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Who's at risk?
What are the symptoms?
How is Hodgkin's disease diagnosed?
What are the stages?
How is it treated?
Hodgkin's disease is a kind of lymphoma - a cancer of the lymphatic system. The lymphatic system is part of the immune system, which helps the body fight infections and diseases. Lymphatic organs include the spleen, thymus, tonsils, bone marrow and lymph nodes. The lymphatic system transports "lymph," a fluid that contains some whole white blood cells, the residue of infections and cell breakdown. These materials may either be reused or further broken down and eliminated.
In the United States, about 7,800 new cases of Hodgkin's occur every year, with nearly 3,610 occurring in women and 4,190 occurring in men.
There are two types of lymphomas: Hodgkin's disease and Non-Hodgkin's disease. Symptoms of the two can be the same, such as enlarged lymph nodes (lumps in the armpit, neck, groin or extranodal sites), fever, night sweats and weight loss. However, there are major differences. Hodgkin's disease can occur at any age. Non-Hodgkin's lymphoma most often occurs in people over age 50; it also occurs in high-risk groups such as organ transplant recipients and patients who are immunosuppressed. Hodgkin's disease tumors appear less frequently than in Non-Hodgkin's disease. Another difference is that cells called Reed-Sternberg cells are seen in biopsy tissue by pathologists and are only present in patients who have Hodgkin's disease.
Who's at risk?
The exact causes of Hodgkin's disease are not known, although a virus etiology (cause) is suspected. Unlike many other types of cancer, Hodgkin's disease does not seem to be caused by something wrong with a person's genes or diet, or a cancer-causing agent (carcinogen) in the environment. Scientists, however, have discovered that Hodgkin's is associated with certain medical conditions as well as weakened immune systems. The strongest risk factors associated with Hodgkin's disease are:
- Having a weakened immune system due to human immunodeficiency virus (HIV) or medications to prevent rejection of a transplanted organ.
- Having the Epstein-Barr virus - the virus that can cause infectious mononucleosis ("mono")
- Having a family history - brothers and sisters of those with Hodgkin's disease have a higher-than-average chance of developing the disease
- Age - Hodgkin's disease occurs most often in two groups: young adults (ages 15 to 40) and older adults (age 55 and older)
- Gender - Hodgkin's disease affects more men than women
What are the symptoms?
A doctor should be seen if any of the following symptoms persist for longer than two weeks:
- Painless swelling in the neck, armpits and/or groin
- Cough
- Shortness of breath
- Chest pain
- Feeling of fullness or abdominal pain
- Night sweats (fever)
- Itching
- Unexplainable, significant loss of weight
- Fever, often every three to four days, occasionally as high as 105 degrees F (Pel-Epstein fever)
How is Hodgkin's disease diagnosed?
Hodgkin's disease can start in almost any part of the body because there is lymph tissue throughout the body. The cancer can spread to almost any body organ or tissue, including the liver, bone marrow, spleen and lungs.
Hodgkin's is diagnosed by taking a tissue sample (biopsy) and searching for the presence of Reed-Sternberg cells, cells specific to Hodgkin's disease. A needle biopsy is sometimes used, but a surgical biopsy (removal of a whole node), is preferred so that doctors are sure of getting enough tissue for a definite diagnosis.
Other tests a doctor may order include:
- A blood work-up may show anemia (reduced red blood cell count).
- A chest x-ray to view lymph nodes and to see if other organs are involved.
- A computerized tomography (CT or CAT) scan or magnetic resonance imaging (MRI) scan of the chest, pelvis, and abdomen to determine the possible spread of the disease.
- A positron emission tomography (PET) scan is often helpful in staging.
What are the stages?
Doctors identify four stages of Hodgkin's disease to determine the best treatment for each individual patient at each stage:
- Stage I - The disease is found only in the nodes in one spot.
- Stage II - The disease is in more than one spot, but only on one side of the diaphragm (the large thin muscle separating the chest from the abdomen).
- Stage III - The disease is found in the lymph nodes, both above and below the diaphragm.
- Stage IV - The disease has spread outside the lymph nodes to other organs.
The more advanced the disease stage, the more advanced the treatments need to be.
How is it treated?
Treatments for Hodgkin's disease are based on the following factors:
- Number, size and location of the affected lymph nodes in the body
- Whether the affected nodes are on one or both sides of the diaphragm
- Whether the disease has spread to the bone marrow, spleen, or places outside the lymph system, such as the liver
Treatments for Hodgkin's disease can involve radiation or chemotherapy, and may include both. Surgery is not a treatment option for Hodgkin's disease but is important for lymph node biopsy for diagnosis.
Radiation therapy is the use of high-energy waves (like X-rays) to kill cancer cells in the area of the body that is being treated. Most often, this treatment (which doesn't hurt or burn) is done to patients on an outpatient basis, taking several minutes and usually over a three to four week period.
Chemotherapy involves treating a patient with strong anticancer drugs to help kill abnormal, cancerous cells. Chemotherapy is usually given in cycles. This means a patient undergoes treatments with powerful medication on a number of different occasions, over a period of time. These treatments are repeated because chemotherapy not only kills cancerous cells, but also kills some healthy cells in the body, and healthy cells need time to heal from the effects of these strong chemicals. Not until the healthy cells start working again, will it be safe to receive another chemotherapy treatment to kill the remaining cancerous cells. This is checked (or followed) with periodic blood counts. Usually, a patient can receive chemotherapy as an outpatient. However, depending on the type of chemotherapy, he or she may have to stay overnight at the hospital.
Other Hodgkin's disease treatments being studied by scientists include:
- Bone marrow transplant - a procedure that replaces bone marrow destroyed by radiation or chemotherapy
- Peripheral stem cell transplant - a method of replacing blood-forming cells destroyed by strong treatments
- Biological therapies - treatments that stimulate or restore the immune system's ability to fight infection and disease
This article was reviewed and updated June 2007.
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