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This website is not intended as a substitute for professional medical advice and does not address specific treatments or conditions specific to any patient. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. The information on this website is subject to change.
The information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.
WHAT IS HODGKIN'S DISEASE?
Hodgkin's disease is a type of lymphoma. Lymphomas are cancers that develop in the lymphatic system, a part of the body's immune system. The job of the lymphatic system is to help fight diseases and infection.
The lymphatic system includes a network of thin tubes that branch, like blood vessels, into the tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are groups of small, bean-shaped organs called lymph nodes that filter the lymph as it passes through the nodes. Clusters of lymph nodes are found in the underarm, groin, neck, and abdomen. Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow.
Like all types of cancer, Hodgkin's disease affects the body's cells. Healthy cells grow, divide, and replace themselves in an orderly manner. This process keeps the body in good repair. In Hodgkin's disease, cells in the lymphatic system grow abnormally and can spread to other organs. As the disease progresses, the body is less able to fight infection.
Hodgkin's disease is rare. It accounts for less than 1 percent of all cases of cancer in this country. It is most often seen in young people aged 15 to 34 and in people over the age of 55. Other cancers of the lymphatic system are called non-Hodgkin's lymphomas.
WHAT ARE SYMPTOMS OF HODGKIN'S DISEASE?
The most common symptom of Hodgkin's disease is a painless swelling in the lymph nodes in the neck, underarm, or groin. Other symptoms may include fevers, night sweats, tiredness, weight loss, or itching skin. However, these symptoms are not sure signs of cancer. They may also be caused by many common illnesses, such as the flu or other infections. But it is important to see a doctor if any of these symptoms lasts longer than 2 weeks. Any illness should be diagnosed and treated as early as possible, and this is especially true of Hodgkin's disease.
HOW IS HODGKIN'S DISEASE DIAGNOSED?
If Hodgkin's disease is suspected, the doctor will ask about the patient's medical history and will perform a thorough physical exam. Blood tests and x-rays of the chest, bones, liver, and spleen will also be done.
Tissue from an enlarged lymph node will be removed. This is known as a biopsy and is the only sure way to tell if cancer is present. A pathologist will look at the tissue under the microscope for Reed-Sternberg cells, abnormal cells that are usually found with Hodgkin's disease. When Hodgkin's disease is diagnosed, the doctor needs to know the stage, or extent, of the disease. Knowing the stage is very important for planning treatment. The stage indicates where the disease has spread and how much tissue is affected. In staging, the following are checked:
- The number and location of affected lymph nodes
- Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen)
- Whether the disease has spread to the bone marrow, to the spleen, or to places outside the lymphatic system, such as the liver
In staging, the doctor usually order several tests, including biopsies of the lymph nodes, liver, and bone marrow. Many patients have lymphangiograms, x-rays of the lymphatic system using a special dye to outline the lymph nodes and vessels. Another test is computed tomography (also called CT or CAT scan), a series of x-rays of cross-sections of the body.
HOW IS HODGKIN'S DISEASE TREATED?
Treatment for Hodgkin's disease usually includes radiation therapy or chemotherapy. Sometimes, both are given. Treatment decisions depend on the stage of disease, its location in the body, which symptoms are present, and the general health and age of the patient (treatment for children with Hodgkin's disease is more complex and is not discussed here).
Often, patients are referred to doctors or medical centers that specialize in the different treatments of Hodgkin's disease. Also, patients may want to talk with their doctor about taking part in a research study of new treatment methods.
Radiation therapy uses high-energy rays to damage cancer cells and stop their growth. Radiation therapy is generally given in a hospital or clinic. Most often, patients receive radiation therapy 5 days a week for several weeks as outpatients.
Chemotherapy is the use of drugs to kill cancer cells. To treat Hodgkin's disease, the doctor prescribes a combination of drugs that work together. The drugs may be given in different ways: Some are given by mouth; others are injected into an artery, vein, or muscle. The drugs travel through the bloodstream to almost every part of the body. Chemotherapy is usually given in cycles: a treatment period followed by a rest period, then another treatment period, and so on.
WHAT ARE THE SIDE EFFECTS OF TREATMENT FOR HODGKIN'S DISEASE?
The methods used to treat Hodgkin's disease are very powerful. That is why the treatment often causes side effects - both short-term and permanent. Side effects depend on the type of treatment and on the part of the body being treated. Also, each patient may respond differently.
During radiation therapy, patients can become unusually tired as therapy continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the area being treated are common. Patients should be gentle with the treated area of skin. Lotions and creams should not be used without the doctor's advice. When the chest is treated, patients can have a dry, sore throat and have trouble swallowing. Sometimes they have shortness of breath or a dry cough. Radiation treatment to the lower abdomen can cause nausea, vomiting, or diarrhea. Some patients have tingling or numbness in their arms, legs, and lower back. These side effects gradually disappear when treatment is over.
