Mesothelioma Info

Hodgkin's disease (HD) is a type of cancer that affects the lymph system. A lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body's immune system. Lymphomas occur when cells in the lymph system are injured, become abnormal, and begin to multiply continuously; this makes it difficult for the body to produce healthy cells that protect a person from infection. Hodgkin's disease is found most commonly in the chest and neck. In most cases, enlarged lymph nodes are found in the space between the two lobes of the lung.
Cells collected from a biopsy can be examined under a microscope to look for abnormal cells. The most characteristic cells associated with Hodgkin's disease are called Reed-Sternberg cells.
Hodgkin's disease can progress either slowly or aggressively. Lymphomas that grow slowly and produce fewer symptoms than more aggressive tumors are called indolent lymphomas. Aggressive lymphomas--also called intermediate- and high-grade lymphomas—grow and spread at an accelerated rate, and are associated with more severe symptoms.
Hodgkin's disease is a cancer that may spread from one lymph node to another. Hodgkin’s disease spreads from one lymph node to another either slowly or very aggressively, but always in an orderly way. Hodgkin's disease usually spreads downward from the initial site. In addition to affecting the lymph nodes, the cancer cells may also spread to the bone marrow or the spleen.
Hodgkin's disease is most prevalent in people in their late teens or in their sixties.
In the US, the disease primarily affects people who are 15 to 35 or 50 to 70 years of age. Hodgkin's disease is newly diagnosed in only about 7,500 people in the US each year, and doesn’t seem to be increasing in incidence. As a result, the disease accounts for less than 1% of all cases of cancer in the US. Treatment for Hodgkin’s disease varies with the stage of the disease; however, it usually responds to anticancer drugs and radiation treatment.
Treatment for patients with Hodgkin's disease depends on the number and location of tumors, but usually involves radiation therapy, chemotherapy, or a combination of both, and may require surgery or bone marrow transplantation.
Treatment for Hodgkin's disease is determined by the stage of the condition. When treatment is needed, chemotherapy, radiation therapy, or a combination of both is used. Patients with a highly aggressive or nonresponsive disease are treated with more intensive therapy. Patients with localized Hodgkin's disease are treated with radiation, and those with more disseminated Hodgkin's disease are treated with chemotherapy.
Causes

While there are some known risk factors for Hodgkin’s disease, there are no known direct causes.
Symptoms

A painless swelling of one or more lymph nodes is the most common sign of Hodgkin’s disease. The lymph nodes in the groin, abdomen, neck, or armpit are most commonly affected. A lump can be felt on either side of the neck, in the groin, in the armpit, or above the collarbone. Because enlarged lymph nodes are also a sign of infection, a doctor may observe them for a period of weeks to see if they change in size.
If swelling occurs in the abdomen, the patient may appear to be pregnant due to fluid collection or swollen lymph nodes. This abdominal swelling also may cause constipation.
Other symptoms of Hodgkin's disease include:

• Fever
• Excessive sweating or night sweats
• Weight loss; loss of appetite
• Fatigue
• Weakness
• Bone/flank pain
• Severe itchiness
• Coughing, shortness of breath, suffocation
• Constant tiredness
• Red patches on the skin
• Enlarged spleen
• Pain in lymph node after drinking alcohol

Patients experiencing generalized symptoms such as weight loss, night sweats, fever, and itchiness (referred to as B symptoms ) may have an increased number of cancer cells. While these symptoms do not necessarily mean that a patient has Hodgkin's disease, patients who have been diagnosed with Hodgkin’s disease and are experiencing B symptoms typically have more advanced disease and a poorer prognosis.
Risk Factors

Infection may play a role in Hodgkin's disease. In particular, tuberculosis, Epstein-Barr Virus (EBV; the virus that causes mononucleosis), H. pylori infection, human T-cell leukemia virus (HTLV), and Kaposi’s sarcoma-associated herpesvirus (KSHV) have been linked to Hodgkin’s disease. However, it is unclear whether or not any of these infections directly cause Hodgkin’s disease.
Hodgkin's disease may be hereditary. People who have brothers or sisters with Hodgkin's disease have a higher-than-average incidence of developing the disease.
In most cases, Hodgkin's disease affects people who are 15 to 35 or 50 to 70 years of age.
Diagnosis

