Hodgkin's Lympoma

Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites.

Causes, incidence, and risk factors

The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.

The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Infection with the Epstein-Barr virus (EBV) is thought to contribute to most cases.

Symptoms

• Fatigue
• Fever and chills that come and go
• Itching all over the body that cannot be explained
• Loss of appetite
• Soaking night sweats
• Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
• Weight loss that cannot be explained

Other symptoms that may occur with this disease:

• Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
• Excessive sweating
• Pain or feeling of fullness below the ribs due to swollen spleen or liver
• Pain in lymph nodes after drinking alcohol
• Skin blushing or flushing

Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms.

Signs and tests

The disease may be diagnosed after:

• Biopsy of suspected tissue, usually a lymph node biopsy
• Bone marrow biopsy

If tests reveal you do have Hodkin's lymphoma, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

The following procedures will usually be done:

• Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level
• CT scans of the chest, abdomen, and pelvis
• Complete blood count (CBC) to check for anemia and white blood count
• PET scan

In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary.

Treatment

Treatment primarily depends on the following:

• The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
• The stage (where the disease is found)
• Whether the tumor is more than 4 inches (10 cm) wide
• The patient's age and other medical issues
• Other factors, including weight loss, night sweats, and fever

A staging evaluation is necessary to determine the treatment plan.

• Stage I indicates one lymph node region is involved (for example, the right neck).
• Stage II indicates involvement of two lymph node areas on the same side of the diaphragm (for example, both sides of the neck).
• Stage III indicates lymph node involvement on both sides of the diaphragm (for example, groin and armpit).
• Stage IV involves the spread of cancer outside the lymph nodes (for example, to bone marrow, lungs, or liver).

Treatment varies with the stage of the disease and age of the patient. The best treatment depends on each individual and should be discussed with a doctor who has experience treating this disease.

• Stages I and II (limited disease) can be treated with local radiation therapy, chemotherapy, or a combination of both.
• Stages III is treated with chemotherapy alone or a combination of radiation therapy and chemotherapy.
• Stage IV (extensive disease) is most often treated with chemotherapy alone.

People with Hodgkin’s lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by an autologous bone marrow transplant (using stem cells from yourself).

Additional treatments depend on other symptoms. They may include:

• Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia
• Antibiotics to fight infection, especially if a fever occurs

Support Groups

You can often ease the stress of illness by joining a support group of people who share common experiences and problems. Seecancer - support group.

Expectations (prognosis)

Hodgkin’s disease is considered one of the most curable forms of cancer, especially if it is diagnosed and treated early. Unlike other cancers, Hodgkin's disease is often very curable even in late stages.

With the right treatment, more than 90% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment is more intense but the percentage of people who survive 5 years is about 90%.

Patients who survive 15 years after treatment are more likely to later die from other causes than Hodgkin’s disease.

People with Hodgkin’s lymphoma whose disease returns within a year after treatment or do not respond to the first-line therapy have a poorer prognosis.

It is important for patients to receive periodic examinations and imaging tests for years after treatment to check for signs of relapse and to check for the long-term effects of treatments.

Complications

Long term complications of chemotherapy or radiation therapy include:

• Bone marrow diseases
• Heart disease
• Inability to have children (infertility)
• Lung problems
• Other cancers
• Thyroid problems

Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. Use a soft toothbrush and electric razor for personal hygiene.

Infection should always be taken seriously during cancer treatment. Contact your doctor immediately if you develop fever or other signs of infection. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia.

Calling your health care provider

Call your health care provider if:

• You have symptoms of Hodgkin's lymphoma
• You are being treated for Hodgkin's lymphoma and you experience side effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding

References

1. Horning SJ. Hodgkin’s lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 111.

Review Date: 3/2/2010.

Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Sumber: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001606/