The side effects of chemotherapy depend mainly on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, such as blood cells that fight infection, cells that line the digestive tract, and cells in the hair follicles. As a result, patients can have side effects such as a lowered resistance to infection, nausea, vomiting, or mouth sores. They can also have less energy and may their hair.
Loss of appetite can be a problem for patients receiving radiation therapy or chemotherapy. Researchers are learning that patients who eat well may be better able to tolerate the side effects of their treatment. Therefore, nutrition is an important part of the treatment plan. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles, and organs. Many patients find that eating several small meals and snacks throughout the day is easier than trying to have three large meals.
Treatment for Hodgkin's disease can cause fertility problems. Women's menstrual periods may stop. Periods are more likely to return in younger women. In men, both Hodgkin's disease and its treatment can affect fertility. Younger men are more likely to regain their fertility. Sperm banking before treatment can be an option for some men.
The side effects that patients have during cancer therapy vary from person to person and may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
WHAT HAPPENS AFTER TREATMENT FOR HODGKIN'S DISEASE?
Regular follow-up exams are very important for anyone who has been treated for Hodgkin's disease. The doctor will want to continue to watch the patient closely for several years. Generally, checkups include a thorough physical exam, x-rays, blood tests, and other laboratory tests.
Patients treated for Hodgkin's disease have an increased risk of developing other types of cancer later in life, especially leukemia. Patients should follow their doctor's recommendations on health care and checkups. Having regular checkups allows problems to be detected and treated promptly if they should arise.
When people have cancer, life can change for them and for the people who care about them. These changes in daily life can be difficult to handle. It is natural for a person with Hodgkin's disease to have many different and sometimes confusing emotions.
At times, patients and family members may be depressed, angry, or frightened. At other times, feelings may vary from hope to despair or from courage to fear. Patients usually are better able to cope with their emotions if they can talk openly about their illness and their feelings with family members and friends.
Concerns about the future, as well as about medical tests, treatments, a hospital stay, and medical bills, are common. Talking to doctors, nurses, or other members of the health care team can help to ease fear and confusion. Patients can take an active part in decisions about their medical care by asking questions about their treatment. Patients and family members often find it helpful to write down questions for the doctor as they think of them. Taking notes during visits to the doctor can help them remember what was said. Patients should ask the doctor to explain anything that is not clear.
Patients have many important questions to ask about their disease, and their doctor is the best person to provide answers. Most people want to learn how Hodgkin's disease can be treated, how successful the treatment is likely to be, and how much the treatment is expected to cost.
The patient's doctor is the best person to give advice about working or limiting other activities, but it may be hard for some people to talk to the doctor about their feelings and other very personal matters. Many patients find it helpful to talk with others who are facing similar problems. This kind of help is available through cancer-related support groups. It also may be helpful to talk with a nurse, social worker, counselor, or member of the clergy.
WHAT DOES THE FUTURE HOLD FOR PATIENTS WITH HODGKIN'S DISEASE?
More than 8 million Americans living today have had some type of cancer. Thirty years ago, few patients with Hodgkin's disease recovered from their illness. Now, because of modern radiation therapy and combination chemotherapy, more than 75 percent of all newly diagnosed Hodgkin's disease patients are curable. The chances for recovery continue to improve as scientists find new and more effective treatments.
Doctors often talk about "surviving" cancer, or they may use the word "remission" rather than "cure." Even though many patients recover completely, doctors use these terms because Hodgkin's disease can recur. Patients are naturally concerned about their future and may try to use statistics they have read or heard about to try to figure out their own chances of being cured. It is important to remember, however, that statistics are averages based on the experiences of large numbers of people, and no two cancer patients are alike. Only the doctor who takes care of a patient knows enough about that person to discuss the prognosis.
Scientists at hospitals and medical centers all across the country are studying Hodgkin's disease. They are trying to learn more about the possible causes of the disease and how it might be prevented.
In addition, scientists are exploring new methods of treatment, including new drugs, drug combinations, and combinations of radiation therapy and chemotherapy. Other methods, such as bone marrow transplantation and biological therapy, are being studied with some Hodgkin's disease patients in clinical trials. These trials are designed to answer scientific questions and to find out whether a promising new treatment is both safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods.
HODGKINS DISEASE AT A GLANCE
- Hodgkin's disease is a type of lymphoma (cancer of the lymphatic system)
- The most common symptom of Hodgkin's disease is a painless swelling in the lymph nodes in the neck, underarm or groin
- Hodgkin's disease is diagnosed when abnormal tissue is detected by a pathologist after a biopsy of an enlarged lymph node
- Treatment of Hodgkin's disease depends on the symptoms, stage and location of disease, as well as the age and health of the patient
- Treatment of Hodgkin's disease usually includes radiation therapy or chemotherapy
- Regular follow-up examinations are important after treatment for Hodgkin's disease. Patients treated for Hodgkin's disease have an increased risk of developing other types of cancer later in life, especially leukemia
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