Keeping on top of Your Condition
Hodgkins disease, Hogkin, Hogkins, Hotchkins, Hodkin, Hodkins
What Is Hodgkin's Disease?
Hodgkin's disease is one of a group of cancers called
lymphomas.
Lymphoma is a general term for cancers that develop in the
lymphatic
system. Hodgkin's disease, an uncommon lymphoma, accounts for less
than 1 percent of all cases of cancer in this country. Other cancers of
the lymphatic system are called non-Hodgkin's lymphomas.
Lymphatic system
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The lymphatic system is part of the body's
immune
system. It helps the body fight disease and infection. The
lymphatic system includes a network of thin lymphatic vessels that branch,
like blood vessels, into tissues throughout the body. Lymphatic vessels
carry
lymph,
a colorless, watery fluid that contains infection-fighting cells called
lymphocytes.
Along this network of vessels are small organs called
lymph
nodes. Clusters of lymph nodes are found in the underarms,
groin,
neck, chest, and
abdomen.
Other parts of the lymphatic system are the
spleen,
thymus,
tonsils,
and
bone
marrow. Lymphatic tissue is also found in other parts of the body,
including the stomach, intestines, and skin.
Cancer is a group of many related diseases that begin in cells, the
body's basic unit of life. To understand Hodgkin's disease, it is helpful
to know about normal cells and what happens when they become cancerous.
The body is made up of many types of cells. Normally, cells grow and
divide to produce more cells only when the body needs them. This orderly
process helps keep the body healthy. Sometimes cells keep dividing when
new cells are not needed, creating a mass of extra tissue. This mass is
called a growth or
tumor.
Tumors can be either
benign
(not cancerous) or
malignant
(cancerous).
In Hodgkin's disease, cells in the lymphatic system become abnormal.
They divide too rapidly and grow without any order or control. Because
lymphatic tissue is present in many parts of the body, Hodgkin's disease
can start almost anywhere. Hodgkin's disease may occur in a single lymph
node, a group of lymph nodes, or, sometimes, in other parts of the
lymphatic system such as the bone marrow and spleen. This type of cancer
tends to spread in a fairly orderly way from one group of lymph nodes to
the next group. For example, Hodgkin's disease that arises in the lymph
nodes in the neck spreads first to the nodes above the collarbones, and
then to the lymph nodes under the arms and within the chest. Eventually,
it can spread to almost any other part of the body.
Risk Factors Associated with Hodgkin's Disease
Scientists at hospitals and medical centers all across the country are
studying Hodgkin's disease. They are trying to learn more about what
causes the disease and more effective methods of treatment.
At this time, the cause or causes of Hodgkin's disease are not known,
and doctors can seldom explain why one person gets this disease and
another does not. It is clear, however, that Hodgkin's disease is not
caused by an injury, and it is not contagious; no one can "catch" this
disease from another person.
By studying patterns of cancer in the population, researchers have
found certain
risk
factors that are more common in people who get Hodgkin's disease
than in those who do not. However, most people with these risk factors do
not get Hodgkin's disease, and many who do get this disease have none of
the known risk factors.
The following are some of the risk factors associated with this
disease:
-
Age/Sex -- Hodgkin's disease occurs most often in people
between 15 and 34 and in people over the age of 55. It is more common in
men than in women.
-
Family History -- Brothers and sisters of those with Hodgkin's
disease have a higher-than-average chance of developing this disease.
-
Viruses -- Epstein-Barr virus is an infectious agent that may
be associated with an increased chance of getting Hodgkin's
disease.
People who are concerned about the chance of developing Hodgkin's
disease should talk with their doctor about the disease, the symptoms to
watch for, and an appropriate schedule for checkups. The doctor's advice
will be based on the person's age, medical history, and other factors.
Symptoms of Hodgkin's Disease
Symptoms of Hodgkin's disease may include the following:
-
A painless swelling in the lymph nodes in the neck, underarm, or
groin
-
Unexplained recurrent fevers
-
Night sweats
-
Unexplained weight loss
-
Itchy skin
When symptoms like these occur, they are not sure signs of Hodgkin's
disease. In most cases, they are actually caused by other, less serious
conditions, such as the flu. When symptoms like these persist, however, it
is important to see a doctor so that any illness can be diagnosed and
treated. Only a doctor can make a diagnosis of Hodgkin's disease. Do
not wait to feel pain; early Hodgkin's disease may not cause pain.
