|
 |
|
|
|
|
|
Hodgkin's lymphoma Alternative Names
Hodgkin's disease
Definition
Hodgkin's lymphoma is a cancer of the lymphatic tissue, which includes the lymph nodes, spleen, and bone marrow.
What is going on in the body?
Hodgkin's disease, or HD, 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 disease.
Sometimes Hodgkin's disease 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, and the liver, spleen, and bone marrow become involved. Hodgkin's disease rarely spreads to the bones, brain, and kidneys.
This disease is linked to overall immune deficiencies and unusual infections. It can also occur years after another cancer of the blood, called leukaemia, is cured. It can be a highly curable cancer and there have been many advancements made in treating it. 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 disease are male.
What are the signs and symptoms of the disease?
Possible symptoms include: - enlarged lymph nodes
- enlarged liver or spleen
- fatigue
- weight loss
- pain
- night sweats
- unexplained fever
Other symptoms can be related to the size and location of the Hodgkin's masses.
These include: - chest pain
- difficulty with lung function and shortness of breath
- fluid build-up in the lungs
- inflammation of the membrane that covers the heart, which is called pericarditis
- obstruction of large blood vessels, especially in the chest
- unusual skin rashes
The bone marrow is usually not involved. If it is, it can cause anaemia, or a decrease in red blood cells, low platelet count, and low levels of other white blood cells. Viral infections, including herpes zoster, which is a severe infection causing skin blisters, can occur.
What are the causes and risks of the disease?
The cause and risks of developing Hodgkin's disease are not known.
There is some thought that it might be caused by a virus, possibly the Epstein-Barr virus. A virus or combination of viruses could damage certain susceptible immune cells, and change the genes that are responsible for lymph cell growth and regulation. How this would work is being studied.
Hodgkin's may be genetic. It seems to affect people with a higher education and socio-economic level. People with a number of immune deficiency disorders, including AIDS, may be at risk.
What can be done to prevent the disease?
There is no way to prevent this disease. Early diagnosis provides the best chance of a cure.
How is the disease diagnosed?
Usually this disease is discovered when a person or the doctor feels an enlarged lymph node. But a definite diagnosis cannot be made without: - a lymph node biopsy, which takes tissue from a lymph node to send to a laboratory for evaluation
- a biopsy of the enlarged mass
- a bone marrow biopsy
- a test for Reed-Sternberg cells
What are the long-term effects of the disease?
While Hodgkin's disease can recur at any point and the disease may not be curable, the systematic approach to treatment of 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 life-long 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?
There is no risk to other people.
What are the treatments for the disease?
Everyone with this disease, whether it is contained or has spread, needs either: - radiation, which uses radioactive waves to kill certain cells
- chemotherapy, which uses chemicals or drugs to kill certain cells
- a combination of both radiation and chemotherapy
Which treatment is chosen depends on the location of the cancer and whether or not it has spread.
Hodgkin's lymphoma that recurs after radiation is often treated successfully with 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 and/or sometimes total body radiation, and an infusion of their own stored bone marrow cells.
People who have had their spleen removed need to be vaccinated to prevent certain bacterial infections, including pneumonia, Haemophilus influenza, and, sometimes, meningococcal meningitis.
What are the side effects of the treatments?
Radiation can cause: - skin burning
- nausea and vomiting
- irritation of the oesophagus or intestines
- lymphoedema, which occurs when a clear, thin fluid called lymph builds up and causes swelling of an extremity
- temporarily lowered blood counts
- a risk for other cancers
Chemotherapy can cause: - hair loss
- nausea and vomiting
- lowered blood counts
- an increased risk of needing blood transfusions
- a risk of infections
- abnormal bleeding
- stomach upset
- fatigue
These treatments also can cause damage to: - the heart
- the liver
- the kidneys
- the lungs
- the bone marrow
- peripheral nerves
A combination of radiation and chemotherapy can increase the severity of 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 diarrhoea. 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.
How is the disease monitored?
Hodgkin's disease sometimes recurs. For this reason, doctors will monitor a person for several years by doing: Author: Thomas Fisher, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
|
|
| |
|
|
|
|
|
|
|
|
