The extent of Hodgkin’s disease at the time of diagnosis is the most important single factor affecting prognosis and the choice of treatment.1 2 Thorough investigation is needed to determine the stage of the disease,3 and it is best to refer patients to a centre with special experience of the condition. The staging process requires haematological, biochemical and radiographic studies, including abdominal lymphography.4 Some patients may also need laparotomy with splenectomy and hepatic and node biopsy to localise any intra-abdominal spread, particularly into the liver which is ominous and an important determinant in the choice of therapy.5 6 Laparotomy is less usually performed in patients over 60. In children under 6 splenectomy should not be carried out because it makes them more susceptible to infection.7 In young women the ovaries may be sewn to the abdominal wall in the mid-line so that they can be shielded from x-rays directed at iliac lymph nodes.
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