Hodgkin's Lymphoma
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Adult Hodgkin's lymphoma is a disease in which malignant (cancer) cells
form in the lymph system.
Adult Hodgkin's lymphoma is a type of cancer that
develops in the lymph system, part of the body's immune system.
The lymph system is made up of the following:
- Lymph: Colorless, watery fluid that travels through the lymph system
and carries white blood cells called lymphocytes. Lymphocytes protect the
body against infections and the growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph from different parts
of the body and return it to the bloodstream.
- Lymph nodes: Small, bean-shaped structures that filter substances in lymph and
help fight infection and disease. Lymph nodes are located along the network
of lymph vessels found throughout the body. Clusters of lymph nodes are found
in the underarm, pelvis, neck, abdomen, and groin.
- Spleen: An organ that produces lymphocytes, filters the blood, stores blood cells,
and destroys old blood cells. It is located on the left side of the abdomen
near the stomach.
- Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the
chest behind the breastbone.
- Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils
produce lymphocytes.
- Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow
produces white blood cells, red blood cells, and platelets.
Because lymph tissue is found throughout the body,
Hodgkin's lymphoma can begin in almost any part of the body and spread to almost
any tissue or organ in the body.
Lymphomas are divided into 2 general types: Hodgkin's
lymphoma and non-Hodgkin's lymphoma.
Hodgkin's lymphoma can occur in both adults and children;
however, treatment for adults may be different than treatment for children.
Hodgkin's lymphoma may also occur in patients who have acquired immunodeficiency
syndrome (AIDS); these patients require special treatment.
There are 5 different types of Hodgkin's lymphoma. These 5 types are based
on the way they look under a microscope.
- Nodular sclerosing Hodgkin's lymphoma.
- Mixed cellularity Hodgkin's lymphoma.
- Lymphocyte depletion Hodgkin's lymphoma.
- Lymphocyte-rich classical Hodgkin's lymphoma.
- Nodular lymphocyte-predominant Hodgkin's lymphoma.
Age, gender, and Epstein-Barr infection can affect the risk of developing
adult Hodgkin's lymphoma.
Risk factors for adult Hodgkin's lymphoma include
the following:
- Being in young or late adulthood.
- Being male.
- Being infected with the Epstein-Barr virus.
- Having a first-degree relative (parent, brother, or sister) with Hodgkin's lymphoma.
Possible signs of adult Hodgkin's lymphoma include swollen lymph nodes,
fever, night sweats, and weight loss.
These and other symptoms may be caused by adult
Hodgkin's lymphoma or by other conditions. A doctor should be consulted if
any of the following problems do not go away.
- Painless, swollen lymph nodes in the neck, underarm, or groin.
- Fevers (unexplained).
- Drenching night sweats.
- Weight loss (unexplained).
- Itchy skin.
- Tiredness.
Tests that examine the lymph nodes are used to detect (find) and diagnose
adult Hodgkin's lymphoma.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general
signs of health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's past illnesses
and treatments will also be taken.
- Complete blood count: A procedure in which a sample of blood is drawn and checked
for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.
- Sedimentation rate: A procedure in which a sample of blood is drawn
and checked for the rate at which the red blood cells settle to the bottom
of the test tube.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure
the amounts of certain substances released into the blood by organs and tissues
in the body. An unusual (higher or lower than normal) amount of a substance
can be a sign of disease in the organ or tissue that produces it.
- Lymph node biopsy: The removal of all or part of a lymph node. A pathologist
views the tissue under a microscope to look for cancer cells. One of the
following types of biopsies may be done:
- Excisional biopsy: The removal of an entire lymph node.
- Incisional biopsy or core biopsy: The removal of part of a lymph node.
- Needle biopsy or fine-needle aspiration: The removal of a sample of tissue from
a lymph node with a needle.
- Immunophenotyping: A test in which the cells in a sample of blood
or bone marrow are looked at under a microscope to find out if malignant
lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The patient's symptoms.
- The stage of the cancer.
- The type of Hodgkin's lymphoma.
- Blood test results.
- The patient's age, gender, and general health.
- Whether the cancer is recurrent or progressive.
Adult Hodgkin's lymphoma can usually be cured
if found and treated early.
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After adult Hodgkin's lymphoma has been diagnosed, tests are done to find
out if cancer cells have spread within the lymph system or to other parts of
the body.
The process used to find out if cancer has spread
within the lymph system or to other parts of the body is called staging. The
information gathered from the staging process determines the stage of the disease.
