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Hodgkin’s lymphoma
Definition
Hodgkin's lymphoma is a malignancy (cancer) of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow.
Alternative Names
Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphomaCauses
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 and later may spread to the lungs, liver, or bone marrow.
The cause is not known. Hodgkin's lymphoma is most common among people 15 - 35 and 50 - 70 years old.
Symptoms
- Fatigue
- Fever and chills
- Generalized itching
- Loss of appetite
- Night sweats
- Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
- Weight loss
Additional symptoms that may be associated with this disease:
- Clubbing of the fingers or toes
- Excessive sweating
- Flank pain
- Hair loss
- Neck pain
- Skin blushing or flushing
- Splenomegaly
Exams and Tests
The disease may be diagnosed after:
- A lymph node biopsy
- A bone marrow biopsy
- A biopsy of suspected tissue
- Detection of Reed-Sternberg (Hodgkin's lymphoma) cells by biopsy
A staging evaluation (tumor staging) may be done to determine the extent of the disease. The following procedures may be done:
- Physical examination
- CT scans of the chest, abdomen, and pelvis
- Bone marrow biopsy
- Blood chemistry tests
- 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.
Hodgkin's lymphoma may change the results of the following tests:
- Lymphocyte count
- Small bowel biopsy
- Schirmer's test
- Peritoneal fluid analysis
- Mediastinoscopy with biopsy
- Gallium scan
- Ferritin
- Cytology exam of pleural fluid
- Cryoglobulins
- Bone marrow aspiration
- Blood differential
- ACE levels
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)
- If the tumor is greater than 4 inches (10 cm) wide
- The patient's age
- 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 2 lymph nodes 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. Stages I and II (limited disease) can be treated with localized radiation therapy, with chemotherapy or with a combination of both. Stages III and IV (extensive disease) are treated with chemotherapy alone or a combination of radiation therapy and chemotherapy. The best treatment for an individual patient depends on many factors, and should be discussed in detail with a doctor who has experience treating this disease.
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. A soft toothbrush and electric razor should be used for personal hygiene.
Infection should always be taken seriously during cancer treatment, so contact your doctor immediately if fever or other signs of infection develop. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia.
Support Groups
The stress of illness can often be eased by joining a support group of people sharing common experiences and problems. See cancer - support group.
Outlook (Prognosis)
With appropriate treatment, more than 80% of people with stage I or II Hodgkin's survive for at least 10 years. With widespread disease, the treatment is more intense and the 5-year survival rate is about 60%.
Possible Complications
- Other cancers
- Lung problems
- Liver failure
- Adverse effects of radiation and chemotherapy
- Inability to have children (sterility)
When to Contact a Medical Professional
Call your health care provider if you have symptoms suggestive of Hodgkin's lymphoma.
Call your health care provider if you are being treated for Hodgkin's lymphoma and experience adverse effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding.
References
Fermé C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. Nov 8, 2007;357(19):1916-27.
Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. Feb 10, 2007;25(5):571-8. Epub 2007 Jan 22.
National Cancer Institute. Adult hodgkin lymphoma treatment (PDQ). 2008. Accessed June 10, 2008.
Reviewed By: James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
