Hodgkin's Disease
Table of Contents
What is Hodgkin's disease?
- Stage Explanation
-
Stages of Hodgkin's disease
- Stage I
- Stage II
- Stage III
- Stage IV
- Recurrent
- Treatment Option Overview
-
How Hodgkin's disease is treated
- Treatment by stage
- Stage I
- Stage II
- Stage III
- Stage IV
- Recurrent
-
- To Learn More...
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.
Non-Hodgkin's lymphomas are covered in the PDQ patient information summaries on
non-Hodgkin's lymphoma (adult or childhood).
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. (For more information on lymphoma in
patients with AIDS, see the PDQ patient information summary on AIDS-related lymphoma).
Hodgkin's disease can also occur in children and is treated differently from that in
adults. (For more information on the treatment of Hodgkin's disease in children, see the
PDQ patient information summary on childhood Hodgkin's disease).
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.
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.
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.
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. Radiation therapy to the lymph nodes in the upper abdomen and pelvis, or total nodal
irradiation. The spleen or the groin may also be treated if needed.
4. 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.
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 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.
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.
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. Total or subtotal nodal irradiation. Radiation may also be given to the liver.
4. 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.
Treatment may be one of the following:
- 1. Combination chemotherapy.
2. Combination chemotherapy and radiation therapy.
3. A clinical trial of bone marrow transplantation.
4. A clinical trial of chemotherapy.
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.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about adult Hodgkin's disease, call the National Cancer Institute's
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By
dialing this toll-free number, you can speak with a trained information specialist who can
answer your questions.
The Cancer Information Service also has a variety of booklets that are available to the
public and can be sent on request. The following booklet about adult Hodgkin's disease may
be helpful:
- What You Need To Know About Hodgkin's Disease
The following general booklets related to questions on cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
Research Report: Bone Marrow Transplantation
There are many other places where people can get materials and information about cancer
treatment and services. The social service office at a hospital can be checked for local
and national agencies that help with getting information about finances, getting to and
from treatment, getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 09/98
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
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