Hodgkin's Disease (Adult)


General Information


What is Hodgkin's disease?

Hodgkin's disease is a type of lymphoma. Lymphomas are cancers that develop in the lymph system, part of the body's immune system.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.

Because there is lymph tissue in many parts of the body, Hodgkin's disease can start in almost any part of the body. The cancer can spread to almost any organ or tissue in the body, including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), and spleen.

Lymphomas are divided into two general types: Hodgkin's disease and non-Hodgkin's lymphomas. The cancer cells in Hodgkin's disease look a certain way under a microscope. (Refer to Adult Non-Hodgkin's Lymphoma Treatment and Childhood Non-Hodgkin's Lymphoma Treatment for more information.)

Adult Hodgkin's disease most commonly affects young adults and people older than 55 years of age. It may also be found in patients with acquired immunodeficiency syndrome (AIDS); these patients require special treatment. (Refer to AIDS-Related Lymphoma Treatment for more information.) Hodgkin's disease can also occur in children and is treated differently from that in adults. (Refer to Childhood Hodgkin's Disease Treatment for more information.)

A doctor should be seen if any of the following symptoms persist for longer than 2 weeks: painless swelling of the lymph nodes in the neck, underarm, or groin; fever; night sweats; tiredness; weight loss without dieting; or itchy skin.
If there are symptoms, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, a doctor may need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), the size of the swollen areas, the results of blood tests, the type of symptoms, and the patient's age, sex, and overall condition.

Stage Information

Stages of adult Hodgkin's disease:

Once Hodgkin's disease is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. A doctor needs to know the stage of the disease to plan treatment.

A doctor may determine the stage of the disease by conducting a thorough examination which may include blood tests and different kinds of x-rays. This type of staging is called clinical staging. In some cases, the doctor may need to do an operation called a laparotomy to determine the stage of the cancer. During this operation, the doctor cuts into the abdomen and carefully looks at the organs inside to see if they contain cancer. The doctor will cut out (biopsy) small pieces of tissue during the operation and look at them under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done only when it is needed to help the doctor plan treatment.

Each stage for Hodgkin's disease is further divided by an "A" or "B," based on whether there are certain symptoms called B symptoms. B symptoms include the following: loss of more than 10% of weight in the previous 6 months, fever without any known cause other than Hodgkin's disease, and night sweats that leave the body soaked. For example, if a patient had stage I disease without any B symptoms, the patient would have stage IA disease; if the patient had stage I disease with B symptoms, then the patient would have stage IB disease.

The following stages are used for Hodgkin's disease:

Stage I
Cancer is found in only one lymph node area or in only one area or organ outside of the lymph nodes.

Stage II
Either of the following means the disease is stage II:

-Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps us breathe).
-Cancer is found in only one area or organ outside of the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.

Stage III
Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.

Stage IV
Either of the following means the disease is stage IV:

-Cancer has spread in more than one spot to an organ or organs outside the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs.
-Cancer has spread to only one organ outside the lymph system, but lymph nodes far away from that organ are involved.

Recurrent
Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

Treatment Option Overview

How adult Hodgkin's disease is treated:

There are treatments for all patients with adult Hodgkin's disease. Two types of treatment are used:

-radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors)
-chemotherapy (using drugs to kill cancer cells and shrink tumors)

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for Hodgkin's disease usually comes from a machine outside the body (external-beam radiation therapy). Radiation therapy given to the neck, chest, and lymph nodes under the arms is called radiation therapy to a mantle field. Radiation therapy given to the mantle field and to the lymph nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis is called total nodal irradiation. Radiation therapy may be used alone or in addition to chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Also, bone marrow transplants are being studied in clinical trials for certain patients. Bone marrow transplantation is a newer type of treatment. Sometimes Hodgkin's disease becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the bones before treatment. The marrow is then frozen, and the patient is given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow is taken from another person, the transplant is called an allogeneic transplant.

