Hodgkin's Disease: The Facts

What is it?

Hodgkin's Disease is a type of Cancer that begins in the lymphatic tissue. The lymphatic system is a connected network of lymph vessels (similar to blood vessels), lymph nodes, and other structures including the spleen, thymus, and bone marrow. Lymph nodes are small, bean shaped structures that form and store white blood cells to fight infection. Lymph vessels connect lymph nodes throughout the body. The lymphatic system is involved in the body's ability to fight infection and in the formation of blood cells. The various components of this system are spread all over much of the body. For this reason, many other types of cancer (besides Hodgkin's Disease) can eventually spread to the lymphatic system. Hodgkin's Disease can begin in many areas of the body because the lymphatic system is so widespread. As the disease progresses, the cancer can spread throughout the lymphatic system and reach many areas of the body. If the cancer enters the blood stream it can spread to other organs such as the lungs or liver. Hodgkin's Disease is considered to be a type of lymphoma because it is a cancer that first begins in the lymphatic system. There is also another type of lymphoma called Non-Hodgkin's Lymphoma. This is a separate disease that will not be discussed here. The main difference between the two is that a special type of immune system cells, called Reed-Sternberg cells, are found in Hodgkin's Disease.

Hodgkin's Disease is classified using a staging system based on how advanced the cancer is. The following staging system is most commonly used. The staging system has several components to it.

• Stage I - Only one lymph node is affected.
  
  
• Stage II - Two or more lymph nodes are affected on the same side of the diaphragm (the diaphragm is the large muscle under the lungs).
  
  
• Stage III - The cancer is found in lymph nodes on both sides of the diaphragm.
  
  
• Stage IV - The cancer has spread to organs outside the lymphatic system such as the liver or lungs.
  

If the cancer has extended to the surrounding tissue, the letter E is added to the stage, e.g. Stage IE. If the cancer has spread to the spleen, the letter S is added, e.g. Stage IIIS.

Hodgkin's Disease is further classified by the letters "A" and "B" based on the absence or presence of certain symptoms. These symptoms include:

• Fever
  
• Night sweats
  
• Weight loss
  

- Patients without these symptoms are classified as "A."
- Patients with these symptoms are classified as "B."

Who gets it?

Annually, about 7,400 new cases of Hodgkin's Disease will be diagnosed. Approximately 35 to 40 people a year are diagnosed in Rhode Island. This type of Cancer is slightly more common in men than in women. Very little is known about exactly how Hodgkin's Disease first develops. Scientists have identified certain risk factors that may increase a person's chances of developing Hodgkin's Disease. Having these risk factors does not mean that you will necessarily develop Hodgkin's Disease. Also, many people that develop the disease have none of these risk factors.

• Age:  Hodgkin's Disease most often occurs in people 15 to 34 years old and in people over 55 years old.
  
• Family History of Hodgkin's Disease:  Having a brother or sister with Hodgkin's Disease indicates that you may be at higher risk because of genetic factors.
  
• Viruses:  People who have had an infection from the Epstein-Barr virus or who have had infectious mononucleosis ("mono") are at a higher risk.
  
• Compromised Immune System:  AIDS, immune system suppressing drugs, and various immunodeficiency syndromes have been associated with an increased risk.
  

How is it detected?

A number of different tests are performed when a physician suspects that someone may have Hodgkin's Disease. These tests are used to determine if the person has Cancer, if it is Hodgkin's Disease, and what stage the disease is in. Some of the tests commonly used are listed below.

Diagnostic Tests:

• Physical Exam: A general physical exam is important, with blood work to rule out other causes of symptoms. Different clusters of lymph nodes are felt and examined for lumps or swelling.
  
  
• X-rays: A type of high-energy radiation used to create images of areas inside the body such as the lungs and bones.
  
  
• CT Scan: A special type of X-ray machine is used to create detailed computer images of areas inside the body.
  
  
• MRI: A powerful type of magnet is used to make computer-generated images of areas inside the body.
  
  
• Fine Needle Aspiration Biopsy: A needle is used to remove some fluid and cells from the tumor or lymph node.
  
  
• Surgical Biopsy: A surgeon cuts through the skin and removes an entire lymph node (excisional biopsy) or a piece of a tumor (incisional biopsy). This is later examined in a lab for cancer cells. Local anesthetic is used if the lymph node is near the surface, but general anesthetic is used if it is deeper in the body.
  

There are different symptoms that have been associated with Hodgkin's Disease. Unfortunately, these symptoms are also associated with many common infections that aren't Hodgkin's Disease. It is impossible to determine if someone has Hodgkin's Disease based only on symptoms alone. If any of the following symptoms persist for more than a few days, then a doctor should be consulted. Remember: experiencing any of the following symptoms does NOT necessarily mean that you have Hodgkin's Disease. Most likely it is a result of an infection, but this also needs to be reported to a physician.

Symptoms:

• A painless swelling in the lymph nodes of the neck, underarm, or groin
  
• Unexplained recurrent fevers or night sweats
  
• Unexplained weight loss
  
• Persistent itchy skin
  
• Coughing or shortness of breath
  
• Fatigue
  
• Decreased appetite
  
• Alcohol Sensitivity - Pain in involved area after alcohol consumption
  

Is it curable?

Recent advances in treatments have resulted in a promising outlook for patients with Hodgkin's Disease. On average, almost 90% of patients are successfully treated. Like most cancers, early detection of Hodgkin's Disease greatly increases the chances for survival. If the cancer spreads to other organs, it is more difficult to treat. Talk to your doctor about any symptoms, risk factors, or concerns you may have regarding Hodgkin's Disease. The following survival rates are based on the stage of the disease when it was first diagnosed. These rates are based on a large number of patients and do not apply to every case, but they can give a rough idea of the outlook Hodgkin' s Disease patients face.

It's easier to prevent cancer than to treat it....

Hodgkin's Disease has not been associated with any preventable risk factors; however, there are certain healthy lifestyle habits that can lower your risk of developing other cancers and improve your general health. These include:

• Not smoking
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat, high fiber diet
  

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