Your physician will carefully examine enlarged lymph nodes in your neck, armpits, or groin if he or she suspects Hodgkin’s disease. Your physician will ask you about your medical history and conduct a physical examination to detect lymph node enlargement. As swelling of lymph nodes may indicate infection and not necessarily Hodgkin’s disease, the physician may watch the swelling for a period of weeks before sending you for more testing (e.g., biopsy, blood tests, and imaging).
Your physician will ask about B symptoms, such as fever, night sweats, and weight loss.
Your physician may order x-rays, MRIs, and CAT scans of your body to look for evidence of tumors.
Your physician will take a sample of tissue from fluid or a lymph node to make a diagnosis. If you have abnormal cancer cells or signs of infection in the biopsy sample, you may have Hodgkin’s disease. The types of cells contained in the biopsy enable the pathologist to tell the grade, or aggresiveness (e.g., low, intermediate, or high) of the lymphoma. Based on how the tumor cells appear under a microscope, the pathologist estimates their potential to grow and spread. The staging of the tumor describes what parts of the body are affected by the cancer cells.
In order to stage a tumor, doctors consider:

• The number and location of the lymph nodes that have cancer cells
• The location of the affected lymph nodes: above, below, or on both sides of the diaphragm
• The presence of cancer cells in the bone marrow, spleen, or organs outside the lymphatic system (e.g., the liver)

In some cases, a surgeon will perform a procedure called a laparotomy to look at tissues that are suspected of being cancerous. This procedure can help a doctor diagnose Hodgkin’s disease. After making an incision through the wall of the abdomen, the surgeon will look at the internal organs; especially the liver, spleen, and lymph nodes. The surgeon will then remove (biopsy) samples of tissue that are suspected to be cancerous, and study them under a microscope.
Table 1. Stages and Treatment Options for Patients with Hodgkin's Disease

Stage Location Treatment Comment I Only one lymph node or one area/organ outside the lymph nodes Radiation therapy Stage I often put into remission or alleviated.

Treatment depends on cell type II Two or more lymph nodes in similar areas of the body, or one lymph node and area outside the lymph nodes Radiation therapy Treatment and remission or alleviation rates for stage II are 30% to 75%.

Treatment depends on cell type III Multiple areas of the body adjacent to lymph tissue, both above and below the diaphragm, particularly to an area or organ near the lymph nodes or spleen Chemotherapy
with or without radiation IV Many areas of the body near and far from the lymph system (extralymphatic spread) Chemotherapy Prevention and Screening

There is usually no way to prevent lymphoma. Most people with Hodgkin’s disease have no known risk factors.
Treatment

Urgent Care

If you have Hodgkin's disease and have been prescribed chemotherapy, you may need to be hospitalized for treatment. Although chemotherapy is often given in a doctor’s office or clinic, sometimes patients are hospitalized for a short time to receive treatment.
Swollen lymph nodes in the thymus gland, which is located in the neck, may produce life-threatening symptoms. Swollen lymph nodes in the thymus can block bloodflow inside the chest or airflow through the trachea. Blocked blood vessels cause the head and arms to swell, which can cause brain damage. Blockage of the trachea may cause shortness or breath, coughing, or suffocation. If you start to experience any of these symptoms, seek immediate medical attention.
Self Care

If you are undergoing chemotherapy, take steps to avoid infection: wash your hands thoroughly, avoid uncooked fruit or other germ-carrying foods, and avoid contact with children or other individuals suspected of having an infection. Patients receiving anticancer drugs are more likely to get an infection because such drugs weaken the immune system. Children are more likely than adults to get infections; however, taking precautions to avoid exposure to germs minimizes the risk.
Update your vaccinations at least one week before being treated for Hodgkin's disease. Patients should make sure that their immunizations for the flu, pneumonia, and meningitis are current. This applies to patients who have and have not had their spleens removed. In some cases, doctors may recommend re-vaccinating two years after the end of treatment, and every six years thereafter with the pneumonia vaccine.
Eat a healthy diet. Patients undergoing anticancer treatment need to make every effort to get enough calories and protein in their diet to help them regain strength, increase energy, and prevent weight loss.
Drug Therapy

Your doctor is the best source of information on the drug treatment choices available to you.
Other Therapies

