Hodgkin's lymphoma (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, MD

Overview
There are two kinds of lymphoma: Hodgkin's disease and Non-Hodgkin lymphoma. Hodgkin's disease is also called Hodgkin's lymphoma, which is named after Dr. Thomas Hodgkin who recognized the disease in 1832. Hodgkin's lymphoma is rare in America. Usual symptoms include painless swelling of the lymph nodes in the neck, armpits, or groin, fever and chills, night sweat, and etc. Hodgkin's lymphoma can be diagnosed by biopsy. Treatment includes radiation therapy, chemotherapy, high dose chemotherapy and bone marrow or peripheral blood stem cell transplant and a combination of them.

What are the symptoms of Hodgkin's lymphoma?
Early Hodgkin's lymphoma does not have any symptoms. People may notice one or more of the following symptoms as the tumor developing or when detected by regular examinations:


 * Painless swelling of the lymph nodes in the neck, armpits, or groin


 * Fever and chills


 * Night sweats


 * Weight loss


 * Loss of appetite


 * Itching in skin

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at highest risk?
Clinical data has suggested that the development of Hodgkin's lymphoma is related to several factors.


 * Epstein-Barr Virus (EBV) infection/Mononucleosis: The role of EBV in the development of Hodgkin lymphoma is not very clear. As we know, mononucleosis is an infection caused by the Epstein-Barr virus (EBV). Clinical data show that mononuclesis has a close relationship with Hodgkin's lymphoma.


 * Family history: The reason why family history may increase risk of developing Hodgkin's lymphoma is not clear. Some researchers proclaimed they had found certain changes in the genes responsible for immunity in patients with Hodgkin's lymphoma.


 * Socioeconomic status: Clinical survey shows patients with Hodgkin's lymphoma posses higher socioeconomic background. The reason is not clear.


 * Geography: Epidemiological data demonstrates that Hodgkin's lymphoma is most common in western countries such as the United States, Canada and northern Europe, and is least common in Asian countries.


 * Age: Epidemiological survey suggests that Hodgkin's lymphoma is most common in early adulthood (ages 15 to 40, especially in a person's 20s) and in late adulthood (after age 55).


 * Gender: Hodgkin's lymphoma occurs slightly more often in men than in women.

When to seek urgent medical care?
Call your health care provider if symptoms of Hodgkin's lymphoma develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
 * Hyperpyrexia and severe chills
 * Severe infection

Diagnosis

 * Lymph nodes biopsy and immunohistochemistry: Many of the symptoms of Hodgkin's lymphoma are not specific enough to say for certain. They can also be caused by non-cancerous problems or by other kinds of cancers. As we stated before, painless swelling of the lymph nodes in the neck, armpits, or groin may be the most common symptom of Hodgkin's lymphoma. So biopsy may be the most valuable test. The goal of a biopsy is to get enough of a sample to identify the diagnosis, as well as the type of the disease. Usual types of biopsy include excisional or incisional biopsy, fine needle aspiration (FNA) or core needle biopsy and bone marrow aspiration and biopsy. After checked under the microsope by the pathologists, sometimes the samples need to further test by immunohistochemistry.


 * Images tests such as computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound and chest-x-ray: The goal of these image tests are to help find out the extent of the Hodgkin's lymphoma and determine the stage of the disease.

Treatment options
Patients with Hodgkin's lymphoma have many treatment options. The selection depends on the stage of the disease. The options are radiation therapy, chemotherapy and high dose chemotherapy and bone marrow or peripheral blood stem cell transplant. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.


 * Chemotherapy: This treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Doctors give chemotherapy in cycles and each chemotherapy cycle generally lasts for several weeks. The most common regimen used in the United States is ABVD regimen, which includes Adriamycin, Bleomycin, Vinblastine and Dacarbazine.


 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation. Radiation is also used together with chemotherapy when the Hodgkin's lymphoma involves a large tumor mass.


 * High dose chemotherapy and bone marrow or peripheral blood stem cell transplant: In this treatment, at first higher doses of chemical drugs (sometimes along with radiation therapy) may be given to patients to obtain more effective. Then, the patient receives a transplant of blood-forming stem cells to restore the bone marrow.

Diseases with similar symptoms
Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed in the following:


 * Lymph nodes reactive hyperplasia


 * Non-Hodgkin lymphoma


 * Chronic lymphocytic leukemia


 * Chronic neutrophilic leukemia

Where to find medical care for Hodgkin's lymphoma?
Directions to Hospitals Treating Hodgkin's disease

Prevention
Hodgkin's lymphoma is not related with life style, so there is no known risk factors for people to change at present. But more researches are needed to verify.

What to expect (Outook/Prognosis)?
The prognosis of Hodgkin's lymphoma suggested by the international study depends on:


 * The stage of Hodgkin's lymphoma


 * Lymphocyte count and white blood count


 * Hemoglobin and albumin level


 * Patient's age and gender

Resources

 * Cancer.org


 * Cancer.org