Hodgkin's Disease (HD) Introduction
Roughly 8,000 Americans develop this illness each year. It is slightly more frequent in men than in women, and is more commonly seen in the third decade of life, after age 50. This disease is caused by overproduction of lymphoid cells. Hodgkin's Disease is highly curable, even in advanced stages.
Causes
The cause of this illness is unknown in the majority of patients. Certain viruses like EBV or HIV have been linked to causation of Hodgkin's Disease..
Signs and Symptoms
Patients may not show any signs for sometime. As the disease progresses, it can cause any of the following problems:
- Enlargement of lymph glands
- Enlargement of spleen
- Enlargement of liver
- Anemia
- Low platelet count
- Frequent infections
- Fever
- Weight loss
- Night sweats
- Itching
The diagnosis is made by taking a biopsy of an enlarged lymph node or involved organ of the body. Evaluation of bone marrow under microscope may also lead to this diagnosis.
Staging
Refers to the extent of the disease and is a very good guideline as to the treatment plans and outcome of the disease. The extent of the disease can be established by physical examination, CT scan of the chest, abdomen, and pelvis and a bone marrow test.
- Stage 1 is when patients develop enlargement of lymph glands in one region.
- Stage 2 is when a patient has enlargement of lymph glands in two or more regions.
- Stage 3 is when a patient develops enlargement of the spleen.
- Stage 4 s when the disease involves the liver, lung or bone marrow.
Gallium Scan is highly sensitive in the staging of patients. A radioactive substance, Gallium, is injected intravenously into the patient and is picked up by the sites of illness. This procedure can visualize hidden sites where the disease may be located.
Treatment of Hodgkin’s Disease
Patients with stages 1 and 2 are mainly treated with radiation therapy. Higher stages are normally treated with chemotherapy, with or without radiation. A cure is possible in the vast majority of patients. The standard chemotherapy regimens for Hodgkin’s Disease are MOPP and ABVD regimens.
Certain patients are treated with Bone Marrow Transplantation:
- Patients who do not enter a remission
- Patients who relapse soon after initial remission
Side effects of Radiation
- Dryness of the mouth
- Difficulty swallowing
- Heartbur
- Dry cough
- Skin irritation
Refers to the response of any cancer to treatment.
Complete remission refers to the situation where the disease disappears completely with the treatment.
Partial remission refers to the situation where the disease shrinks, but does not disappear completely with the treatment.
Prognosis
Patients with lower stages have a better prognosis. They may, however, gradually transform into higher stages. The prognosis for patients with Hodgkin's disease depends on its response to chemotherapy, but the majority of patients are cured with treatment.
Special Situations
Patients with advanced Hodgkin's lymphoma may develop any of the following complications:
- Spinal cord compression
- Brain metastasis
- Bone metastasis
- Paraneoplastic syndromes
- High calcium level
- Pain
- High uric acid
- Pleural effusion
Survival of patients with Hodgkin's disease is excellent. In those patients in whom a cure is not possible, survival could vary from months to years, depending on the extent of the cancer and the overall condition of the patient, as well as the response to treatment and the duration of that response.
Follow-up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of a recurrence of cancer. Follow-up shall be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. At each follow-up visit, patients are examined. Normally, a chest x-ray, CT scan of the chest and abdomen along with a Gallium scan is obtained every few months.
Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy, using the same agents as mentioned above, or bone marrow transplantation . Radiation therapy may be helpful in managing this condition. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.
Hogdkin's Disease
Hogdkin's Disease
Hogdkin's Disease
Hogdkin's Disease
Hogdkin's Disease
