Hodgkin's Lymphoma—Adult
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Definition
Hodgkin's lymphoma is a cancer of the lymphatic system. The lymphatic system drains excess fluid from the blood and protects against infection. Hodgkin's lymphoma is different from other forms of lymphoma .

The Lymphatic Organs

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Cancer occurs when cells in the body—in this case a type of white blood cell called lymphocyte—divide without control or order. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and can spread to other parts of the body. A benign tumor does not invade or spread.

Causes
The cause of Hodgkin's lymphoma is unknown. It is likely related to complex genetic and environmental factors that lead to changes of the immune system. There are some compelling pieces of data to suggest that it is caused by a virus. The Epstein-Barr virus (EBV) has been considered.

Risk Factors
Factors that increase your chance of getting Hodgkin's lymphoma include:

  • Sex: male
  • Ages: 15-40 and over 55
  • Family history
  • History of infectious mononucleosis or infection with Epstein-Barr virus, which causes mononucleosis
  • Weakened immune system, including infection with HIV or the presence of AIDS
Symptoms
Symptoms include:

  • Painless swelling of the lymph nodes in the neck, armpit, or groin
  • Persistent fatigue
  • Night sweating
  • Coughing
  • Unexplained fever
  • Weight loss
  • Itching
  • Decreased appetite
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done, paying particular attention to your lymph nodes. Most enlarged or swollen lymph nodes result from infection, not lymphomas. If infection is suspected, you may be given medication and instructed to return for a follow-up appointment.

If swelling persists, your doctor may order a lymph node biopsy . The biopsy results will show whether there is cancer, and if so, the type and extent of the cancer that is present.

Treatment of Hodgkin’s disease depends on the stage of the disease. The stage identifies how far the cancer has spread and what organs are affected. In general, this means that staging tests to evaluate the condition of the lymph nodes in the body, the liver, spleen, and bone marrow must be done.

Your bodily fluids may be tested. This can be done with blood tests.

Your internal bodily structures may need to be viewed. This can be done with:

Abdominal surgery may be needed to remove the spleen and to biopsy the liver. This is not common because of the accuracy of noninvasive scans.

Treatment
Hodgkin's lymphoma is generally considered one of the more curable forms of cancer. Treatment options include:

Chemotherapy and External Radiation Therapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

In radiation therapy , radiation is directed at the tumor from a source outside the body to kill the cancer cells.

In many cases, both chemotherapy and radiation are used to cure a patient of Hodgkin’s lymphoma. The choice of treatments will be based on:

  • Extent of disease—the stage
  • Location of the affected lymph node(s)
  • Many other patient-related features that your doctor will discuss with you
It is important that you be seen by both the medical oncologist to discuss chemotherapy and the radiation oncologist to discuss the radiation therapy. The best treatment results come from a discussion and integrated approach.

If the cancer does not respond to chemotherapy or radiation, the outcome is usually very poor. There are some treatment options available, including:

  • Bone marrow transplantation —Bone marrow is removed. Large doses of chemotherapy and/or radiation therapy are then applied to kill the cancer cells. After treatment, the bone marrow is replaced via a vein. Transplanted bone marrow may be the patient's bone marrow that was treated to remove cancer cells or marrow from a healthy donor.
  • Peripheral blood stem cell transplantation —Stem cells are very immature cells that produce blood cells. They are removed from circulating blood before chemotherapy or radiation treatment and then replaced after treatment.
Splenectomy
Splenectomy is the surgical removal of the spleen, an organ that is part of the lymphatic system. In some cases, splenectomy is recommended in people who have lymphoma.

Prevention
There are no guidelines for preventing Hodgkin's lymphoma because the cause is unknown.




RESOURCES:
American Cancer Society

National Cancer Institute

CANADIAN RESOURCES:
Canadian Cancer Society

Lymphoma Foundation Canada

References:
Braunwald E. Harrison's Principles of Internal Medicine . 16th ed. New York, NY: McGraw Hill; 2005.

Hodgkin disease. American Cancer Society website. Available at: http://www.cancer.org/cancer/hodgkindisease/index. Accessed April 30, 2013.

Hodgkin disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 8, 2013. Accessed April 30, 2013.

Hodgkin lymphoma. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/hodgkin. Accessed April 30, 2013.

Indications for splenectomy. The Society for Surgery of the Alimentary Tract website. Available at: http://www.ssat.com/cgi-bin/spleen7.cgi. Updated May 2003. Accessed April 30, 2013.

Last Reviewed April 2013



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