The cells which make up our bodies normally divide in a set and orderly fashion so they can repair our tissues. This process sometimes goes wrong and there is an uncontrolled growth of cells.
A characteristic of all cancers is this disorderly formation of body cells, causing swellings or tumours. A tumour is referred to as benign when it remains contained in a localised area of the body and, on removal by surgery, does not recur.
The term is cancer is used when the tumours are malignant i.e. they spread and invade healthy tissue.

Hodgkin's disease was first identified by Dr Thomas Hodgkin in 1832. It is characterised by the large 'Reed-Sternberg' cells that may be seen under a microscope when a biopsy of an affected lymph node, or gland, is studied.
The incidence of HD peaks in the 15 - 30 age group and more men are affected than women.
Nowadays, Hodgkin's disease can be very successfully treated and many people are completely cured.
As the improvement in treatment is relatively recent - since 1965 - some textbooks may be out-of-date and thus the information they contain can be misleading. Lymphoma is not inherited and is not infectious, so it cannot be passed on to your family or friends. SYMPTOMS AND DIAGNOSIS

Often the first symptom is a painless swelling in one or more of the glands in the neck, armpit, groin or abdomen. Other symptoms may include:
night sweats
fevers
loss of weight, poor appetite and tiredness
a cough or breathlessness
persistent itch all over
pain from drinking even a small quantity
of alcohol On their own, each of these symptoms can be caused by less serious illnesses. You should consult your GP who will examine you and decide if further investigation is needed.
Your doctor will refer you to a local hospital where you will be examined again, before tests take place.
These tests may include:
A biopsy which is the removal of a small sample of tissue, such as an enlarged lymph node, for examination under a microscope. This is usually performed under a general anaesthetic, when you are sent to sleep for about half an hour or so. Blood samples will show the state of your general health and how, for example, your kidneys and liver are functioning. Chest x-rays will be taken to examine your lungs and the lymph glands in your chest. A bone marrow examination will show if tissue in this area is affected. The samples will normally be taken from your hip and the procedure, which takes only a few minutes, is carried out using a local anaesthetic and it may cause some discomfort. Sedation may be offered, depending on the samples required. You will probably be asked to undergo a scan. This can be a CT scan (also known as a body or CAT scan) or an MRI scan or an ultrasound scan of the abdomen. These scans are painless and take only about an hour, although preparation may be necessary in advance.
Occasionally a lymphangiogram is used. This is a special X-ray of the lymphatic system, taken after a dye has been injected into the foot. An overnight stay in hospital may be required for this test. This type of test is necessary because many lymph nodes (or glands) in the body cannot be seen or felt, and other organs must be checked to see if they are affected.
The assessment of what treatment is required will be based on these tests. You will probably have the results within 10 - 14 days.

More than 75% of all newly diagnosed patients with adult Hodgkin's disease are curable with radiation therapy and/or combination chemotherapy regimens.
Since the selection of treatment is influenced

by the stage, careful clinical and/or pathologic staging

is essential.
Treatment planning by a multidisciplinary

team of cancer specialists is required to

determine optimal treatment of patients with

this disease.

National mortality is falling more rapidly for adult Hodgkin's disease than for any other malignancy, largely due to excellent results achieved with modern radiation therapy and effective combination chemotherapy.

Effective drug combinations can produce prolonged disease-free survival in the majority of patients who have recurrent disease when radiation therapy was the initial treatment. Depending on the duration of the remission after the drug treatment was stopped, patients whose disease recurs following combination chemotherapy may be salvaged when re-treated with another regimen. Other patients may benefit from high-dose consolidation therapy.
Hodgkin's disease is the main cause of death over the first 15 years after treatment. By 15-20 years after therapy, the cumulative mortality from a second malignancy will exceed the cumulative mortality from Hodgkin's disease.

Prognosis for a given patient depends on several factors. The most important factors are the presence or absence of systemic symptoms, the stage of disease, and the quality and suitability of the treatment administered.
Other important factors are age (therapy for very young children requires special attention), presence of large masses, sex, erythrocyte sedimentation rate, number of splenic nodules, extent of abdominal involvement, hematocrit, and absolute number of nodal sites of involvement. STAGES OF HODGKINS

<

Stage IA Patients with early-stage disease are candidates for radiation therapy, combined modality therapy, or chemotherapy alone (under evaluation in clinical trials). Radiation therapy is the traditional treatment of patients with stage IA disease and it can achieve a cure in approximately 90% or more of treated patients.

When chemotherapy or combined modality therapy is applied, laparotomy is not required. Patients with early-stage disease and favorable prognostic features can undergo radiation therapy without staging laparotomy.
These favorable subgroups of patients have an 80% relapse- free survival rate at 5-10 years with mantle-field, para-aortic, and splenic irradiation and no laparotomy. Favorable features include sedimentation rate of less than 50, patient age of 50 years or younger, lymphocyte-predominant or nodular sclerosing histology, and no bulky adenopathy. If chemotherapy regimens (with or without radiation therapy) prove to be just as effective as radiation therapy, the ultimate treatment choice may depend on differences in short-term and long-term toxic effects.

