Hodgkin's Lymphoma

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What are lymphomas?

Lymphomas are cancers that develop in the lymphatic system. This system is composed of a network of thin lymphatic channels that branch into tissues all over the body, much like blood vessels. Circulating in this system is a colorless, watery fluid called lymph, which contains infection-fighting cells known as lymphocytes. Along this network are small organs called lymph nodes, clusters of which are found in our neck, armpit, chest, abdomen, groins. Other parts of this system are the spleen, tonsils, thymus and bone marrow, and lymphatic tissues are also found in the skin, stomach and intestines.

What is Hodgkin's Disease?

Hodgkin's Disease is one of the lymphomas, an uncommon one, less than 1 percent of all cases of cancer in the United States. The other variety is called Non-Hodgkin's lymphomas. Our body cells, under normal condition, grow and divide in an orderly and timely fashion to produce more cells when our body needs them. Carcinogens (cancer-causing agents) can cause the cells to grow in a disorderly, rapid and uncontrolled fashion, forming a mass (tumor) of extra tissues. This could either be benign (not cancerous) or malignant (cancerous). Since lymphatic tissues are all over our body, Hodgkin's can start in almost any organ, affecting groups of lymph nodes, spreading to the next contiguous group of nodes.

What causes lymphomas?

The etiology of Hodgkin's or the other forms of lymphomas is still unknown but it is an established fact that it is not caused by injury and that it is not contagious. Why some people get it and others don't, we still d not know.

What are the risk factors?

Persons who develop Hodgkin's disease are usually between 15 and 34 years old, and among those older than 55. It is more common among males. It has some familial predisposition, since siblings have higher-than-average chance of getting the disease. Epstein-Barr virus is suspect in increasing the risk of Hodgkin's, but remains to be proven.

Are lymphomas linked to sexually transmitted diseases?

No, there is no known link between sexually transmitted diseases (syphilis, gonorrhea, AIDS, etc) and the lymphomas, which cannot be transmitted by sexual contact.

Does having TB make one more prone to Hodgkin's ?

Pulmonary tuberculosis in a person does not increase his/her chances of having Hodgkin's lymphoma. There is no scientific evidence that shows those afflicted with tuberculosis are more at risk of developing lymphomas of any type.

What are the symptoms of Hodgkin's?

The signs and symptoms may include unexplained fevers, night sweats, painless lymph nodes in the neck, armpit or groin, itchy skin, unexplained weight loss. Most often, though, patients with these symptoms, have been found to have less serious medical conditions, like influenza. However, if these symptoms persist, medical consultation is strongly recommended.

How is the diagnosis made?

After the routine history and physical examination (especially for enlarged lymph nodes ("kulane" in Tagalog) in the neck, armpit or groin), the physician may order X-rays, CT (Computerized Tomography) Scan, or even an MRI (Magnetic Resonance Imaging). For definitive tissue diagnosis, a palpable lymph node may be biopsied for microscopic evaluation, in search of cancer cells (Reed-Sternberg cells, large abnormal cells found in Hodgkin's).

If it is Hodgkin's, then what?

If the biopsy confirms the diagnosis of Hodgkin's, the physician needs to know the staging (extent or location and severity of the spread, if any). Biopsy of lymph nodes, and in some cases including those in the abdomen, liver, bone marrow, etc. is the gold standard in staging lymphomas.

Which specialists should be consulted?

The comprehensive treatment of Hodgkin's is best handled by a team of specialists, composed of the referring family physician, medical and surgical oncologists, oncology nurse and/or radiation oncologist.

What is the treatment for Hodgkin's?

The usual treatment for Hodgkin's is either radiation or chemotherapy. Following the diagnosis and staging, the specialist develops a plan according to the patient's age, needs, general health, the size of the lymph nodes, the symptoms present, and very importantly, the stage of the disease.

Are there side effects of treatment?

Yes, just like radiation treatment or chemotherapy for other malignant tumors, the therapy for Hodgkin's also has side effects. These usually depends on the type, dose and length of treatments. The oncologists will explain all the details of the treatment and the side effects of the therapy as a part of an informed consent for the patient.

What is the prognosis of Hodgkin's?

Today, most patients with Hodgkin's disease are curable, or at least the disease can be controlled for years. The research on cancers has progressed so much, especially with Hodgkin's, that most of these patients now have increased survival rates and improved quality of life. Majority of them can now be cured.

Can treated Hodgkin's patients live a normal life?

The main aim of treatment is to enable the patient to lead a normal life, especially among Hodgkin's patients, where therapy is very successful. Except for the expected lifestyle changes brought on by the illness, diagnosis and treatment, patients are encouraged to live and be as active as normally possible, according to their condition and endurance. The general outlook for most of them is very good.

How about follow-up care?

Regular medical check-up is most essential in the treatment of Hodgkin's, and the follow-up will be for the rest of the life of the patient. One of the main reasons for this close monitoring is the observation that patients with Hodgkin's are more prone to develop leukemia and those with Non-Hodgkin's, cancer of the colon, breast, lung, thyroid, and bone.

Where can one get more information on cancers?

Today, one of the best sources of information in general is the internet. For medical information, www.webMD.com is a very popular site. There are, of course, at least half a dozen others. Most other websites (like Yahoo, MSN, etc) have a health section or link. In the United States, publications and brochures on health and diseases are available from the National Cancer Institute (NCI), phone 1-800-4-CANCER.

©2003Raoul R. Diez, M.A.O.D.