however, modern speculation has suggested that it may have been Hodgkin's disease.<ref>{{cite journal |author=Upfal A |title=Jane Austen’s lifelong health problems and final illness: New evidence points to a fatal Hodgkin’s disease and excludes the widely accepted Addison's |journal=J Med Ethics Med Humanities | volume=31 |year=2005 |pages=3–11|url=http://mh.bmj.com/cgi/content/full/31/1/3 |doi=10.1136/jmh.2004.000193}}</ref>
*[[Seumas McNally]], a [[computer game]] programmer and president of [[Longbow Digital Arts]], died on March 21, 2000; he was diagnosed with the disease three years earlier.
*Famous American writer [[Dale Carnegie]] died of Hodgkin's disease in 1955.
== Cultural references ==
* A main character in the movie ''[[October Sky]]'' (and the book [[Rocket Boys]]), [[Freida J. Riley|Miss Riley]], was diagnosed with Hodgkin's lymphoma.
* In the novel ''Don't Die, My Love'', by [[Lurlene McDaniel]], one of the main characters, Luke, is diagnosed with Hodgkin's and dies after about a year and a half.
* In the latter part of the television series ''[[Party of Five]]'', Charlie Salinger (played by [[Matthew Fox (actor)|Matthew Fox]]), was diagnosed with Hodgkin's and, through rigorous regimens and treatments, went into remission.
* In the movie ''[[Sweet November]]'', the character of [[Charlize Theron]] is in a terminal stage of Hodgkin's lymphoma.
* In ''[[Desperate Housewives]]'', the character of [[Lynette Scavo]], (played by [[Felicity Huffman]]) is diagnosed with Hodgkin's lymphoma, which she tries to keep a secret.
* ''[[Bang the Drum Slowly]]'' by [[Mark Harris (author)|Mark Harris]] is a novel about a baseball player's last season when only he and his best friend know he is dying of Hodgkin's disease. It was later made into a [[Bang the Drum Slowly (film)|film]] of the same name.
* In the television show ''[[Curb your Enthusiasm]]'' episode "The Five Wood" Larry David believes his friend's father suffered from "the good hodgkin's," and that he learned about it from an episode of Party of Five.
* In [[Jeffrey Archer]]'s "Kane and Abel", Matthew Lester is diagnosed with Hodgkin's, but does not disclose his discovery to anyone. His best friend, William Kane, is told by Doctor MacKenzie abut the illness shortly before Matthew's death.
* In the 1996 film [[Infinity]] (with [[Matthew Broderick]] and [[Patricia Arquette]]), Arline Greenbaum (Arquette) is suspected of having Hodgkin's lymphoma. It later turns out to be lymphatic tuberculosis.
* Constable [[Deirdre 'Dash' McKinley]] in Australian Police Drama [[Blue Heelers]] was diagnosed with Hodgkins and shaved her head to save herself the trauma of going through hair loss.
* Actor [[DJ Qualls]] diagnosed with Hodgkin's lymphoma at 14, declared to be in remission after 2 years of treatment at 16
==See also==
* [[ABVD]]
* [[Stanford V]]
* [[Non-Hodgkin lymphoma]]
==References==
{{reflist}}
== Headline text ==
==External links==
'''Information'''
* [http://www.cancer.gov/cancertopics/types/hodgkinslymphoma Hodgkin's Lymphoma] at the American [[National Cancer Institute]]
* [http://www.lymphomainfo.net/hodgkins/timeline.html Timeline of discovery and treatment of Hodgkin's Lymphoma]
*[http://www.kids-cancer.org/lymphomas.htm Lymphomas in Children and Adolescents] From the Centre for Cancer and Blood Disorders at [[Sydney Children's Hospital]]
* [http://www.merck.com/mmpe/sec11/ch143/ch143b.html Hodgkin Disease] from the [[Merck Manual]]
* [http://www.pathologyatlas.ro/Reed%20Sternberg%20Cell%20Hodgkin%20Lymphoma.html Photos at Atlas of Pathology]
*[http://www.antibodypatterns.com/tr.php Anti-Tr antibody]
'''National charities'''<br>
* [http://www.leukaemiacare.org.uk Leukaemia CARE] (UK)
* [http://www.lymphoma.org.uk/ Lymphoma Association] (UK)
* [http://www.leukemia-lymphoma.org/all_page?item_id=7085 The Leukemia & Lymphoma Society] (US) Information from [[LLS]].
* [http://www.ahln.org/ Australian Hodgkin's Lymphoma Network] (AU)
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[[Category:Types of cancer]]
[[Category:Rare diseases]]
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