It is important to know the stage in order to plan treatment. The following
tests and procedures may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed
pictures of areas inside the body, taken from different angles. The pictures
are made by a computer linked to an x-ray machine. A dye may be injected
into a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography. For adult Hodgkin's lymphoma, CT scans
of the chest, abdomen, and pelvis are taken.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor
cells in the body. A small amount of radionuclide glucose (sugar) is injected
into a vein. The PET scanner rotates around the body and makes a picture
of where glucose is being used in the body. Malignant tumor cells show up
brighter in the picture because they are more active and take up more glucose
than normal cells.
- Bone marrow biopsy: The removal of a small piece of bone and bone marrow by inserting
a needle into the hipbone or breastbone. A pathologist views both the bone
and bone marrow samples under a microscope to look for signs of cancer.
- Laparotomy: A surgical procedure in which an incision (cut) is made in the wall
of the abdomen to check the inside of the abdomen for signs of disease. The
size of the incision depends on the reason the laparotomy is being done.
Sometimes organs are removed or tissue samples are taken for biopsy. This
procedure is done only if it is needed to make decisions about treatment.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a
type of energy beam that can go through the body and onto film, making a
picture of areas inside the body.
- Needle or surgical biopsy: The removal of tissue using a thin needle or scalpel.
A pathologist views the tissue under a microscope to look for cancer cells.
- Thoracentesis: The removal of fluid from the space between the lining of the
chest and the lung, using a needle. A pathologist views the fluid under a
microscope to look for cancer cells.
Adult Hodgkin's lymphoma may be classified as follows:
- A: The patient has no symptoms.
- B: The patient has symptoms such as fever, weight loss, or night sweats.
- E: "E" stands for extranodal and means the cancer is found in an organ or tissue other
than the lymph nodes or extends to tissues beyond, but near, the major lymphatic
areas.
- S: "S" stands for spleen and means the cancer is found in the spleen.
Stage I is divided into stage I and stage IE.
- Stage I: Cancer is found in a single group of lymph nodes.
- Stage IE: Cancer is found in one area or organ other than the lymph nodes.
Stage II is divided into stage II and stage IIE.
- Stage II: Cancer is found in two or more lymph node groups on the
same side of the diaphragm (the thin muscle below the lungs that helps breathing
and separates the chest from the abdomen).
- Stage IIE: Cancer is found in one area or organ other than the lymph nodes and
in the lymph nodes near that area or organ, and may have spread to other
lymph node groups on the same side of the diaphragm.
Stage III is divided into stage III, stage IIIE,
Stage IIIS, and stage IIIS+E.
- Stage III: Cancer is found in lymph node groups on both sides of
the diaphragm.
- Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm
and in a nearby area or organ other than the lymph nodes.
- Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm
and in the spleen.
- Stage IIIS+E: Cancer is found in lymph node groups on both sides of the diaphragm,
in a nearby area or organ, and in the spleen.
Stage III is also divided into stage III(1) and
stage III(2) as follows:
- Stage III(1): Cancer is limited to the upper abdomen above the renal
vein.
- Stage III(2): Cancer is found in lymph nodes in the pelvis and/or near the heart.
In stage IV, the cancer either:
- is found throughout at least one organ other than the lymph nodes
and may be in lymph nodes near those organs; or
- is found in one organ other than the lymph nodes and has spread to lymph nodes
far away from that organ.
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Recurrent adult Hodgkin's lymphoma is cancer that
has recurred (come back) after it has been treated. The cancer may come back
in the lymph system or in other parts of the body.
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Different types of treatment are available for patients
with adult Hodgkin's lymphoma. Some treatments are standard (the currently
used treatment), and some are being tested in clinical trials. Before starting
treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the standard
treatment, the new treatment may become the standard treatment.
Patients with Hodgkin's lymphoma should have their treatment planned by
a team of doctors with expertise in treating lymphomas.
Treatment will be overseen by a medical oncologist,
a doctor who specializes in treating cancer. The medical oncologist may refer
you to other doctors who have experience and expertise in treating adult Hodgkin's
lymphoma and who specialize in certain areas of medicine. These may include
the following specialists:
- Neurosurgeon.
- Neurologist.
- Rehabilitation specialist.
- Radiation oncologist.
- Endocrinologist.
- Hematologist.
- Other oncology specialists.
Chemotherapy is a cancer treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by stopping
the cells from dividing. When chemotherapy is taken by mouth or injected into
a vein or muscle, the drugs enter the bloodstream and can reach cancer cells
throughout the body (systemic chemotherapy). When chemotherapy is placed directly
into the spinal column, an organ, or a body cavity such as the abdomen, the
drugs mainly affect cancer cells in those areas (regional chemotherapy). The
way the chemotherapy is given depends on the type and stage of the cancer being
treated. Combination chemotherapy is treatment with more than one anticancer
drug.
