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About Hodgkin's disease
Posted Tue, 30 May 2000
Hodgkin's disease, also known as Hodgkin's lymphoma, is a relatively common, potentially curable cancer. Unlike the non-Hodgkin's lymphomas, the incidence does not increase with age. There are two main peaks of occurence, one between the ages of 15 to 35, and the other after the age of 50. In developing countries, the first peak is shifted into childhood.
The illness is more common in men, particularly young adults.
Are there risk factors for Hodgkin's lymphoma?
There do seem to be clusters of Hodgkin's patients. Increased risk has been associated with having few siblings, single family dwellings, a decreased number of playmates, having a brother or sister with Hodgkin's, having your tonsills out and certain of the HLA antigens.
There is a strong chance that Hodgkin's is caused by a cancer causing virus, and there is an increased risk of the disease among those with immunodeficiencies, such as HIV and autoimmune diseases.
What are the symptoms of Hodkin's lymphoma?
Most people first notice a lump in their neck or upper body. These are not painful and are generally mobile and firm, and are caused by enlarged lypmph glands. Because they are not painful, people often don't notice these lymph glands until they are quite large. About 50% of people have enlargement of the lymph glands in their chest as the first sign, often picked up on routine chest x-ray.
In a very small percentage of patients, these enlarged glands become painful after drinking alcohol.
Many people have no symptoms at all, simply noticing the lump caused by enlarged glands. But, 25 to 40% have a low grade fever associated with recurrent night sweats. Some may only have night sweats. These fevers may persist for several weeks, followed by symptom free intervals. These fevers and night sweats are more common in older patients and in those with advanced disease.
Another important symptom loss of more than 10% of body weight.
The combination of fever, night sweats, and weight loss are known as B symptoms.
People may also complain of malaise, fatigue and weakness.
How is Hodgkin's lymphoma diagnosed?
Diagnosis is by biopsy, usually by surgically removing the gland since a lot of tissue is needed to accurately see the characteristic features of Hodkin's under the microscope.
Once diagnosed, Hodgkin's is classified according the the so-called Rye classification, important in treatment.
There are four types of Hodgkin's lymphoma according to the Rye classification:
- Lymphocyte-predominant
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte-depleted
These distinctions are made by looking at the cells from the biopsied lymph nodes under the microscope.
Each of these types is efectively a distinct type of the disease, with different natural histories. Nodular sclerosis and those of mixed cellularity are the most common types while the lymphocyte-predominant and lymphocyte-depleted type are both rare. The only type in which the prognosis is poor is lymphocyte-depleted.
In Hodkin's lymphoma, treatment and prognosis are dependent entirely on the stage of the disease, that is, to what extent it has spread.
Most people will have a chest x-ray and a CAT scan of the chest and abdomen after diagnosis, to tell if there is any spread from the original lymph nodes. A few people will need more invasive investigations such as lymphograms in which a dye is injected into the lymphatic system and then followed using radiographic techniques.
How is Hodgkin's disease treated?
All patients with Hodgkin's should be treated as curable. The exact method of treatment will vary with the stage of the disease. Radiotherapy alone may cure at least 80% of patients with localised disease, and chemotherapy more than 50% of those with disease which has spread.
As with all cancers treatment is constantly being re-evaluated to improve survival and minimise side effects.
Links
There are many sites dealing with cancers of all types. This list is not meant to be comprehensive but will provide starting points from which further searches can be made. The British site, the Cancer Web Project is worth a look, providing plenty of information on cancer in general and allowing searches for specific types of cancer. Another British site is Cancer Help UK, which provides information specifically for cancer patients and their families. Medicine Net promises state of the art medical information and is an excellent resource.
