Hodgkin's Disease

Hodgkin's disease is a type of lymphoma. Lymphoma (say: lim- foh -mah) is cancer of the lymphatic system and is the third most common type of cancer in kids and teens ages 10 to 14. But it is still very rare for kids to get it.

A neoplastic disease, Hodgkin's disease is characterized by painless, progressive enlargement of lymph nodes, spleen, and other lymphoid tissue resulting from proliferation of lymphocytes, histiocytes, eosinophils, and Reed-Sternberg giant cells. The latter cells are its special histologic feature.

Untreated, Hodgkin's disease follows a variable but relentlessly progressive and ultimately fatal course. Advances in therapy have made Hodgkin's disease potentially curable, even in advanced stages, and appropriate treatment yields a 5-year survival rate of about 90%.

In the United States, approximately 1,700 children and adolescents younger than 20 are diagnosed with lymphomas each year. For younger children, non-Hodgkins lymphoma is more common than Hodgkin's disease, but the reverse is true for adolescents.

Causes

No one really knows what causes Hodgkin's disease, but we do know that it can't be caused by getting someone else's germs or by eating the wrong foods. People who have had Epstein-Barr virus, which can cause infectious mononucleosis (mono), may be at a slightly higher risk for Hodgkin's. There is a slightly increased risk of Hodgkin's among family members of patients who carry the disease.

Signs and symptoms

Symptoms vary, depending on the stage of the disease.

Early signs : The first sign of Hodgkin's disease is usually a painless swelling of one of the cervical lymph nodes (but sometimes the axillary, mediastinal, or inguinal lymph nodes), occasionally in a patient who has a history of recent upper respiratory tract infection.

In older patients, the first symptoms may be nonspecific: persistent fever, night sweats, fatigue, weight loss, and malaise. Rarely, if the mediastinum is initially involved, Hodgkin's disease may produce respiratory symptoms.

Another early and characteristic indication of Hodgkin's disease is pruritus, which, although mild at first, becomes acute as the disease progresses. Other symptoms depend on the degree and location of systemic involvement.

Lymph nodes may enlarge rapidly, producing pain and obstruction, or slowly and painlessly for months or years. It's not unusual to see the lymph nodes "wax and wane," but they usually don't return to normal.

Late signs : Sooner or later, most patients develop systemic manifestations, including enlargement of retroperitoneal nodes and nodular infiltrations of the spleen, liver, and bones. At this late stage, other symptoms include edema of the face and neck, progressive anemia, possibly jaundice, nerve pain, and increased susceptibility to infection.

Diagnosis

Your doctor may perform a series of tests to determine if you have Hodgkin's Disease. The tests may include, blood tests, x-rays, ct scans, and/or and MRI.

• CT (or CAT) scan : A series of detailed pictures of areas inside the body.
• MRI (magnetic resonance imaging) : Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.

Treatment

Appropriate therapy (chemotherapy, radiation therapy, or both, depending on the stage of the disease) is based on a careful physical examination with accurate histologic interpretation and proper clinical staging. Correct and timely treatment allows longer survival and even induces an apparent cure in many patients.

Chemotherapy and radiation therapy

Radiation therapy is used alone for stage I and stage II and in combination with chemotherapy for stage III. Chemotherapy is used for stage IV, sometimes inducing a complete remission. The well-known MOPP protocol (mechlorethamine, vincristine (Oncovin), procarbazine, and prednisone) was the first to provide significant cures in patients with generalized Hodgkin's disease.

Another useful combination is ABVD (doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine). Treatment with these drugs may require concomitant anti emetics, sedatives, or antidiarrheals to combat G1 adverse effects.

Other treatments

New treatments include high-dose chemotherapeutic agents with autologous bone marrow transplantation or autologous peripheral blood stem cell transfusions. Biotherapy alone hasn't proved effective.

Prevention

While there are no preventive measures for Hodgkin's Disease, early diagnosis is important to a full recovery. Report any Hodgkin's-like symptoms that persist to your health care provider and be sure to follow the full course of treatment that is recommended.

After being treated for Hodgkin's lymphoma, the doctor may recommend follow-up examinations for several years to detect a return of the disease or the development of another cancer, a possible side affect of treatment. Advances in radiation therapy and chemotherapy are enabling many patients to survive this once dreaded disease.