• Hodgkin's Lymphoma—Adult

    (Hodgkin's Disease—Adult)

    Definition

    Hodgkin's lymphoma is a cancer of the lymphatic system. The lymphatic system drains excess fluid from the blood and protects against infection. Hodgkin's lymphoma is different from other forms of lymphoma.
    The Lymphatic Organs
    The Lymphatic Organs
    Copyright © Nucleus Medical Media, Inc.
    Cancer occurs when cells in the body (in this case a type of white blood cell called lymphocyte) divide without control or order. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and can spread to other parts of the body. A benign tumor does not invade or spread.

    Causes

    The cause of Hodgkin's lymphoma is unknown. It is likely related to complex genetic and environmental factors that lead to alteration of the immune system. There are some compelling pieces of data to suggest that it is caused by a virus, and the Epstein-Barr virus (EBV) has been considered.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    Risk factors include:
    • Sex: male
    • Ages: 15-40 and over 55
    • Family history
    • History of infectious mononucleosis or infection with Epstein-Barr virus, the causative agent of mononucleosis
    • Weakened immune system, including infection with HIV or the presence of AIDS

    Symptoms

    Symptoms include:
    • Painless swelling of the lymph nodes in the neck, armpit, or groin
    • Persistent fatigue
    • Night sweating
    • Coughing
    • Unexplained fever
    • Weight loss
    • Itching
    • Decreased appetite

    Diagnosis

    The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will carefully examine your lymph nodes. Most enlarged or swollen lymph nodes result from infection, not lymphomas. If infection is suspected, you may be given medication and instructed to return for re-examination.
    If swelling persists, your doctor may order a lymph node biopsy. The biopsy results will show whether there is cancer, and if so, the type and extent of the cancer that is present.
    Treatment of Hodgkin’s disease depends on the stage of the disease: how far the cancer has spread and what organs are affected. In general, this means that staging tests to evaluate the condition of the lymph nodes in the body, the liver, spleen, and bone marrow must be done.
    In addition:
    • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body; done to evaluate the lymph nodes
    • Blood tests—to establish the condition of the liver and blood
    • PET/CT scan—an extremely sensitive way of evaluating the spread of the disease
    • Gallium scan—a test that uses a radioactive compound to scan and take pictures of your body
    • Abdominal surgery to remove the spleen and to biopsy the liver—much less common because of the accuracy of noninvasive scans

    Treatment

    Hodgkin's lymphoma is generally considered one of the more curable forms of cancer. Treatment options include:

    Chemotherapy and External Radiation Therapy

    Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.
    In radiation therapy, radiation is directed at the tumor from a source outside the body to kill the cancer cells.
    In many cases, both chemotherapy and radiation are used to cure a patient of Hodgkin’s lymphoma. The choice of treatments will be based on:
    • Extent of disease (the stage)
    • Location of the affected lymph node(s)
    • Many other patient-related features that your doctor will discuss with you
    It is very important that you be seen by both the medical oncologist to discuss chemotherapy and the radiation oncologist to discuss the radiation therapy. It is not wise to see only one of these specialists since the best treatment results come from a discussion and integrated approach.
    If the cancer does not respond to chemotherapy or radiation, the outcome is usually very poor. There are some treatment options available, including:
    • Bone marrow transplantation—Bone marrow is removed, treated, and frozen. Large doses of chemotherapy and/or radiation therapy are then applied to kill the cancer cells. After treatment, the bone marrow is replaced via a vein. Transplanted bone marrow may be the patient's bone marrow that was treated to remove cancer cells or marrow from a healthy donor.
    • Peripheral blood stem cell transplantation—Stem cells (very immature cells that produce blood cells) are removed from circulating blood before chemotherapy or radiation treatment and then replaced after treatment.

    Splenectomy

    Splenectomy is the surgical removal of the spleen, an organ that is part of the lymphatic system. In some cases, the doctor may recommend a splenectomy in people who have lymphoma.

    Prevention

    There are no guidelines for preventing Hodgkin's lymphoma because the cause is unknown.

    RESOURCES

    American Cancer Society http://www.cancer.org

    National Cancer Institute http://www.cancer.gov

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    Lymphoma Foundation Canada http://www.lymphoma.ca

    References

    Braunwald E. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw Hill; 2005.

    Editorial staff and contributors. Splenectomy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated November 2, 2009. Accessed July 15, 2010.

    Hodgkin disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated July 14, 2010. Accessed July 15, 2010.

    The Society for Surgery of the Alimentary Tract. Indications for splenectomy. The Society for Surgery of the Alimentary Tract website. Available at: http://www.ssat.com/cgi-bin/spleen7.cgi. Accesed July 15, 2010.

    What is hodgkin disease? American Cancer Society website. Available at: http://www.cancer.org/cancer/hodgkindisease/index. Accessed July 1, 2009.

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