If you have stage I or II Hodgkin's disease, you may be treated with radiation therapy. Radiation therapy involves exposing cancer-infected areas to high-energy radiation, usually focusing on the neck, chest, armpit, and abdomen, where the radiation kills the cancer cells in those localized areas. Radiation alone is the treatment of choice for early-stage disease. Radiation treatment is usually given for three to four weeks, and, depending on the stage, is often combined with chemotherapy to treat Hodgkin's disease. This treatment can also be used to ease the symptoms associated with lymphoma in the internal organs, such as the brain and the spinal cord. Radiation treatment is provided by a hospital or clinic on an outpatient basis.
If you are currently taking anticancer drugs or undergoing radiation therapy and your blood cell counts are low, you may need a blood transfusion.
Platelet transfusions protect against bleeding; red cell transfusions are used to treat the fatigue associated with radiation-induced anemia.
If you have Hodgkin's disease that relapses after treatment, your doctor may recommend a combination of chemotherapy and radiation therapy, or hospitalization for bone marrow or blood cell transplantation. Patients who relapse and are still sensitive to anticancer drugs usually receive bone marrow transplantation. Bone marrow can be retrieved either from the patient or from a relative whose basic cell type is identical. The goal of transplantation is to replace the blood-forming cells that have been destroyed by cancer treatment. Therefore, transplantation is done after chemotherapy. This helps the patient to produce healthy blood cells that are needed to fight infection.
Bone marrow is obtained by placing a long needle in the hip and withdrawing the marrow. Marrow can also be obtained during a process called apheresis or leukopheresis. The procedure involves taking blood from one vein, filtering certain cells out through a machine, and then returning the blood to the body via another vein. This process usually takes three to four hours. The cells obtained may be purged of any unwanted cells, and the sample is then frozen. The cells are thawed and used when the patient is ready for transplantation.
Patients who have transplants generally stay in the hospital for several weeks to be monitored for infection, because the procedure temporarily weakens the immune system. Patients can be discharged when their blood cell count is sufficient.
Joining a support group may help you cope with Hodgkin's disease. Because support from friends and family may not be enough, some patients benefit from discussing their concerns with other cancer patients.
Surgery

A laparotomy and a splenectomy may be performed by a surgeon to remove the cancer cells and the spleen, respectively. Splenectomy (removal of the spleen) may be performed during the course of a staging laparotomy in Hodgkin’s disease. Staging is important to identify those whose cancer is widespread and therefore beyond management with irradiation alone. Splenectomy is currently less commonly performed because non-invasive studies (CT/MRI) permit staging in most patients. Splenectomy should only be performed if its results will alter the therapy in Hodgkin’s disease.
Alternative Medicine

Some patients may want to try alternative therapies in addition to standard cancer treatment to relieve pain, reduce side effects, and enhance emotional, physical, and spiritual well-being. Always consult your doctor before starting any alternative therapy to make sure it will not be harmful to you.
Special Circumstances

If you are pregnant, discuss treatment options for Hodgkin’s disease with your doctor. Data are scarce regarding the long-term effects of anticancer drugs on the fetus. Some patients choose to deliver early, when possible, to avoid exposing the fetus to radiation and anticancer drugs.
Prognosis

Hodgkin's disease is highly curable. Treatment of HD is one the great cancer success stories. Cure rates for patients who are treated for stage I and II disease are reported in excess of 90%. Patients who are treated for stages III and IV disease also have a high survival rate five years after treatment. Seventy to eighty percent of people with stage I or II Hodgkin's survive for a minimum of 10 years. With more aggressive disease, the 5-year survival rate is 20% to 50%.
The prognosis for patients diagnosed with Hodgkin's disease depends on the stage of the cancer, the response to treatment, and the age and general health of the patient.
Patients who relapse more than a year after initial treatment have long-term survival rates of 22% to 54% when retreated with chemotherapy. Even though HD recurs in 20% to 35% of patients on average, it is still considered to be potentially curable. People who relapse in less than a year after initial treatment have a reduced chance of living long-term.
Follow-up

Schedule a visit with your physician every three months for one year after treatment. Regular follow-up visits are necessary to discuss changes in your health. During your appointment, the doctor will take a general medical history and conduct a physical examination, paying careful attention to the size and firmness of your lymph nodes. Repeat CT/MRI studies will be obtained at regular intervals.
Report any new symptoms to your doctor immediately. New symptoms may be caused by side effects of treatment or recurrent cancer. People who have been treated for Hodgkin's disease have an increased risk of developing leukemia, non-Hodgkin's lymphoma, and cancers of the lung, colon, bone, thyroid, and breast.
Contact your physician if your symptoms do not resolve after treatment.