Radiation therapy is a cancer treatment that uses
high-energy x-rays or other types of radiation to kill cancer cells. There
are two types of radiation therapy. External radiation therapy uses a machine
outside the body to send radiation toward the cancer. Internal radiation therapy
uses a radioactive substance sealed in needles, seeds, wires, or catheters
that are placed directly into or near the cancer. The way the radiation therapy
is given depends on the type and stage of the cancer being treated.
Laparotomy is a procedure in which an incision
(cut) is made in the wall of the abdomen to check the inside of the abdomen
for signs of disease. The size of the incision depends on the reason the laparotomy
is being done. Sometimes organs are removed or tissue samples are taken for
biopsy. If cancer is found, the tissue or organ is removed during the laparotomy.
Other types of treatment are being tested in clinical trials. These include
the following:
High-dose chemotherapy and radiation therapy with stem cell transplantation
High-dose chemotherapy and radiation therapy with
stem cell transplantation is a method of giving high doses of chemotherapy
and radiation therapy and replacing blood-forming cells destroyed by the cancer
treatment. Stem cells (immature blood cells) are removed from the blood or
bone marrow of the patient or a donor and are frozen and stored. After therapy
is completed, the stored stem cells are thawed and given back to the patient
through an infusion. These reinfused stem cells grow into (and restore) the
body's blood cells.
Clinical trials comparing new methods of treatment
This summary section refers to specific treatments
under study in clinical trials, but it may not mention every new treatment
being studied.
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Treatment of stage I depends on whether the patient
has stage IA (without symptoms) or stage IB (with symptoms) and where the cancer
is.
- Stage IA
If the cancer is above the diaphragm and does not involve a large part of the
chest, treatment may include the following:
- Combination chemotherapy with or without radiation therapy.
- Radiation therapy to lymph nodes in the mantle field (neck, chest, and armpits),
including those near the aorta, with radiation therapy to the spleen
if laparotomy is not done.
- Radiation therapy to the mantle field, with or without laparotomy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
If the cancer is above the diaphragm and
does involve a large part of the chest, treatment may include the following:
- Combination chemotherapy and radiation therapy to the mantle
field (neck, chest, and armpits).
- A clinical trial of combination chemotherapy with or without radiation therapy.
If the cancer is below the diaphragm, treatment
may include the following:
- Radiation therapy to the groin.
- Combination chemotherapy with radiation therapy to involved areas.
- A clinical trial of chemotherapy.
- Stage IB. Treatment of stage IB is usually combination chemotherapy
with or without radiation therapy.
Treatment of stage II depends on whether the patient
has stage IIA (without symptoms) or stage IIB (with symptoms) and where the
cancer is.
- Stage IIA
If the cancer is above the diaphragm and does not involve a large part of the
chest, treatment may include the following:
- Combination chemotherapy with or without radiation therapy.
- Radiation therapy to lymph nodes in the mantle field (neck, chest, and armpits),
including those near the aorta, with radiation to the spleen if laparotomy
is not done.
- Radiation therapy to the mantle field with or without laparotomy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
If the cancer is above the diaphragm and
does involve a large part of the chest, treatment may include the following:
- Combination chemotherapy and radiation therapy to the mantle
field.
- A clinical trial of combination chemotherapy with or without radiation therapy.
- Stage IIB. Treatment of stage IIB may include the following:
- Combination chemotherapy with or without radiation therapy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
Treatment of stage III depends on whether the
patient has stage IIIA (without symptoms) or stage IIIB (with symptoms) and
where the cancer is.
- Stage IIIA
If the cancer does not involve a large part of the chest, treatment may include
the following:
- Combination chemotherapy with or without radiation therapy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
If the cancer does involve a large part
of the chest, treatment may include the following:
- Combination chemotherapy with radiation therapy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
- A clinical trial of combination chemotherapy and stem cell transplantation.
- Stage IIIB. Treatment of stage IIIB may include the following:
- Combination chemotherapy with or without radiation therapy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
- A clinical trial of combination chemotherapy and stem cell transplantation.
Treatment of stage IV may include the following:
- Combination chemotherapy.
- A clinical trial of combination chemotherapy with or without radiation therapy.
- A clinical trial of chemotherapy and stem cell transplantation.
- A clinical trial of new treatment options.
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Treatment of recurrent adult Hodgkin's lymphoma
may include the following:
- Combination chemotherapy.
- Combination chemotherapy followed by high-dose chemotherapy and stem cell transplantation
with or without radiation therapy.
- Radiation therapy with or without chemotherapy.
- Chemotherapy as palliative therapy to relieve symptoms and improve quality of
life.
- A clinical trial of high-dose chemotherapy and stem cell transplantation.
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