Hodgkin's lymphoma is a cancer of the lymphatic tissue. This includes the lymph nodes, spleen, and bone marrow. The lymphatic system drains fluid from tissue and returns it to the blood. It plays an important role in the body's defense against infection.
What is going on in the body?
Hodgkin's lymphoma is a one of several types of cancer that can develop in a certain type of lymphatic cell called the "B-cell". It causes lymphatic organs to become enlarged and spreads to the bone marrow and other tissues.When a Reed-Sternberg cell, a large, unusual-looking lymphocyte, is seen in any tissue or blood specimen, it confirms the diagnosis of Hodgkin's lymphoma. However, in some forms of Hodgkin's lymphoma, the classic Reed-Sternberg cells are not identified but other closely related or "variant" cells may be instead.
Sometimes this malignancy grows and spreads very slowly. Other times it can progress rapidly. It can restrict itself to one lymph node area. At other times, all lymph nodes, as well as the liver, spleen, and bone marrow, become involved. Hodgkin's lymphoma rarely spreads to the bones, brain, or kidneys.
What are the causes and risks of the disease?
The cause and risks of developing Hodgkin's lymphoma are not fully known. Some cases have been linked to the Epstein-Barr virus. A virus or combination of viruses could damage certain susceptible immune cells. This damage may change the genes that are responsible for lymph cell growth and regulation.
Hodgkin's lymphoma appears to have some genetic predisposition. It seems to affect people from higher educational and socioeconomic backgrounds. People with immunodeficiency disorders, including AIDS, may be at risk. Some cases are linked to other unusual infections.Hodgkin's may occur years after a person is cured of leukemia, another type of blood cancer. 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 lymphoma are male.
What can be done to prevent the disease?
There is no practical way to prevent Hodgkin's lymphoma. Early diagnosis provides the best chance of a cure.
How is the disease diagnosed?
Hodgkin's lymphoma may be discovered when a person or the healthcare provider feels an enlarged lymph node. Diagnosis begins with a medical history and physical exam. However, a definite diagnosis cannot be made without the following:
- a biopsy of the enlarged mass
- a bone marrow biopsy
- a lymph node biopsy, which takes tissue from a lymph node to send to a laboratory for evaluation
- a test for Reed-Sternberg cells
As with other lymphomas, it is important to determine the stage of Hodgkin's lymphoma - that is, to what parts of the body, if any, the disease has spread. The tests listed below are used in staging:
- blood tumor marker tests
- bone marrow biopsy, usually on both sides of the pelvis
- chest X-ray
- complete blood count, or CBC
- CT scans of the chest, abdomen, and pelvis
- kidney function tests
- LDH and isoenzymes blood test, which measures tissue damage
- liver function tests
- Laparotomy (surgery) in some cases
Lymphoma stages are classified as I, II, III, and IV.
- Stage I is limited to one lymph node area in the body.
- Stage II involves two lymph node areas that are next to each other.
- Stage III involves lymph node areas on both sides of the diaphragm, the muscle between the chest and the abdomen.
- Stage IV involves widespread disease that affects other organs, such as the liver, spleen, bone marrow, bone, lung, central nervous system, and skin.
Staging can help predict treatment outcomes. Special laboratory testing called immune analysis can also help predict the outcome of lymphoma. This analysis looks at cell proteins and gene abnormalities. However, it is not always helpful in determining which treatment to use.
Long Term Effects
What are the long-term effects of the disease?
Thanks to the many advances in treatment over the past few decades, Hodgkin's lymphoma has one of the best cure rates of any cancer. A minority of patients recur, though the recurrences can happen even years after treatment. .
Treatment to relieve symptoms or pain is often helpful over the long term. Many people with Hodgkin's disease have lifelong 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?
Hodgkin's lymphoma is not contagious. It poses no risk to others.
What are the treatments for the disease?
Some of the treatment options for Hodgkin's lymphoma are as follows:
- chemotherapy, which uses chemicals or drugs to kill certain cells
- radiation therapy
- a combination of both radiation and 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, total body radiation, and an infusion of bone marrow from another person.
Hodgkin's lymphoma that recurs after radiation is often treated successfully with chemotherapy. If the spleen is involved, it may be removed with surgery.
What are the side effects of the treatments?
can cause these side effects:
- irritation of the esophagus or intestines
- lymphedema, which occurs when a fluid called lymph builds up and causes swelling of an extremity
- nausea and vomiting
- risk for other cancers
- skin burning
- temporarily lowered blood counts
can cause side effects such as the following:
- abnormal bleeding
- hair loss
- increased chance of needing blood transfusions
- lowered blood cell counts
- mouth and lip sores
- nausea and vomiting
- risk of infections
- stomach upset
These treatments also can cause damage to the following areas:
- bone marrow
- peripheral nerves
A combination of radiation and chemotherapy can cause more severe 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 diarrhea. Sometimes major organ failure occurs, 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. People who have had their spleen removed need to be vaccinated to prevent certain bacterial infections. Recommended vaccines include those for pneumonia,and, sometimes, meningococcal meningitis.
How is the disease monitored?
Because of the risk of recurrence of Hodgkin's disease, the healthcare provider will monitor a person for several years by doing the following:
- blood chemistry tests
- bone marrow biopsies
- bone scans
- CAT scans
- complete blood counts
- physical exams
Any new or worsening symptoms should be reported to the healthcare provider.