Diagnosis and Staging of Hodgkin's Disease
If Hodgkin's disease is suspected, the doctor asks about the person's
medical history and performs a physical exam to check general signs of
health. The exam includes feeling to see if the lymph nodes in the neck,
underarm, or groin are enlarged. The doctor may order blood tests.
The doctor may also order tests that produce pictures of the inside of
the body. These may include:
MRI
(magnetic resonance imaging): Detailed pictures of
areas inside the body produced with a powerful magnet linked to a
computer.
The diagnosis depends on a
biopsy.
A surgeon removes a sample of lymphatic tissue (part or all of a lymph
node) so that a
pathologist
can examine it under a microscope to check for cancer cells. Other tissues
may be sampled as well. The pathologist studies the tissue and checks for
Reed-Sternberg
cells, large abnormal cells that are usually found with Hodgkin's
disease.
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A patient who needs a biopsy may want to ask the doctor some of
the following questions:
-
Why do I need to have a biopsy?
-
How long will the biopsy take? Will it hurt?
-
How soon will I know the results?
-
If I do have cancer, who will talk with me about treatment?
When? |
If the biopsy reveals Hodgkin's disease, the doctor needs to learn the
stage,
or extent, of the disease. Staging is a careful attempt to find out
whether the cancer has spread and, if so, what parts of the body are
affected. Treatment decisions depend on these findings.
The doctor considers the following to determine the stage of Hodgkin's
disease:
-
The number and location of affected lymph nodes;
-
Whether the affected lymph nodes are on one or both sides of the
diaphragm
(the thin muscle under the lungs and heart that separates the chest from
the abdomen); and
-
Whether the disease has spread to the bone marrow, spleen, or places
outside the lymphatic system, such as the liver.
In staging, the doctor may use some of the same tests used for the
diagnosis of Hodgkin's disease. Other staging procedures may include
additional biopsies of lymph nodes, the liver, bone marrow, or other
tissue. A
bone
marrow biopsy involves removing a sample of bone marrow through a
needle inserted into the hip or another large bone. Rarely, an operation
called a
laparotomy
may be performed. During this operation, a surgeon makes an incision
through the wall of the abdomen and removes samples of tissue. A
pathologist examines tissue samples under a microscope to check for cancer
cells.
Treatment of Hodgkin's Disease
The doctor develops a treatment plan to fit each patient's needs.
Treatment for Hodgkin's disease depends on the stage of the disease, the
size of the enlarged lymph nodes, which symptoms are present, the age and
general health of the patient, and other factors.
Patients with Hodgkin's disease may be vaccinated against the flu,
pneumonia, and meningitis. They should discuss a vaccination plan with
their health care provider.
Hodgkin's disease is often treated by a team of specialists that may
include a
medical
oncologist,
oncology
nurse, and/or
radiation
oncologist. Hodgkin's disease is usually treated with
radiation
therapy or
chemotherapy.
The doctors may decide to use one treatment method or a combination of
methods.
Taking part in a
clinical
trial (research study) to evaluate promising new ways to treat
Hodgkin's disease is an important option for many people with this
disease.
Getting a Second Opinion regarding Hodgkin's Disease
Before starting treatment, patients may want a second opinion to
confirm their diagnosis and treatment plan. Some insurance companies
require a second opinion; others may cover a second opinion if the patient
or doctor requests it.
There are a number of ways to find a doctor who can give a second
opinion:
-
The patient's doctor may be able to suggest specialists to consult.
-
The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about cancer treatment facilities, including cancer centers and other
programs supported by the National Cancer Institute.
-
Patients can get the names of doctors from their local medical
society, a nearby hospital, or a medical school.
-
The Official ABMS Directory of Board Certified Medical
Specialists lists doctors' names along with their specialty and
medical background. This resource, produced by the American Board of
Medical Specialties, is available in most public libraries and on the
Internet.
Preparing for Treatment of Hodgkin's Disease
Many people with cancer want to learn all they can about their disease
and their treatment choices so they can take an active part in decisions
about their medical care. When a person is diagnosed with cancer, shock
and stress are natural reactions. These feelings may make it difficult for
people to think of everything they want to ask the doctor. Often, it helps
to make a list of questions. To help remember what the doctor says,
patients may take notes or ask whether they may use a tape recorder. Some
people also want to have a family member or friend with them when they
talk to the doctor -- to take part in the discussion, to take notes, or
just to listen.