The late mortality from cardiovascular disease and from solid tumors, especially in the lung, breast, gastrointestinal tract, and connective tissue, makes extended-field radiation therapy a less attractive option. The long-term effects (more than 15 years after completion of therapy) are not yet available. The most effective and least toxic chemotherapy regimen is

Most patients with a subdiaphragmatic presentation and clinical stage IA disease should receive chemotherapy with or without involved-field radiation to avoid extended pelvic/abdominal fields which are myeloablative and to avoid staging laparotomy.

Patients with massive mediastinal disease should receive combined modality therapy; staging laparotomy is not required. A specialized approach to therapy can be taken in the following circumstances. Patients with non-bulky lymphocyte-predominant disease presenting in unilateral high neck (above the thyroid notch) or epitrochlear locations require only involved-field irradiation after clinical staging. Patients with non-bulky nodular sclerosing disease presenting in the anterior mediastinum only after clinical staging also do well with mantle irradiation alone.
Treatment options for supradiaphragmatic presentation with massive mediastinal involvement (defined as a mediastinal mass width greater than one third of the maximum chest diameter or 10 centimeter mass): Most patients with massive mediastinal disease will receive combined modality therapy; therefore, staging laparotomy is not required.

Stage IB Patients with "B" symptoms require combination chemotherapy with or without additional radiation therapy because, of the patients who undergo a laparotomy, 30%-40% will be upstaged at laparotomy and 25% will relapse after radiation.

Stage IIA Patients with early-stage disease are candidates for radiation therapy, combined modality therapy, or chemotherapy alone (under evaluation in clinical trials). Radiation therapy is the traditional treatment of patients with stage IIA disease and it can achieve a cure in approximately 80% or more of treated patients.
When chemotherapy or combined modality therapy is applied, laparotomy is not required. Patients with early-stage disease and favorable prognostic features can undergo radiation therapy without staging laparotomy.
These favorable subgroups of patients have an 80% relapse- free survival rate at 5-10 years with mantle field, para-aortic, and splenic radiation therapy and no laparotomy. Favorable features include sedimentation rate of less than 40-50, patient age of 40-50 years or younger, lymphocyte- predominant or nodular sclerosing histology, and no bulky adenopathy.
If chemotherapy regimens (with or without radiation therapy) prove to be just as effective as radiation therapy, Patients with "B" symptoms require combination chemotherapy with radiation therapy.

Stage IIIA Chemotherapy with or without radiation therapy is the treatment of choice for stage IIIA disease. While some trials support chemotherapy alone as an acceptable initial management approach in selected patients with stage IIIA adult Hodgkin's disease, other trials suggest that combined modality therapy may be superior.

STAGE IV ADULT HODGKIN'S DISEASE Combination chemotherapy is the treatment of choice for this stage of adult Hodgkin's disease. Radiation therapy is sometimes used to sites of initial disease or areas of bulky disease involvement.

RECURRENT ADULT HODGKIN'S DISEASE

Patients who experience a relapse after initial wide-field, high-dose radiation therapy have a good prognosis. Combination chemotherapy results in 10-year disease-free and overall survival rates of 57%-80% and 57%-81%, respectively.
Patients who experience a relapse after initial combination chemotherapy, especially if the recurrence occurs within the first 12 months of treatment, have a poor prognosis although some can be salvaged with conventional chemotherapy.
Prognosis is determined more by the duration of the first remission than by the specific induction or salvage combination chemotherapy regimen.
Patients whose initial remission was longer than 1 year (late relapse) have long-term survivals with salvage chemotherapy of 22%-54%.
Patients whose initial remission was shorter than 1 year (early relapse) do much worse and have long-term survivals of 11%-28%. For the small subgroup of patients with only limited nodal recurrence following initial chemotherapy, radiation therapy with or without additional chemotherapy may provide long-term survival for about 50% of patients. The best results appear in patients who are aggressively restaged and re-treated with wide-field (subtotal nodal irradiation or total nodal irradiation) high-dose radiation therapy, or more limited (mantle) irradiation and combination chemotherapy.
Initial stage IV disease may be a contraindication for this treatment; if it is used, there should be no evidence for disseminated disease at the time of nodal relapse.

A SIMPLE PAGE : BY A NEW PATIENT OF HODGKIN'S

NON-HODGKINS' LYMPOMA: WHAT IS ADULT HODGKINS?

HODGKINS:FOR THE NEW PATIENT

GLEN FLEISMAN'S HODGKIN'S PAGE

DAVE'S HAPPY LITTLE HODGKIN PAGE

HODGKINS DISEASE DURING PREGNANCY

Back to MAIN INDEX