Hodgkin's disease


Hodgkin's disease is a type of lymphoma described by Thomas Hodgkin in 1832,
and characterized by the presence of Reed-Sternberg cells.

Epidemiology

Unlike other lymphomas, whose incidence increases with age, Hodgkin's
lymphoma has a bimodal incidence curve: that is, it occurs more frequently
in two separate age groups, the first being young adulthood (age 15-35), the
second being in those over 50 years old. It is more common in males.

Symptoms

Swollen, but non-painful, lymph nodes are the most common sign of Hodgkin's
disease, often occurring in the neck. The lymph nodes of the chest are often
affected and these may be noticed on chest X-ray.

About one-third of people with Hodgkin's disease may also notice some
systemic symptoms, such as low-grade fever, night sweats, weight loss, or fatigue.

Diagnosis

Hodgkin's disease must be distinguished from non-cancerous causes of lymph
node swelling (such as various infections) and from other types of cancer.
Definitive diagnosis is by lymph node biopsy (removal of a lymph node for
pathological examination).

Hodgkin's disease can be sub-classified by histological type. The cell
histology in Hodgkin's lymphoma is not as important as it is in
non-Hodgkin's lymphoma: the treatment and prognosis in Hodgkin's lymphoma
depend on the stage of disease rather than the cell type.

Staging

After Hodgkin's disease is diagnosed, a patient will be staged: that is,
they will undergo a series of tests and procedures which will determine what
areas of the body are affected. These procedures will alway include
documentation of their histology, a physical examination, blood tests, chest
X-Ray, CT scans or MRI (magnetic resonance imaging) scans of the chest,
abdomen and pelvis, and a bone marrow biopsy. Some patients will also
require liver biopsy, lymphangiograms, gallium scans, bone scans, and
surgical laparotomy, which involves opening the abdominal cavity and
visually inspecting for tumors.

On the basis of this staging, the patient will be classified according to a
staging classification (the Ann Arbor staging classification scheme is a
common one):

   * Stage I is involvement of a single lymph node region or single
     extralymphatic site;
   * stage II is involvement of two or more lymph node regions on the same
     side of the diaphragm or of one lymph node region and a contiguous
     extralymphatic site;
   * stage III is involvement of lymph node regions on both sides of the
     diaphragm;
   * stage IV is disseminated involvement of one or more extralymphatic
     organs.

The absence of systemic symptoms is signified by adding 'A' to the stage;
the presence of systemic symptoms is signified by adding 'B' to the stage.

Treatment

Patients with early stage disease (IA or IIA) are effectively treated with
radiation therapy. Patients with later disease (III, IVA, or IVB) are
treated with combination chemotherapy alone. Patients of any stage with a
large mass in the chest are usually treated with combined chemotherapy and
radiation therapy.

Those undergoing chemotherapy require a minimum of six cycles and may
require longer treatment.

With appropriate treatment, over 85% of Hodgkin's disease cases are curable.

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