10 Jul Hodgkin’s Disease
Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
Hodgkin’s disease, known in medical terms as Hodgkin’s lymphoma, is a form of cancer that develops in the lymphatic system which plays a central role in the body’s immune system.
The lymphatic system is made up of (1) lymphatic tissue like lymph nodes and lymph vessels, (2) related organs that are part of the body’s immune system such as spleen, bone marrow, tonsils and thymus, and (3) a blood forming system.
Because the lymphatic system is spread in many parts of the body, Hodgkin’s disease can start almost anywhere, but often occurs in the lymph nodes located in the upper part of the body, like in the chest, neck or underarms area. When Hodgkin’s disease occurs., lymphatic tissues start to enlarge, putting pressure on neighboring organs or tissues and normally spread out through the lymphatic vessels to other nearby lymph nodes. It is not common for the Hodgkin’s disease to be carried by blood vessels and spread to other areas of the body.
Because lymph nodes can inflame for numerous other reasons, (when the body fights against an infection), a complex examination by a doctor is necessary where medical procedures and tests are conducted in order to establish a cancer diagnosis. When Hodgkin’s disease occurs, new type of cells called Reed-Sternberg cells are produced. These cells look different from other type of cancers cells and scientists now consider these Reed-Sternberg cells a type of malignant B lymphocytes or abnormal B cells.
Hodgkin’s lymphoma occurs in both adults and children, but the treatment is different for both age categories. There are two main types of Hodgkin’s disease:
I. Classical Hodgkin’s lymphoma: – lymphocytes predominance, which includes:
Nodular sclerosis Lymphocytes depletion
II. Nodular lymphocyte predominant Hodgkin’s lymphoma
Signs and Symptoms
Because Hodgkin’s disease does not cause pain during the initial stages, it can be difficult for patients to notice and doctors to diagnose. Since this disease affects the lymphatic system, one of the first major signs of this disease is that lymph nodes start to enlarge and become noticeable in the neck and underarm.It is important to note that most lymph nodes can routinely swell during our lifetime, especially in children as a result of an infection, but they will return to normal after the infection is cured.
The method by which a doctor must distinguish the difference between a swelling node caused by a normal infection and Hodgkin’s lymphoma is that a normally infected inflammated node will return to it’s normal size, – while the cancer inflammated node will never go away on it’s own.
Always keep in mind that the earlier a correct diagnosis is established, the faster the treatment can be started and the more effective the treatment will be. If these symptoms sound familiar, or you are not sure, please consult with a physician immediately
Hodgkin’s Lymphoma Stages
Hodgkin’s disease develops through 4 major stages which can be divided in three types which include:
Type A – stage without symptoms being present,
Type B – stage with certain symptoms being present, like loss of more than 10% of body weight over the previous 6 months, fever or night sweats without any obvious causes, and
Type E – stage when the disease spreads locally from a lymph node to a nearby organ.
When the disease is in the first stage, only one lymph node area is affected or cancer occurs locally into adjacent tissue around lymph node. When the disease enters the second stage, two or more lymph node areas above the diaphragm are affected and the cancer spreads out from the lymph node area to the nearby tissue.
When the cancer progresses to the third stage, the disease affects lymph node areas on both sides of the diaphragm, and it is even possible that the cancer affects not just different lymph node areas, but have been extended to an area or organ adjacent to the lymph node and/or the spleen.
In the last stage, or the fourth stage, cancer has been affected one or more organs outside the lymphatic system, like the bone marrow or liver.
Physical Exam and History A physical examination of the body is peformed to check for any noticeable signs of the disease like weight loss, fever, lumps or inflamed lymph nodes around the neck or underarm area.
Blood Tests The next step in order to make a correct diagnosis is blood tests. Hodgkin’s lymphoma cells do not appear in blood, but there are other indicators of this disease that can be detected through blood analysis like levels of anemia or high blood pressure, etc.
Chest X-Ray and Computer Tomography (CT) If the inflammated lymph nodes are in the chest area, they can be seen in a plain chest x-ray. In most cases, an X-Ray image is followed by a CT scan in order to obtain a better image of the tumor. The CT scan is an advanced x-ray procedure that produces a more detailed cross-sectional image of the body.
Magnetic Resonance Imaging (MRI) This technique is not commonly used as a method to diagnose Hodgkin’s lymphoma. However, it might be employed if there is some concern if the spinal cord or brain is being affected.
Gallium Scan This procedure involves the administration of Gallium-67, a radioactive substance that is injected intravenously into the body. This substance is left for a couple of hours to be absorbed into the Hodgkin’s disease affected areas and then the patient will be placed under a special scanner that will record the absorbed radioactivity on a special film.
Positron Emission Tomography (PET) This procedure is a new type of radioactive scan. A special glucose substance that contains a radioactive atom is being administrated to the patient and a special camera will detect radioactivity. Hodgkin’s disease cells have a high rate of metabolism and makes them absorb a high amount of radioactive sugar. This procedure is effectively used in detecting Hodgkin’s lymphoma.
Bone Marrow Biopsy and Aspiration A bone marrow biopsy is a procedure where a small amount of bone is removed. This procedure is used to detect if the Hodgkin’s disease has spread to the bone marrow.Similar with the biopsy is the aspiration procedure which allows a small amount of bone marrow to be removed.
These two tests are used to settle cancer staging and are recommended if the person that suffers from Hodgkin’s disease displays anemia, fever or night sweats – signs that the cancer is affecting the bone marrow.
Chemotherapy One of the most used and effective therapy options for treating Hodgkin’s lymphoma is chemotherapy. This involves different combination of drugs administrated with IV’s and/or orally in order to kill tumor cells.
Radiotherapy Another treatment option for Hodgkin’s lymphoma is radiotherapy, where the tumor area is bombarded with radiation in order to disolve it. If the cancer relapses after radiotherapy, chemotherapy becomes necessary.
Bone Marrow Transplant Another treatment option used if chemotherapy and radiotherapy are ineffective is a bone marrow transplant. This procedure involves the transplantation of the patient’s own bone marrow or peripheral stem cells. Peripheral stem cells are bone marrow cells accumulated in the bloodstream. Because the chemotherapy destroys these cells, in order for this transplant to be performed peripheral stem cells need to be collected before the treatment and frozen. They will be injected back into the body after the patient is finished with the chemotherapy treatment.