Hodgkin's Disease

Hodgkin’s disease is a type of lymphoma. Lymphoma is a blood cancer that starts in the lymphatic system. The lymphatic system helps the immune system get rid of waste and fight infections. There are two main types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

Hodgkin’s disease (HD) is also called Hodgkin disease, Hodgkin lymphoma, or Hodgkin’s lymphoma. The disease was named after its discoverer, Dr. Thomas Hodgkin. The cancer originates in white blood cells called lymphocytes. These cells help the body fight infection.

HD can occur at any age but is most prevalent between the ages of 15 and 40 and after the age of 55, according to the American Cancer Society (ACS, 2012). HD originates most often in the lymph nodes of the chest, neck, and underarms.

There are two main types of HD: classic Hodgkin’s disease and nodular lymphocyte predominant Hodgkin’s disease. Classic HD has several subtypes and comprises approximately 95 percent of all diagnoses of HD in developed countries (ACS, 2012). While the main cause of HD is unknown, there have been links to environmental exposures as well as to the Epstein-Barr virus, which causes mononucleosis.

The overall survival rate for HD has increased due to advances in treatment. According to the American Cancer Society, the five-year and 10-year survival rates for the disease are approximately 85 percent and 81 percent, respectively (ACS, 2012).

Although the most common symptom of HD is painless swelling of the lymph nodes, there are other signs that can indicate HD, including:

• night sweats
• itchy skin
• unexplained fever
• fatigue
• unintended weight loss
• persistent cough
• pain in the lymph nodes after consuming alcohol
• enlarged spleen

If you have any of these symptoms, see your doctor. They can be signs of other conditions as well, and it is important to get an accurate diagnosis.

Diagnosis

To diagnose Hodgkin’s disease, your doctor will perform a physical examination and ask you about your medical history. Tests may be ordered to get a more definitive diagnosis, including:

• lymph node biopsy (involves removing a piece of lymph node tissue to test for the presence of abnormal cells)
• imaging tests, such as X-rays or CT scans
• blood tests such as a complete blood count (CBC) and others to measure levels of red and white blood cells, platelets, uric acid, and blood protein.
• immunophenotyping to determine what kind of lymphoma cells are present
• lung function tests to determine how well the lungs are working
• echocardiogram to determine how well the heart is working
• bone marrow biopsy which involves removal and examination of a small sample of cells from inside your hip or other large bone to see if the cancer has spread

Staging

Once a diagnosis of HD is established, the cancer is then staged. Staging describes the location and spread of disease. There are four general stages of HD, from Stage I to Stage IV, in ascending severity.

• Stage I (early stage): cancer is found in one lymph node region
• Stage II (locally advanced disease): cancer is found in two lymph regions on one side of the diaphragm, or is found in one lymph region plus a nearby area or organ
• Stage III (advanced disease): cancer is found in lymph node areas both above and below the diaphragm or it is found in one lymph node area and one organ on opposite sides of the diaphragm
• Stage IV (widespread disease): cancer is outside the lymph nodes and spleen, and has spread to one or more areas such as bone, bone marrow, skin, or organs

There are also subcategories in each stage, depending on the symptoms and affected organs.

Treatment for HD typically depends on the stage of the disease. The main treatment options are chemotherapy and radiation. Chemotherapy involves using medications that kill cancer cells. These drugs can be given orally or intravenously, depending on the specific medication. Radiation involves using high-energy rays directed at the cancer cells.

For patients who do not respond to chemotherapy or radiation, high-dose chemotherapy and a stem cell transplant may be used. A stem cell transplant replaces cancerous blood-forming cells in your body with healthy blood-forming cells from a donor.

In early stage nodular lymphocyte predominant Hodgkin’s disease (NLPHD), radiation alone may be used. This is because NLPHD tends to be slower growing than classic HD. In advanced stages, targeted therapeutic drugs may be added to the chemotherapy regimen.

Treatments for cancer can have long-term side effects, including increasing your risk for developing other types of cancer. After treatment for HD, it is important to continue with follow-up care to check for any signs of recurrence, as well as for any possible long-term effects from treatment. Radiation to the chest can increase your risk of breast cancer, lung cancer, heart disease, and high cholesterol. Regular mammograms, cholesterol tests, and heart disease screenings are important for survivors of HD.

Talk with your doctor about any concerns you have about long-term side effects and what you can do to help reduce your risk. Support groups and counseling can help you manage your anxiety and give you a place to discuss concerns and feelings about your cancer experience.

Advances in the treatment of Hodgkin’s disease over the past few decades have greatly increased the survival rate for this type of lymphoma. The relative survival rates for all patients diagnosed with Hodgkin’s disease are as follows (ACS, 2012):

• 1-year survival rate: about 92 percent
• 5-year survival rate: about 85 percent
• 10-year survival rate: about 81 percent

These rates vary depending on the stage of the disease and the age of the patient. The five-year survival rates for the different stages are: (ACS, 2012)

• 5-year survival rate for Stage I HD = about 90 percent
• 5-year survival rate for Stage II HD = about 90 percent
• 5-year survival rate for Stage III HD = about 80 percent
• 5-year survival rate for Stage IV HD = about 65 percent

After treatment, your doctor will want to follow up with you on a regular basis. Be sure to keep all medical appointments and follow your doctor’s instructions.