Hodgkin's Lymphoma

 
Hodgkin's lymphoma is a cancer of the lymphatic tissue. This includes the lymph nodes, spleen, and bone marrow. The lymphatic system drains fluid from tissue and returns it to the blood. It plays an important role in the body's defense against infection.

What is going on in the body?

Hodgkin's lymphoma is a cancer that develops in a certain type of lymphatic cell. It causes lymphatic organs to become enlarged and spreads to the bone marrow and other tissues. The exact type of lymph cell that becomes cancerous remains controversial. But, when a Reed-Sternberg cell, or a large, unusual white cell, is seen in any tissue or blood specimen, it confirms the diagnosis of Hodgkin's lymphoma.

Sometimes Hodgkin's lymphoma is very slow growing. Other times it can spread quickly. It can restrict itself to one lymph node area. At other times, all lymph nodes, as well as the liver, spleen, and bone marrow, become involved. Hodgkin's lymphoma rarely spreads to the bones, brain, or kidneys.

What are the signs and symptoms of the disease?

Following are some of the signs and symptoms of Hodgkin's lymphoma: · abdominal pain · bone pain · chills · enlarged liver or spleen · enlarged lymph nodes · fatigue · night sweats · unexplained fever · weight loss

Other symptoms can be related to the size and location of the Hodgkin's masses, for example: · chest pain · shortness of breath · unusual skin rashes

Hodgkin's lymphoma may cause pericarditis, or inflammation of the heart lining. It may also cause obstructions in large blood vessels, especially those in the chest. The bone marrow is usually not involved. If it is, it can cause anemia and other low blood cell counts. Viral infections, including herpes zoster, can occur.

What are the causes and risks of the disease?

The cause and risks of developing Hodgkin's lymphoma are not known. It might be caused by a virus, possibly the Epstein-Barr virus. A virus or combination of viruses could damage certain susceptible immune cells. This damage may change the genes that are responsible for lymph cell growth and regulation.

Hodgkin's lymphoma may be genetic. It seems to affect people with a higher education and socioeconomic level. People with immunodeficiency disorders, including AIDS, may be at risk. It is also linked to certain unusual infections. It may occur years after a person is cured of leukemia, another type of blood cancer. It is most common in people between the ages of 20 and 30, and again after the age of 50. Most children with Hodgkin's lymphoma are male.

What can be done to prevent the disease?

There is no way to prevent Hodgkin's lymphoma. Early diagnosis provides the best chance of a cure.

How is the disease diagnosed?

Hodgkin's lymphoma may be discovered when a person or the healthcare provider feels an enlarged lymph node. Diagnosis begins with a medical history and physical exam. However, a definite diagnosis cannot be made without the following: · a biopsy of the enlarged mass · a bone marrow biopsy · a lymph node biopsy, which takes tissue from a lymph node to send to a laboratory for evaluation · a test for Reed-Sternberg cells

Lymphomas need to be staged, which is a rough measure of the amount of cancer in the body. The tests listed below are used in staging: · blood tumor marker tests · bone marrow biopsy, usually on both sides of the pelvis · chest X-ray · complete blood count, or CBC · CT scans of the chest, abdomen, and pelvis · kidney function tests · LDH and isoenzymes blood test, which measures tissue damage · liver function tests

Lymphoma stages are classified as I, II, III, and IV. · Stage I is limited to one lymph node area in the body. · Stage II involves two lymph node areas that are next to each other. · Stage III involves lymph node areas on both sides of the diaphragm, the muscle between the chest and the abdomen. · Stage IV involves widespread disease that affects other organs, such as the liver, spleen, bone marrow, bone, lung, central nervous system, and skin.

Staging can help predict treatment outcomes. Special laboratory testing called immune analysis can also help predict the outcome of lymphoma. This analysis looks at cell proteins and gene abnormalities. It is not always helpful in figuring out which treatment to use, though.

What are the long-term effects of the disease?

Hodgkin's lymphoma can be a highly curable cancer. Many advancements in treatment have been made recently. While it can recur at any point, the systematic approach to treatment of Hodgkin's disease, also called HD, has produced one of the best cancer cure rates. Treatment to relieve symptoms or pain is often helpful over the long term.

Many people with Hodgkin's disease have lifelong problems with their immune systems even after they have been cured. It puts people at risk of developing certain bacterial, viral, and fungal infections. Prompt antibiotic treatment for all infections is needed.

What are the risks to others?

Hodgkin's lymphoma is not contagious. It poses no risk to others.

What are the treatments for the disease?

Some of the treatment options for Hodgkin's lymphoma are as follows: · chemotherapy, which uses chemicals or drugs to kill certain cells · radiation therapy · a combination of both radiation and chemotherapy

Bone marrow transplants may be successful for some high-risk people whose lymphoma has recurred despite other treatments. This treatment involves giving the person high doses of chemotherapy, total body radiation, and an infusion of bone marrow from another person.

Hodgkin's lymphoma that recurs after radiation is often treated successfully with chemotherapy. If the spleen is involved, it may be removed with surgery.

What are the side effects of the treatments?

Radiation therapy can cause these side effects: · irritation of the esophagus or intestines · lymphedema, which occurs when a fluid called lymph builds up and causes swelling of an extremity · nausea and vomiting · risk for other cancers · skin burning · temporarily lowered blood counts

Chemotherapy can cause side effects such as the following: · abnormal bleeding · fatigue · hair loss · increased chance of needing blood transfusions · lowered blood cell counts · mouth and lip sores · nausea and vomiting · risk of infections · stomach upset

These treatments also can cause damage to the following areas: · bone marrow · heart · kidneys · liver · lungs · peripheral nerves

A combination of radiation and chemotherapy can cause more severe side effects. High-dose chemotherapy and bone marrow transplantation are highly toxic and risky treatments. Sometimes the transplanted immune system attacks the person's normal cells and tissue. There can be mild problems with skin rash and diarrhea. There can also be major organ failure, causing death.

What happens after treatment for the disease?

After treatment, people are managed for chronic side effects. They are also monitored for recurrence of their disease. People who have had their spleen removed need to be vaccinated to prevent certain bacterial infections. Recommended vaccines include those for pneumonia, Haemophilus influenza, and, sometimes, meningococcal meningitis.

How is the disease monitored?

Hodgkin's disease sometimes recurs. For this reason, the healthcare provider will monitor a person for several years by doing the following: · blood chemistry tests · bone marrow biopsies · bone scans · CAT scans · complete blood counts · physical exams · X-rays

Any new or worsening symptoms should be reported to the healthcare provider.

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