Hodgkins disease is now known as Hodgkin’s lymphoma. This disease is a lymphoma that involves the methodical metastasizing of cancer cells through out the lymph system, from one node to another. Hodgkin’s Lymphoma is one of the first cancers to be curable through combination (cocktail) chemotherapy.
The first sign of Hodgkin’s lymphoma is swollen lymph nodes, usually in the neck. The swollen nodes are typically not painful. Lymph nodes in the chest may also be stricken and can be detected via a chest x-ray.
An enlarged spleen, also known as splenomegaly is found in thirty percent of patients with Hodgkin’s Lymphoma. The swelling is rarely great. In five percent of patients, the liver can be enlarged.
Thirty percent of patients with Hodgkin’s lymphoma can also experience night sweats, weight loss, pruitis (itchy skin), fatigue and a low-grade fever. A cyclical high grade fever, referred to as Pel-Epstein fever can also be present. Fever and weight loss are systemic symptoms that are known as B symptoms.
Lymph nodes can swell as a reaction to infection and other types of cancer, so it is important to confirm the diagnosis unequivocally. Diagnosis is made from a lymph node biopsy. The procedure involves removing the suspected lymph node. A pathologist will examine the tissue. Blood tests will also be prescribed to determine functioning of major organs.
A PET scan, a CT scan and a Gallium scan are used to detect the extent of the lymphoma that is where it may have spread.
Hodgkin’s lymphoma has subtypes which are defined by the cellular presentation of the tissues affected. The tumor attributes will affect the choices in treatment. Every Hodgkin’s lymphoma patient will have tumor cells and Reed-Sternberg cells. Reed-Sternberg cells are named after Dorothy Reed and Carl Sternberg who first defined the microscopic presentation of Hodgkin’s lymphoma (at the time 1902, Hodgkin’s disease). Reed-Sternberg cells are large cells with multiple or bi-lobed nuclei. Reed-Sternberg cells are necessary for diagnosis of Hodgkin’s lymphoma, but are not exclusive to the diagnosis. These cells can also be noted in patients with non-Hodgkin’s lymphoma (though rarely) and reactive lymphadenopathies – such as infectious mononucleosis. In all subtypes of Hodgkin’s lymphoma, it is believed that the cancerous cells are malignant b-lymphocytes.
Nodular sclerosis is the most common subtype of this disease. The second most common subtype is mixed cellularity. Lymphocyte predominant and lymphocyte depletion are the other two subtypes and are rare subtypes.
Nodular sclerosis is known as Classical Hodgkin’s disease. Lymph nodes affected contain Reed-Sternberg cells and normal white cells. The lymph nodes also contain obvious scar tissue – sclerosis means scarring. This subtype is diagnosed in up to 75% of Hodgkin’s lymphoma patients. In mixed cellularity, the scaring is not evident and other other cells are present in the affected lymph nodes. This form of this disease affects mainly older adults, diagnosed in up to 15% of all Hodgkin’s lymphoma patients
Lymphocyte-rich is diagnosed in adults, and usually diagnosed early in its growth. Lymph nodes contain Reed-Sternberg cells and many normal lymphocytes. Lymphocyte depletion subtype has few normal lymphocytes, but a large amount of Reed-Sternberg cells in the affected lymph nodes. This disease is usually not diagnosed until later stages of the cancer. Both Lymphocyte-rich and Lymphocyte depletion account for 5% each of all diagnosis of this disease.
Determining the type of Hodgkin’s lymphoma and the stage of the cancer are important in determining treatment options. Staging of cancer involves determining if the cancer has spread and where it has spread whether the disease is progressive or recurrent.
Stage I means a single lymph node area is affected. Stage II is defined as two or more lymph node regions affected- on the same side of the diaphragm. Stage III is defined as two or more lymph nodes on both sides of the diaphragm. Stage IV defines Hodgkin’s lymphoma as affecting other organs or systems in the body besides the lymph system. Progressive Hodgkin’s lymphoma does not respond to treatment: meaning the cancer grows or spreads while receiving treatment. Recurrent Hodgkin’s Lymphoma means the disease has returned after treatments and usually it returns to it’s original site, but can appear in a different area of the body.
Patients who experience B symptoms, such as fever, weight loss or night sweats will have an additional clarifier of the stage of this disease: designated with a ‘B’. Patients who do not experience the B symptoms will have their cancer stage clarified with an ‘A”.
There are no known causes of Hodgkin’s lymphoma, but risk factors for getting the disease have been identified. Individuals who are infected with the Epstein-Barr virus (causes mono or mononucleosis) can have a slightly higher risk for this disease. A familial predisposition has been noted, meaning that the risk increases if another family member has this disease.
In the United States lymphoma is the third most common cancer for children aged ten to fourteen. Even though it is the third most common cancer, it is extremely rare. Seventeen hundred people under the age of twenty are diagnosed with lymphoma. Adolescents are more likely to get Hodgkin’s lymphoma than younger children.
There are four treatments for Hodgkin’s lymphoma are chemotherapy, bone marrow and peripheral blood transplants, immunotherapy and radiation therapy.
The goal of therapy is to achieve remission. Remission occurs when there are no traces of cancer in the body. The first stage of therapy is called induction. The second stage of therapy is called maintenance. After induction therapy, maintenance therapy is used to kill any hidden pockets or undetected cancer cells in the body.
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