Hodgkin's Lymphoma

Hodgkin's Lymphoma: Overview

Hodgkin's disease is one of a group of cancers called lymphomas (cancers that develop in the lymphatic system).  Hodgkin's disease – an uncommon lymphoma – accounts for less than 1% of all cases of cancer in the US.  Other cancers of the lymphatic system are called non-Hodgkin's lymphomas.

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In Hodgkin's disease, cells in the lymphatic system become abnormal.  They divide too rapidly and grow without any order or control.  Because lymphatic tissue is present in many parts of the body, Hodgkin's disease can start almost anywhere.  Hodgkin's disease may occur in a single lymph node, a group of lymph nodes, or, sometimes, in other parts of the lymphatic system such as the bone marrow and spleen.  This type of cancer tends to spread in a fairly orderly way from one group of lymph nodes to the next group.  For example, Hodgkin's disease that arises in the lymph nodes in the neck spreads first to the nodes above the collarbones, and then to the lymph nodes under the arms and within the chest.  Eventually, it can spread to almost any other part of the body.

Causes and Development; Contributing Risk Factors

At the time of writing, the cause or causes of Hodgkin's disease are not known, and doctors can seldom explain why one person gets this disease and another does not.  It is clear, however, that Hodgkin's disease is not caused by an injury, and it is not contagious; no one can "catch" this disease from another person.

By studying patterns of cancer in the population, researchers have found certain risk factors that are more common in people who get Hodgkin's disease than in those who do not.  However, most people with these risk factors do not get Hodgkin's disease, and many who do get this disease have none of the known risk factors.

  • Age/Sex. Hodgkin's disease occurs most often in people between 15 and 34 and in people over the age of 55.  It is more common in men than in women.
  • Family History. Brothers and sisters of those with Hodgkin's disease have a higher-than-average chance of developing this disease.
  • Viruses. Epstein-Barr virus is an infectious agent that may be associated with an increased chance of getting Hodgkin's disease.

Signs and Symptoms

Symptoms of Hodgkin's disease may include the following:

  • A painless swelling in the lymph nodes in the neck, underarm, or groin
  • Unexplained recurrent fevers
  • Night sweats
  • Unexplained weight loss
  • Itchy skin.

When symptoms like these occur, they are not sure signs of Hodgkin's disease.  In most cases, they are actually caused by other, less serious conditions, such as the flu.  When symptoms like these persist, however, it is important to see a doctor: only a doctor can make a diagnosis of Hodgkin's disease.  Do not wait to feel pain; early Hodgkin's disease may not cause pain.

Diagnosis and Tests

If Hodgkin's disease is suspected, the doctor performs a physical exam, including feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged.  The doctor may order blood tests and other tests such as X-rays, CAT scan or MRI.

The final diagnosis depends on a biopsy, in which a surgeon removes a sample of lymphatic tissue (part or all of a lymph node) so that a pathologist can examine it under a microscope to check for cancer cells.  Other tissues may be sampled as well.  The pathologist studies the tissue and checks for Reed-Sternberg cells, large abnormal cells that are usually found with Hodgkin's disease.

If the biopsy reveals Hodgkin's disease, the doctor needs to learn the stage – or extent – of the disease.  Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected.  Treatment decisions depend on these findings.  The doctor considers the following to determine the stage of Hodgkin's disease:

  • The number and location of affected lymph nodes;
  • Whether the affected lymph nodes are on one or both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen); and
  • Whether the disease has spread to the bone marrow, spleen, or places outside the lymphatic system, such as the liver.

During staging, the doctor may use some of the same tests used for the diagnosis.  Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue.  A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone.  Rarely, an operation called a laparotomy may be performed.  During this operation, a surgeon makes an incision through the wall of the abdomen and removes samples of tissue.  A pathologist examines tissue samples under a microscope to check for cancer cells.

Treatment and Prevention

Treatment for Hodgkin's disease depends on the stage of the disease, the size of the enlarged lymph nodes, which symptoms are present, the age and general health of the patient, and other factors.

Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength.  Good nutrition often helps people feel better and have more energy.

Some people with cancer find it hard to eat a balanced diet because they may lose their appetite.  In addition, common side-effects of conventional treatment, such as nausea, vomiting, or mouth sores, can make eating difficult.  Often, foods taste different.  Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.

Prognosis

The prognosis for Hodgkin's disease can be affected by many factors, particularly the stage of the cancer, the patient's response to treatment, and the patient's age and general health.

Signs, symptoms & indicators of Hodgkin's Lymphoma:

Lab Values - Cells

(Highly) elevated eosinophil count

Hodgkin's lymphoma often causes severe eosinophilia.

Symptoms - Glandular

(Frequent/multiple) swollen cervical nodes

Hodgkin's lymphoma may present initially as painless lymph node enlargement, especially of the neck and above the collar bone.

Conditions that suggest Hodgkin's Lymphoma:

Skin-Hair-Nails

Risk factors for Hodgkin's Lymphoma:

Symptoms - Cancer

Symptoms - Environment

History of herbicide exposure

There is reasonable evidence suggesting occupational exposure to phenoxy herbicides could result in both Hodgkin's and non Hodgkin's lymphoma.  These compounds act as growth regulators and cause destructive proliferation of tissues in plants.

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Hodgkin's Lymphoma suggests the following may be present:

Tumors, Malignant

Hodgkin's Lymphoma can lead to:

Skin-Hair-Nails

Recommendations for Hodgkin's Lymphoma:

Drug

Hydrazine Sulfate

See the link between Cancer (General) and Hydrazine Sulfate.

Environmental

Mineral

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