Hodgkin's disease

What is Hodgkin's disease?

Hodgkin's disease is a lymphoma or a cancer of lymphatic tissue (lymph nodes and spleen). It occurs when the cells of those tissues multiply uncontrollably and destroy the normal structure of the lymphatic structures. It has no known cause but may be related to a virus infection. Hodgkin's disease usually begins as a painless swelling of the lymph nodes, and then progresses within the lymphatic system. It may also spread to the bone marrow and to non-lymphatic structures.

How is it diagnosed?

History: A painless mass in the neck is often the first symptom noted. Other symptoms such as fever, weight loss, or night sweats may occur in one-third of individuals.

Physical exam reveals enlarged lymph nodes, nearly always in the neck or armpit, but occasionally in the groin. The spleen might be enlarged, as well as the liver.

Tests: Definite diagnosis will require a tissue biopsy, preferably of an enlarged lymph node. Routine blood tests are not diagnostic. A chest x-ray will demonstrate any enlarged lymph nodes inside the chest.

How is Hodgkin's disease treated?

Once the diagnosis is made, treatment will depend on the stage of the disease. Stage I disease has only one region of lymph nodes involved (for example, disease that is confined to one side of the neck). In stage II, two regions of lymph nodes are involved, both of which are on the same side of the diaphragm (e. g. , neck and chest). In stage III, lymph node regions on both sides of the diaphragm are involved. Stage IV refers to disease that has spread to other organs such as bone marrow or liver. In addition, the stage is given the suffix A if no systemic symptoms like fever, weight loss, or night sweats are experienced and B if systemic symptoms are present.

Accurate staging may require several tests, including CT scan of the chest, abdomen, and pelvis; bone marrow biopsies; lymphangiography will occasionally be useful; and surgery to explore the abdomen (staging laparotomy), though controversial, may detect abdominal spread of Hodgkin's in one-third of individuals with State I or II disease above the diaphragm.

Individuals in the early stages (IA or IIA) usually receive radiation therapy. Those with advanced disease (stages IIIB and IV) receive chemotherapy with a combination of drugs. Treatment of the intermediate stages (IIB and IIIA) is controversial, but may combine radiation and chemotherapy.

Medications

What might complicate it?

Infections can occur due to depression of the immune system by treatment for Hodgkin's lymphoma or the disease itself. Radiation therapy to the neck can result in an underactive thyroid (hypothyroidism) several years later, or benign thyroid tumors seen twenty years or more later; cancers different from lymphomas can develop in the radiation field. Treatment complications from chemotherapy include heart or lung disorders and infertility. Psychological problems can occur with body image, self-esteem, and relationships.

Predicted outcome

Individuals who are diagnosed and treated in the early stages have an excellent prognosis, with ten- year survival rates between 80% and 95%. Most recurrences occur in the first two or three years after diagnosis, and can be effectively treated with chemotherapy. In general, the more advanced the stage, the poorer the prognosis.

Alternatives

Non-Hodgkin's lymphoma or other lymphomas, mononucleosis, HIV infection, lupus, or tuberculosis may share some of the same symptoms and signs of Hodgkin's.

Appropriate specialists

Hematologist, medical oncologist, radiation oncologist, and general surgeon.

Last updated 28 May 2015