Hodgkin's Disease (or Hodgkin lymphoma) is an uncommon cancer that occurs in the lymphatic system. It arises when developing lymphocytes develop a malignant characteristic which results in their dysregulated multiplication. These abnormal lymphocytes (called lymphoma cells) then form tumors in the lymphatic system and may progress to metastasis.
Hodgkin disease can begin almost anywhere due to the widespread distribution of lymphoid tissue in the body. It most often spreads through the lymph vessels via lymph nodes but can invade the bloodstream and metastasize to areas including the liver, lungs, and/or bone marrow.The most common sites of occurrence are in the chest, neck, groin, or armpit.
Hodgkin lymphoma most commonly affects adults in their early 20s and adults over 70 years old. However, it can develop at any age and also appears to occur in slightly more men than women.
While the underlying cause of Hodgkin lymphoma is unknown, the following appear to increase the risk of developing the condition:
- Medical conditions that weaken the immune system
- Immunosuppressant medications
- Certain viral infections – there is a positive correlation seen between Hodgkin disease and infection by viruses such as the Epstein-Barr virus (responsible for Infectious mononucleosis), and human immunodeficiency virus (HIV)
- Family history - if a first-degree relative (such as a parent, child, or sibling) has suffered the condition.
The symptoms of Hodgkin's disease include the following:
- Painless swelling of the lymph nodes commonly in the neck, groin, or underarms
- Painful lymph nodes following alcohol consumption
- Itchy skin (Pruritis)
- Persistent tiredness
- Chest pain and difficulty breathing
- Unexplained weight loss and loss of appetite
- Relentless fever
- Night sweats
Staging is a process in which the extent of cancer spread is determined - this is useful in indicating what level of treatment will be most appropriate. One method of staging Hodgkin lymphoma is the following:
- Stage 1 – involves one affected lymph node region.
- Stage 2 – involves a minimum of two lymph node regions on the same side of the body (determined by their location relative to the diaphragm), or the spread of cancer from one lymph node into one nearby.
- Stage 3 – involves affected lymph node regions on both sides of the body with further characterization dependant on the affected areas.
- Stage 4 - involves both spread in areas outside the lymphatic system (metastasis), and lymphatic system.
Staging can also be determined by the presence or absence of some symptoms.
- Asymptomatic (A) - No fever, night sweats, or weight loss.
- Symptomatic (B) - Symptoms include fever, night sweats, or weight loss.
The definitive way to diagnose Hodgkin's disease is via biopsy of the suspected lymph node. This involves analysis of the tissue sample for abnormal features.
Factors such as the position and accessibility of the node in question must be considered – this is required to formulate a decision on the type of biopsy appropriate. The whole lymph node may be removed (excisional biopsy) or just a sample of it may be removed (incisional biopsy). Fine needle aspiration can be used at times to obtain a section of the lymph node. A biopsy of the bone marrow might be deemed necessary should spread of the cancer to the bone marrow be suspected.
Physical examination will be used in order to evaluate the consistency of the node. For example, should the affected node be hard and stony, this would signal a metastasized form of cancer. On the other hand, a soft and tender node could indicate an inflammatory condition as a result of infection.
Imaging techniques such as CT scans can be accurate in revealing the extent of cancer spread, i.e. staging of the cancer. It can then be used to monitor the effectiveness of treatment once initiated.
While this form of cancer is relatively aggressive with the ability to spread and metastasize quickly in the body, it is also one that can be most easily managed by treatment.
The recommended treatment plan will depend on the patient’s general health, age, and how widespread the cancer is. The main treatments used in plans are chemotherapy, which is used solely or is followed by radiotherapy.
Approximately 85% of those suffering from Hodgkin lymphoma live at least 5 years. Unfortunately, there is a risk of long-term problems following treatment such as infertility and an increased risk of developing another form of cancer.
Reviewed by Susha Cheriyedath, MSc