Another type of autologous transplant is called a peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop), and then returns the blood to the patient. This procedure is called leukapheresis and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to the patient. This procedure may be done alone or with an autologous bone marrow transplant.

A greater chance for recovery occurs if a doctor chooses a hospital which does more than five bone marrow transplantations per year.

Treatment By Stage

Patients may be immunized with influenza, pneumonia, and meningitis vaccines both before and every few years after treatment in order to guard against infection.

Treatment of adult Hodgkin's disease depends on the type and stage of the disease, and the patient's age, pregnancy status, past surgery to determine the stage of the disease, symptoms, and general health.

Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. Within 5 to 15 years after treatment, some patients develop another form of cancer as a result of their treatment; you should visit your doctor regularly to be checked for this possibility. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of adult Hodgkin's disease. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Adult Hodgkin's Disease
Treatment depends on whether the patient has stage IA or stage IB disease and where the cancer is found.

Stage IA disease
If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

1. Combination chemotherapy and radiation therapy.
2. Radiation therapy to a mantle field and to the lymph nodes in the upper
abdomen.
3. Radiation therapy to a mantle field only, after surgery to determine the
stage of the tumor.
4. Clinical trials of combination chemotherapy alone.

If the cancer is above the diaphragm but involves a large part of the chest, treatment may be one of the following:

1. Radiation therapy to a mantle field plus chemotherapy.
2. Radiation therapy to a mantle field and to the lymph nodes in the upper
abdomen.

If the cancer is below the diaphragm, treatment may be one of the following:

1. Radiation therapy.
2. Combination chemotherapy with radiation therapy.
3. Clinical trials of chemotherapy alone.

Stage IB
Treatment may be one of the following for patients with "B" symptoms:

1. Combination chemotherapy with radiation therapy.
2. Clinical trials of chemotherapy alone.

Stage II Adult Hodgkin's Disease
Treatment depends on whether the patient has stage IIA or stage IIB disease and where the cancer is found.

Stage IIA disease
If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

1. Combination chemotherapy and radiation therapy.
2. Radiation therapy to a mantle field and to the lymph nodes in the upper
abdomen.
3. Radiation therapy to a mantle field only, after surgery to determine the
stage of the tumor.
4. Clinical trials of combination chemotherapy alone.

If the cancer is above the diaphragm but involves a large part of the chest, treatment may be the following:

1. Radiation therapy to a mantle field plus chemotherapy.

Stage IIB
Treatment may be one of the following for patients with "B" symptoms:

1. Combination chemotherapy with or without radiation therapy.
2. Clinical trials of chemotherapy alone.

Stage III Adult Hodgkin's Disease
Treatment depends on whether the patient has stage IIIA or stage IIIB disease and where the cancer is found.

Stage IIIA
If the cancer does not involve a large part of the chest, treatment may be one of the following:

1. Combination chemotherapy alone.
2. Combination chemotherapy plus radiation therapy.
3. A clinical trial of chemotherapy.

If the cancer involves a large part of the chest, treatment may be:

Combination chemotherapy with radiation therapy.

Stage IIIB
Treatment may be one of the following:

1. Combination chemotherapy with radiation therapy.
2. A clinical trial of chemotherapy.

Stage IV Adult Hodgkin's Disease
Treatment may be one of the following:

1. Combination chemotherapy.
2. Combination chemotherapy and radiation therapy.
3. Clinical trials of chemotherapy with bone marrow transplantation.

Recurrent Adult Hodgkin's Disease
The treatment depends on where the disease comes back and the treatment received before. If the treatment received before was radiation therapy without chemotherapy, chemotherapy may be given. If the treatment received before was chemotherapy without radiation therapy and the cancer comes back only in the lymph nodes, radiation therapy to the lymph nodes with or without more chemotherapy may be given. If the disease comes back in more than one area, more chemotherapy may be given or a clinical trial of high doses of chemotherapy with bone marrow or peripheral stem cell transplantation may be presented as an option.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.






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