As with all tumors, management involves a multidisciplinary team:
- Excisional biopsy is usually done to make the diagnosis
- Staging laparotomy - no longer done on a routine basis
- Extent of disease can be accurately assessed with PET-CT scan.
- Chemotherapy is so effective that it no longer matters if microscopic splenic disease is missed on a CT scan
- Splenectomy has many long term adverse consequences (altered immunity and risk of septicemia)
- Therapy - surgery is only used as therapy in the setting of Stage IA lymphocyte predominant Hodgkin lymphoma.
- Hodgkin lymphoma is very sensitive to chemotherapy.
- Combined chemotherapy and RT has resulted in the cure of 80 - 90% of patients with Hodgkin lymphoma.
3. Radiation Therapy (RT)
- Treatment used to involve extensive lymph node regions (mantle field and or upper abdomen to include spleen and para-aortic regions)
- Now limited generally to "involved fields" - sites of bulky disease at presentation and persistent areas of PET avid disease after chemotherapy.