In all cases, there should be consultation between the pediatric oncologist, radiation oncologist, and surgeon prior to the staging operation. Patients who have had a splenectomy are susceptible to sepsis with encapsulated organisms. They should be given HIB and Pneumovax before splenectomy, if possible, and daily prophylactic penicillin thereafter. Also, in some ages, the risk of secondary leukemia is more common in patients who have had splenectomy than in those who have not. The staging classification that is currently used for Hodgkin's disease was adopted at the Ann Arbor Conference held in 1971.
Extralymphatic disease presents confusing problems in staging.
For example, a patient with disease in the chest and neck, with systemic symptoms, and a negative lymphangiogram, might be found at laparotomy to have involvement of the spleen, liver, and bone marrow. The efficacy of lymphangiography in the staging of pediatric Hodgkin's disease. Azizkhan RG, Dudgeon DL, Buck JR, et al. King DR, Patrick LE, Ginn-Pease ME, et al. Mediastinal mass and tracheal obstruction during general anesthesia.