• May detect on yearly exam.
• 2/3 have painless lymph adenopathy that persists 4-6w.
• > 1cm NOT associated with infection
• Usually upper body area.

• Systemic complaints unusual but sometimes:
• cough, chest discomfort, itching.
• Abdominal fullness, chronic pain
• Objective: abnormal CXR, thrombocytopenia
• Anemia, Rare SVC syndrome.

• Tx based on type of tumor & less freqently by stage. Classified by pattern & rate of growth.
• Low Grade: middle age/older, longer survival.
• Intermediate Grade: short survival,
• High Grade: aggressive, short survival.

• Generalized lymphadenopathy.
• Normal CBC or mild lymphocytosis
• Bone marrow involvement 75-90%
• Can convert to more invasive
• Survival 8-10y.

• Large masses
• frequent extranodial involvement.
• Less frequent bone marrow involvement.
• Diffuse large cell= neuro involvement & spreads rapidly.

• Usually > 50y.
• Anemia, Leukemia like S/S.
• Extra nodal/bone marrow & CNS involvement.
• Common males 20-30y.

• Mono
• HIV
• TB
• Hodgkins
• Sarcoid
• CMV
• Histoplasmosis.

• H&P
• CBC, chem, sed rate.
• LFTs, Uric acid, calcium, protien electrophoresis
• CXR
• CT of chest, abdomen, & pelvis. Head if suspected.
• Bone marrow (2 sides)
• endoscopy, LP
• Lmphangiogram
• Scans of involved organs.

• Cancer only in one lymphnode area or organ outside the node.

Either of the two indicate stage 2:

• Cancer is found in lymph node areas on done sode of the diaphram.
• Found only in 1 area or organ outside the lymph node & in surrounding areas.
• Other nodes on same side of the diaphram may also have cancer.

• Cancer is in lymph node areas on BOTH sides of diaphram.
• Spread to other organs near the nodes or to the spleen.

Either of the following define stage 4:

• Spread in more than one spot to organs outside of lymph system.
• Spread only to one organ but distant nodes involved.

• radiation: neck, chest, nodes
• can be used alone or with chemo.
• chemo: usually 14-21d cycles of either CHOP or CHOP & bleomycin.
• ALWAYS GET ECHO FIRST.

What is the incidence of Hodgkin's disease?

• 8000 new cases yearly.
• initial peak: 15-35y
• second peak: >50y
• males > females

• Abnormal cell is called: Reed-Sternberg cell
• begins in one lymph node & travels thru lymph system.
• Advanced: lungs, liver, bone marrow

• painless swelling of nodes, unilateral, usually neck, groin, axilla, abdomen.
• Fatigue, itching, loss of appetite, recurrent fever, night sweats, neck pain, bone pain, wt loss.
• 50% neck or supraclavicular area.
• 70% superficial.
• 60% mediastinal adenopathy
• 25-30% night sweats, fever caled Pel-Epstein fever.
• itching: maybe with rash.

• Mono
• bacterial infections
• HIV
• TB
• Toxo.

• depends on stage
• radiation for localized
• 80% cure rate
• Chemo for disseminated
• 50% cure rate
• some us cobo therapy
• CHOP, MOPP, AVBD + CHOP

• Radiation: fatigue, pneumonitis, pericardial effusion, wt loss, hypothyroidism, cardiac damage, sterility, pharyngitis.
• Pulmonary fibrosis.
• emergence of leukemia.

• 5th ranking fatal CA
• 1 in 70 lifetime risk
• 1 in 20 if 1st degree relative.
• 25,000 new cases yearly
• 15,000 deaths yearly.
• More common in caucasians.
• More common in US and Europe.
• Low parity is risk factor
• infertility tx is a risk factor.

• pelvic exam
• normal ovary not usually palpable in post menopausal women.
• 15% found by routine pelvic.
• PAP Smear: onlly 11% with ovarian ca have positive cervical cytology.
• Serum tumor markers.
• 82% have elevated levels of CA125 in advanced CA

• CT
• MRI
• PET: for monitoring disease not screening
• transabdominal U/S
• Best method: manual exam & pelvic U/S. if + family hx, or risk is up to 50%.

• Annual CA 125
• Ob-Gyn consult
• transvaginal U/S at age 25
• Prophy oophorectomay at 35y or when childbearing complete.

• vague abdominal pain
• fullness
• indigestion
• urinary/bowel dysfunction.
• pelvic discomfort.
• increasing abdominal girth.

• CT pelvis, abdomen, lungs
• CA 125
• LFTs, routine labs
• Pregnancy test if pre meno.
• stagin Lap & debulking

• may need exploratory lap.
• chemo
• interferon?
• bone marrow transplant.
• monitor CA 125

• Next to skin Ca, most common form
• rates much higher is AA
• death rate up to 50% higher in AA.

• 0-39y:  < 1:10,000
• 40-59y: 1:78
• 60-79y: 1:6
• life span: 1:5

• race
• age
• hi fat diet.
• pre existing BPH
• genetics.
• environmental?
• ETOH, hormonal changes

• bones
• ribs
• spine
• pelvis
• skull
• femur
• humerous
• venous blood flow=spread to viscera.

• usually asymptomatic
• Dx thru screening proceedures
• urinary frequency, hesitancy, dribbling,weak stream, hematuria.
• with advanced disease: flank and hip pain.

• Usually a hard nodular and irregular legion.
• Nonelevated with compressible tissue around it.
• Remember that rapid development of s/s is suggestive of CA.

True or false:

A PSA maybe increased with BPH

• 0-3.9    normal, bx not recc.
• 4-9       Bx recommended: probabilty of detecting CA; 25-30%
• >10      Bx recommended: probability of detecting CA >50%

• DRE
• rapid begign prostatic growth
• infections: bacterial, viral, parasitic.

• BPH
• Prostate CA
• Postatitis
• DRE
• Urinary retention
• Ejaculation
• Pelvic Trauma
• Pros. Needle Bx.
• Prostate volume
• Black race

Precent free PSA

When PSA ranges from 4-10, a percent free PSA of >25% is 95% sensative in excluding Prostate CA.