Article updated and reviewed by Corey Cutler, MD MPH FRCP(C), Instructor in Medicine, Harvard Medical School, Dana-Farber Cancer Institute on May 11, 2005.
The body’s 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 white blood cells, called lymphocytes. Along this network of vessels are groups of small, bean-sized organs called lymph nodes that filter the white blood cells in the lymph. Clusters of lymph nodes are found in the underarms, groin, neck, abdomen, and other minor locations. Other components of the immune system include the spleen, thymus, tonsils, and bone marrow.
In Hodgkin's disease, lymphocytes grow abnormally within the lymph nodes and can involve the other organs of the immune system.
Hodgkin's disease is an uncommon cancer Although it accounts for less than one percent of cancer in this country, it is one of the most common cancers in individuals under the age of 35. In addition, it is noted rarely in individuals above the age of 55. The cause of Hodgkin’s disease is unknown, although it is believed to be associated with certain viruses commonly noted in the population.
The symptoms of Hodgkin’s disease vary from person to person. Often, a painless swelling in the neck, armpit, or groin, caused by an enlarged lymph node can be noted by the affected individual. Constitutional symptoms, including persistent, recurrent, or cyclical fevers, night sweats, fatigue, and weight loss may be the initial sign of Hodgkin’s disease. Sometimes, itching of the skin (pruritus) marks the early stages of Hodgkin's disease.
Although all of these symptoms can be present in other illnesses, they may suggest Hodgkin’s disease particularly when lymph-node swelling lasts more than six weeks and does not respond to antibiotics.
Like most cancers, Hodgkin's disease is best treated when diagnosed early. You should see your doctor if you have one of the following for more than two weeks:
- painless swelling in the lymph nodes of the neck, underarm or groin
- fever that does not go away
- night sweats
- feeling tired all the time
- weight loss without dieting
- itchy skin
If you have symptoms, your doctor will examine you carefully and check for swelling or lumps in your neck, underarms, or groin. A lymph node biopsy and/or biopsy of the bone marrow is the most reliable way of establishing the diagnosis of Hodgkin’s disease. In order to determine the extent of the Hodgkin’s disease, several scans will be performed, including CT scans, PET scans, and/or Gallium scans. A bone marrow biopsy may also be performed under certain clinical circumstances.
Hodgkin’s disease is staged according to the number of lymph node groups involved.
Stage I - One lymph node group involved
Stage II - Multiple lymph nodes either above or below the diaphragm involved
Stage III - Multiple lymph nodes on both sides of the diaphragm involved
Stage IV - Multiple lymph nodes involved with involvement of other organs
Hodgkin’s disease is curable with chemotherapy, radiation therapy, or a combination of both. The likelihood of cure depends on several prognostic factors, include the patient’s age and sex, stage of disease, and results found on blood tests.
Almost all cases of Hodgkin’s disease is treated with combination chemotherapy. The rare exception are some individuals with very favorable prognosis, Stage I disease, where radiotherapy may be used as definitive therapy in certain selected cases.
Chemotherapy for Hodgkin’s disease is considered standard. The most commonly used regimen is called ABVD and is comprised of four chemotherapy agents. These drugs are given intravenously (in the vein) every 14 days, often up to 12 times. Alternate chemotherapy regimens exist, and include the Stanford V regimen, MOPP, and ChlVVP. These alternatives should be discussed with your physician.
Radiation therapy may be given once chemotherapy has been completed if there were large tumor masses or if the masses have not completely disappeared with chemotherapy.
While the goal of initial chemotherapy and/or radiation therapy is to put the Hodgkin’s disease into a long-term remission and cure the disease, Hodgkin’s disease is one of the few cancers that can be successfully treated and cured even if the disease returns. If Hodgkin’s disease returns, it must be treated with chemotherapy again. Once a second remission is attained, a bone marrow transplantation is often used to prevent the disease from returning once again. The likelihood of cure from recurrent Hodgkin’s disease depends largely on the duration of the initial remission as well as the amount of disease that is present at the time of relapse.
Do the symptoms indicate a diagnosis of Hodgkin's disease?
Are further tests necessary?
What is the staging of the disease?
Has it spread beyond the original site?
What treatment do you recommend?
Will chemotherapy or radiation therapy be needed?
Would bone marrow transplantation help if chemotherapy is needed?
Editorial review provided by VeriMed Healthcare Network.