Cancer Conditions and Diagnoses

Hodgkin's Disease

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What is Hodgkin's Disease?

Hodgkin's disease is a type of cancer that involves lymphoid tissue. The lymphatic system is made up of hundreds of small, bean-sized lymph nodes that are connected by lymph vessels. Lymph, clear fluid, circulates throughout this system and is mostly made up of white blood cells called lymphocytes. White blood cells are important in the body's ability to fight infection. The lymph nodes filter foreign material, especially bacteria, from lymph before it gets into the bloodstream.

The spleen is an organ on the left side of the abdomen, just behind the stomach. Its functions are to clean the blood of old or imperfect cells and to produce antibodies for fighting infection. In Hodgkin's disease, some of the cells that make up the lymphatic tissues become abnormal. They multiply, crowding out the normal cells. If the disease progresses, it may spread to the liver, bone marrow, bones, or lungs.

Hodgkin's lymphoma has been divided into three age groups: the childhood form (age 14 years and under), the young adult form (age 15-34 years), and the adult form (age 55 to 74 years). There are two age peaks when the disease is most common - the early twenties and after 50. In adolescents, the incidence is relatively equal between males and females but higher in families of higher socioeconomic status and caucasians.

What are the symptoms of Hodgkin's Disease?

The symptoms of Hodgkin's disease depend upon where the disease first occurs and how far it has spread. The most common symptom of Hodgkin's disease is a painless swelling of lymph nodes in the neck, armpit, or groin. These enlarged nodes do not shrink to normal size with antibiotics. However, an enlarged node in the chest may not be noticed until it is large enough to interfere with normal breathing. If lymph nodes in the chest are involved, symptoms may include coughing, shortness of breath, fever, weight loss, night sweats and itching. Hodgkin's disease can involve a single lymph node or many nodes.

How is Hodgkin's Disease diagnosed?

Diagnosis is made by biopsy of an involved lymph node. This procedure is done in surgery. The suspicious lymph node is removed and looked at under a microscope. Thin slices of the tissue are studied for the presence, type and arrangement of malignant cells characteristic of the disease.

Once the diagnosis is made, a number of tests are performed to see if the disease has spread. These tests include blood tests, bone marrow aspirate, X-rays, CT scans, or MRI. A scan is done to check for spread to the liver, bones, or spleen.

The spleen plays a role in fighting certain bacterial infections, especially pneumococcal infections which cause pneumonia. If the spleen is involved and has been removed, your child will be more susceptible to infection and other organisms. To limit susceptibility to infection, a vaccine called pneumovax is usually given before surgery. Your child may also be placed on small preventive doses of penicillin. If your child develops a fever, it is very important to call the doctor immediately.

When all the results of these tests are known, your child's disease will be diagnosed as being in one of the following stages:

Stage I: Involvement of a single lymph node region or area.
Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm (muscle that separates the chest from the abdomen).
Stage III: Involvement of lymph nodes on both sides of the diaphragm.
Stage IV: Involvement of organs or tissues outside of the lymph system, such as liver, bone marrow, lungs, and bone.
Each stage is also split into an A or B category. Your child will be placed in the B category if he has any of these symptoms:

Greater than 10% body weight loss.
Unexplained fever of greater than 101o.
Night sweats.

What is the treatment for Hodgkin's Disease?

Treatment may include chemotherapy and/or radiation therapy, depending upon the disease staging.

What is the prognosis for Hodgkin's Disease?

Children who fall into the A category have a more favorable prognosis than those who fall into the B category. However, the most important prognostic sign is the stage of the disease. Children with Stage I and Stage II disease have an 80-90% chance of being cured.