| Signs and symptoms |
Signs and symptoms of Hodgkin's disease may include:
- Painless swelling of lymph nodes in your neck, armpits or groin
- Persistent fatigue
- Fever and chills
- Night sweats
- Weight loss of 10 percent or more of your body weight and loss of appetite
- Severe itching
- Sudden onset of high fever from any cause
- Loss of bladder or bowel control
- Numbness or loss of strength in your arms and legs
| Causes |
Hodgkin’s disease is among a group of cancers called lymphomas — cancers of the lymphatic system. The lymphatic system includes the lymph nodes (lymph glands), which are located throughout the body and are connected by small vessels called lymphatics. The spleen, thymus gland and bone marrow also are part of the lymphatic system.
Hodgkin’s disease often begins in the lymph nodes in the neck, above the collarbone, under the arms or in the chest above the muscle that separates the chest from the abdomen (diaphragm). Lymphomas also may spread outside the lymph nodes in virtually any part of the body.
A key step in Hodgkin’s disease involves the development of abnormal B cells, which originate in the bone marrow and are an important part of the immune system’s response to foreign invaders. B cells normally work with T cells, which derive from the thymus, to fight infection. T cells kill foreign invaders directly. B cells become plasma cells, which in turn produce antibodies that neutralize foreign invaders.
In most cases of Hodgkin’s disease, B cells develop into large abnormal cells. These abnormal cells are called Reed-Sternberg cells after the two pathologists who first discovered them. Instead of undergoing the normal cell cycle of life and death, these Reed-Sternberg cells don’t die, and they continue to produce more abnormal B cells in a malignant process. Doctors and researchers don’t know what causes this process to begin.
| Screening and diagnosis |
Many people with Hodgkin's disease experience no classic symptoms. Often, an abnormality found on a chest X-ray done for nonspecific symptoms leads to a diagnosis of Hodgkin's disease.
Distinctive characteristics that help diagnose Hodgkin's disease:
- The pattern of spread is orderly, usually involving lymph nodes in the neck, above the collarbone, under the arms or in the chest above the muscle that separates the chest from the abdomen (diaphragm).
- The disease rarely skips over an area of lymph nodes as it spreads.
In Hodgkin's disease, the affected lymph nodes may contain only a few of these malignant cells. Diagnosing Hodgkin's disease can be difficult because it's possible to mistake other cells for Reed-Sternberg cells.
Other procedures that may be valuable in evaluating Hodgkin's disease include a chest X-ray, a computerized tomography (CT) scan of the chest and abdomen, and blood tests. If the disease is predominantly in the abdomen, exploratory surgery may be necessary to help define the extent of the disease.
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| Treatment |
Treatment of Hodgkin's disease depends on the type and stage of the disease. The number and regions of lymph nodes affected and whether only one or both sides of your diaphragm are involved are important considerations. Other factors affecting decisions about treating the disease include:
- Age
- Symptoms
- Whether you're pregnant
- Whether surgery was used to stage the disease
- Overall health status
- Radiation. When the disease is confined to a limited area, radiation therapy is the treatment of choice. It's typical to radiate the affected nodes and the next area of nodes where the disease might progress. The length of radiation treatment varies from 4 to 10 weeks depending on the stage of the disease. The success rate for treatment of early-stage Hodgkin's, when the disease hasn't advanced beyond a single lymph node area, is 80 percent to 85 percent. If you relapse after radiation therapy — usually within 2 years after conclusion of treatment — then chemotherapy becomes necessary. More than 66 percent of these people achieve a disease-free condition.
- Chemotherapy. When the disease progresses and involves more lymph nodes or other organs, chemotherapy is the preferred treatment. Chemotherapy uses specific drug preparations to kill tumor cells. Currently, the greatest concern about chemotherapy for Hodgkin's disease is long-term side effects and complications, which include heart damage, secondary cancers such as leukemia, kidney damage and liver damage. Drug regimens have been developed that substantially diminish the likelihood of long-range, life-threatening complications, including acute leukemia in people who have received multiple courses of chemotherapy and radiation therapy. The two most common drug regimens are MOPP and ABVD. Both are combinations of four chemotherapy drugs designed to kill cancer cells. MOPP (mechlorethamine, vincristine (Oncovin), procarbazine, prednisone) had been the basic regimen, but it’s very toxic and serious side effects began showing up several years after treatment. ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) is a newer regimen, with less severe side effects, and is the preferred treatment. Doctors still occasionally use MOPP because ABVD may cause heart failure in some people.
- Bone marrow transplant. If the disease recurs following an initial chemotherapy-induced remission, high-dose chemotherapy and transplantation of your own (autologous) bone marrow or peripheral stem cells may lead to prolonged remission. Peripheral stem cells are immature bone marrow cells found in the bloodstream. Because high doses of chemotherapy destroy bone marrow, your own marrow or peripheral blood stem cells are collected before treatment and frozen. You'll undergo chemotherapy — with or without radiation — and then your own cells, which have been protected from the effects of the treatment, are injected back into your body.
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| Coping skills |
A diagnosis of cancer can be extremely challenging. Remember that no matter what your concerns or prognosis, you're not alone. These strategies and resources may make dealing with cancer easier:
- Know what to expect. Find out everything you can about your cancer — the type, the stage, your treatment options and their side effects. The more you know, the more active you can be in your own care. In addition to talking with your doctor, look for information in your local library and on the Internet. The National Cancer Institute will answer questions from the public. You can reach them at 800-422-6237. Or contact the American Cancer Society (ACS) at 800-227-2345.
- Be proactive. Although you may feel tired and discouraged, don't let others — including your family or your doctor — make important decisions for you. It's vital that you take an active role in your treatment.
- Maintain a strong support system. Having a support system and a positive attitude can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful. Although support groups aren't for everyone, they can be a good source for practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are.
- Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able work a 40-hour week, for example, but you may be able to work at least part time. In fact, many people find that continuing to work can be helpful.
- Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the down times when you may need to rest more or limit what you do.
- Stay active. Receiving a diagnosis of cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It's important to stay involved as much as you can.
- Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself seems to be a key factor in successfully coping with cancer.
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— January 22, 2002 —