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Hodgkin's Lymphoma

Definition

Hodgkin's lymphoma is a cancer of the lymphatic system. The lymphatic system drains excess fluid from the blood and protects against infection. Hodgkin's lymphoma is different from other forms of lymphoma .

The Lymphatic Organs

The Lymphatic Organs

© 2008 Nucleus Medical Art, Inc.

Cancer occurs when cells in the body (in this case a type of white blood cell called lymphocyte) divide without control or order. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and can spread to other parts of the body. A benign tumor does not invade or spread.

Causes

The cause of Hodgkin's lymphoma is unknown. It is likely related to complex genetic and environmental factors that lead to alteration of the immune system. There are some compelling pieces of data to suggest that it is caused by a virus, and the Epstein-Barr virus (EBV) has been considered.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Sex: male
  • Ages: 15-40 and over 55
  • Family history
  • History of infectious mononucleosis or infection with Epstein-Barr virus, the causative agent of mononucleosis
  • Weakened immune system, including infection with HIV or the presence of AIDS
  • Prolonged use of human growth hormone

Symptoms

Symptoms include:

  • Painless swelling of the lymph nodes in the neck, armpit, or groin
  • Persistent fatigue
  • Night sweating
  • Coughing
  • Unexplained fever
  • Weight loss
  • Itching
  • Decreased appetite

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will carefully examine your lymph nodes. Most enlarged or swollen lymph nodes result from infection, not lymphomas. If infection is suspected, you may be given medication and instructed to return for re-examination.

If swelling persists, your doctor may order a lymph node biopsy . The biopsy results will show whether there is cancer, and if so, the type and extent of the cancer that is present.

Treatment of Hodgkin’s disease depends on the stage of the disease: how far the cancer has spread and what organs are affected. In general, this means that staging tests to evaluate the condition of the lymph nodes in the body, the liver, spleen, and bone marrow must be done.

In addition:

  • Blood tests are done to establish the condition of the liver and blood.
  • CT scans are done to evaluate the lymph nodes.
  • Positive Emission Tomography (PET scanning) is an extremely sensitive way of evaluating the spread of the disease.
  • Gallium scanning may also be done.
  • In some cases, the patient may undergo abdominal surgery to remove the spleen and to biopsy the liver, but this is much less common today than in the past because of the accuracy of noninvasive scans.

Treatment

Hodgkin's lymphoma is generally considered one of the more curable forms of cancer. The two primary ways of treating this cancer are:

Chemotherapy and External Radiation Therapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

In radiation therapy, radiation is directed at the tumor from a source outside the body to kill the cancer cells.

In many cases, both chemotherapy and radiation are used to cure a patient of Hodgkin’s lymphoma. The choice of treatments will be based on the extent of disease (the stage), the location of the affected lymph node(s), and many other patient-related features that your doctor will discuss with you.

It is very important that you be seen by both the medical oncologist to discuss chemotherapy and the radiation oncologist to discuss the radiation therapy. It is not wise to see only one of these specialists, since the best treatment results come from a discussion and integrated approach.

If the cancer does not respond to chemotherapy or radiation, the outcome is usually very poor. There are some “salvage” treatment options available including:

Bone Marrow Transplantation

Bone marrow is removed, treated, and frozen. Large doses of chemotherapy and/or radiation therapy are then applied to kill the cancer cells. After treatment, the bone marrow is replaced via a vein. Transplanted bone marrow may be the patient's bone marrow that was treated to remove cancer cells or marrow from a healthy donor.

Peripheral Stem Cell Transplantation (PSCT)

Stem cells (very immature cells that produce blood cells) are removed from circulating blood before chemotherapy or radiation treatment, and then replaced after treatment.

Prevention

There are no guidelines for preventing Hodgkin's lymphoma because the cause is unknown.

RESOURCES:

American Cancer Society
http://www.cancer.org

National Cancer Institute, National Institutes of Health (NIH)
http://www.cancer.gov

CANADIAN RESOURCES:

BC Cancer Agency
http://www.bccancer.bc.ca/default.htm

Canadian Cancer Society
http://www.cancer.ca

References:

American Cancer Society website. Available at: http://www.cancer.org .

Harrison's Principles of Internal Medicine . 16th ed. McGraw Hill; 2000.



Last reviewed February 2008 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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