Hodgkin's Lymphoma Diagnosis

  • Diagnosis

    Hodgkin's disease (HD) is a type of cancer that affects the lymph system. A lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body's immune system. Lymphomas occur when cells in the lymph system are injured, become abnormal, and begin to multiply continuously; this makes it difficult for the body to produce healthy cells that protect a person from infection. Hodgkin's disease is found most commonly in the chest and neck. In most cases, enlarged lymph nodes are found in the space between the two lobes of the lung.

    Cells collected from a biopsy can be examined under a microscope to look for abnormal cells. The most characteristic cells associated with Hodgkin's disease are called Reed-Sternberg cells.

    Hodgkin's disease can progress either slowly or aggressively. Lymphomas that grow slowly and produce fewer symptoms than more aggressive tumors are called indolent lymphomas. Aggressive lymphomas--also called intermediate- and high-grade lymphomas—grow and spread at an accelerated rate, and are associated with more severe symptoms.

    Hodgkin's disease is a cancer that may spread from one lymph node to another. Hodgkin’s disease spreads from one lymph node to another either slowly or very aggressively, but always in an orderly way. Hodgkin's disease usually spreads downward from the initial site. In addition to affecting the lymph nodes, the cancer cells may also spread to the bone marrow or the spleen.

    Hodgkin's disease is most prevalent in people in their late teens or in their sixties.

    In the US, the disease primarily affects people who are 15 to 35 or 50 to 70 years of age. Hodgkin's disease is newly diagnosed in only about 7,500 people in the US each year, and doesn’t seem to be increasing in incidence. As a result, the disease accounts for less than 1% of all cases of cancer in the US. Treatment for Hodgkin’s disease varies with the stage of the disease; however, it usually responds to anticancer drugs and radiation treatment.

    Treatment for patients with Hodgkin's disease depends on the number and location of tumors, but usually involves radiation therapy, chemotherapy, or a combination of both, and may require surgery or bone marrow transplantation.

    Treatment for Hodgkin's disease is determined by the stage of the condition. When treatment is needed, chemotherapy, radiation therapy, or a combination of both is used. Patients with a highly aggressive or nonresponsive disease are treated with more intensive therapy. Patients with localized Hodgkin's disease are treated with radiation, and those with more disseminated Hodgkin's disease are treated with chemotherapy.

    While there are some known risk factors for Hodgkin’s disease, there are no known direct causes.

    A painless swelling of one or more lymph nodes is the most common sign of Hodgkin’s disease. The lymph nodes in the groin, abdomen, neck, or armpit are most commonly affected. A lump can be felt on either side of the neck, in the groin, in the armpit, or above the collarbone. Because enlarged lymph nodes are also a sign of infection, a doctor may observe them for a period of weeks to see if they change in size.

    If swelling occurs in the abdomen, the patient may appear to be pregnant due to fluid collection or swollen lymph nodes. This abdominal swelling also may cause constipation.

    Other symptoms of Hodgkin's disease include:

    • Fever
    • Excessive sweating or night sweats
    • Weight loss; loss of appetite
    • Fatigue
    • Weakness
    • Bone/flank pain
    • Severe itchiness
    • Coughing, shortness of breath, suffocation
    • Constant tiredness
    • Red patches on the skin
    • Enlarged spleen
    • Pain in lymph node after drinking alcohol

    Patients experiencing generalized symptoms such as weight loss, night sweats, fever, and itchiness (referred to as B symptoms ) may have an increased number of cancer cells. While these symptoms do not necessarily mean that a patient has Hodgkin's disease, patients who have been diagnosed with Hodgkin’s disease and are experiencing B symptoms typically have more advanced disease and a poorer prognosis.

    Infection may play a role in Hodgkin's disease. In particular, tuberculosis, Epstein-Barr Virus (EBV; the virus that causes mononucleosis), H. pylori infection, human T-cell leukemia virus (HTLV), and Kaposi’s sarcoma-associated herpesvirus (KSHV) have been linked to Hodgkin’s disease. However, it is unclear whether or not any of these infections directly cause Hodgkin’s disease.

    Hodgkin's disease may be hereditary. People who have brothers or sisters with Hodgkin's disease have a higher-than-average incidence of developing the disease.

    In most cases, Hodgkin's disease affects people who are 15 to 35 or 50 to 70 years of age.

    Your physician will carefully examine enlarged lymph nodes in your neck, armpits, or groin if he or she suspects Hodgkin’s disease. Your physician will ask you about your medical history and conduct a physical examination to detect lymph node enlargement. As swelling of lymph nodes may indicate infection and not necessarily Hodgkin’s disease, the physician may watch the swelling for a period of weeks before sending you for more testing (e.g., biopsy, blood tests, and imaging).

    Your physician will ask about B symptoms, such as fever, night sweats, and weight loss.

    Your physician may order x-rays, MRIs, and CAT scans of your body to look for evidence of tumors.

    Your physician will take a sample of tissue from fluid or a lymph node to make a diagnosis. Table 01 If you have abnormal cancer cells or signs of infection in the biopsy sample, you may have Hodgkin’s disease. The types of cells contained in the biopsy enable the pathologist to tell the grade, or aggresiveness (e.g., low, intermediate, or high) of the lymphoma. Based on how the tumor cells appear under a microscope, the pathologist estimates their potential to grow and spread. The staging of the tumor describes what parts of the body are affected by the cancer cells.

    In order to stage a tumor, doctors consider:

    • The number and location of the lymph nodes that have cancer cells
    • The location of the affected lymph nodes: above, below, or on both sides of the diaphragm
    • The presence of cancer cells in the bone marrow, spleen, or organs outside the lymphatic system (e.g., the liver)

    In some cases, a surgeon will perform a procedure called a laparotomy to look at tissues that are suspected of being cancerous. This procedure can help a doctor diagnose Hodgkin’s disease. After making an incision through the wall of the abdomen, the surgeon will look at the internal organs; especially the liver, spleen, and lymph nodes. The surgeon will then remove (biopsy) samples of tissue that are suspected to be cancerous, and study them under a microscope.

    Table 1.  Stages and Treatment Options for Patients with Hodgkin's Disease

    Stage Location Treatment Comment
    I? Only one lymph node or one area/organ outside the lymph nodes Radiation therapy Stage I often put into remission or alleviated.Treatment depends on cell type
    II? Two or more lymph nodes in similar areas of the body, or one lymph node and area outside the lymph nodes Radiation therapy Treatment and remission or alleviation rates for stage II are 30% to 75%.Treatment depends on cell type
    III? Multiple areas of the body adjacent to lymph tissue, both above and below the diaphragm, particularly to an area or organ near the lymph nodes or spleen Chemotherapywith or without radiation ?
    IV Many areas of the body near and far from the lymph system (extralymphatic spread) Chemotherapy ?

    There is usually no way to prevent lymphoma. Most people with Hodgkin’s disease have no known risk factors.

  • Prevention and Screening

    There is usually no way to prevent lymphoma. Most people with Hodgkin’s disease have no known risk factors.

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