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These are some questions a patient may want to ask the doctor
before treatment begins:
-
What is my exact diagnosis?
-
What is the stage of the disease?
-
What are my treatment choices? Which do you recommend for me?
Why?
-
What are the risks and possible
side
effects of each treatment?
-
What side effects should I report to you?
-
How long will treatment last?
-
What are the chances that the treatment will be successful?
-
Will treatment affect my normal activities? If so, for how
long?
-
Are new treatments under study? Would a clinical trial be
appropriate for me?
-
What is the treatment likely to
cost? |
Patients do not need to ask all their questions or remember all the
answers at one time. They will have other chances to ask the doctor to
explain things and to get more information.
Methods of Treating Hodgkin's Disease
Radiation therapy and chemotherapy are the most common treatments for
Hodgkin's disease, although
bone
marrow transplantation,
peripheral
stem cell transplantation, and
biological
therapies are being studied in
clinical trials.
Radiation therapy (also called radiotherapy) is the use of
high-energy rays to kill cancer cells. Depending on the stage of the
disease, treatment with radiation may be given alone or with chemotherapy.
Radiation therapy is
local
therapy; it affects cancer cells only in the treated area.
Radiation treatment for Hodgkin's disease usually involves
external
radiation, which comes from a machine that aims the rays at a
specific area of the body. External radiation does not cause the
body to become radioactive. Most often, treatment is given on an
outpatient basis in a hospital or clinic.
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These are some questions a patient may want to ask the doctor
before having radiation therapy:
-
What is the goal of this treatment?
-
What are its risks and possible side effects?
-
What side effects should I report to you?
-
How will the radiation be given?
-
When will the treatments begin? When will they end?
-
How will I feel during therapy?
-
What can I do to take care of myself during therapy?
-
How will we know if the radiation therapy is working?
-
How will treatment affect my normal
activities? |
Chemotherapy is the use of drugs to kill cancer cells.
Chemotherapy for Hodgkin's disease usually consists of a combination of
several drugs. It may be given alone or followed by radiation therapy.
Chemotherapy is usually given in cycles: a treatment period followed by
a recovery period, then another treatment period, and so on. Most
anticancer drugs are given by injection into a blood vessel (
IV);
some are given by mouth. Chemotherapy is a
systemic
therapy, meaning that the drugs enter the bloodstream and travel
throughout the body.
Usually, a patient has chemotherapy as an outpatient (at the hospital,
at the doctor's office, or at home). However, depending on which drugs are
given and the patient's general health, a short hospital stay may be
needed.
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These are some questions patients may want to ask the doctor
before starting chemotherapy:
-
What is the goal of this treatment?
-
What drugs will I be taking?
-
Will the drugs cause side effects? What can I do about
them?
-
What side effects should I report to you?
-
How long will I need to take this treatment?
-
What can I do to take care of myself during treatment?
-
How will we know if the drugs are
working? |
Hodgkin's DiseaseHodgkin's Disease Clinical Trials
Many people with Hodgkin's disease take part in clinical trials.
Doctors conduct clinical trials to learn about the effectiveness and side
effects of new treatments. Trials are exploring new ways of giving
radiation therapy and chemotherapy, new drugs and new drug combinations,
and biological therapies. High-dose chemotherapy with bone marrow or
peripheral blood stem cell transplantation is also being evaluated. In
some trials, all patients receive the new treatment. In others, doctors
compare different therapies by giving the new treatment to one group of
patients and the standard treatment to another group; or they may compare
one standard treatment with another. Research like this has led to
significant advances in the treatment of Hodgkin's disease. Each
achievement brings researchers closer to the eventual control of
cancer.
People who take part in clinical trials have the first chance to
benefit from treatments that have shown promise in earlier research. They
also make an important contribution to medical science.
Patients who are interested in entering a clinical trial should talk
with their doctor.
Side Effects of Hodgkin's Disease Treatment
Treatments for Hodgkin's disease are very powerful. It is hard to limit
the effects of therapy so that only cancer cells are destroyed. Because
treatment also damages healthy cells and tissues, it often causes side
effects.
The side effects of cancer treatment depend mainly on the type and
extent of the therapy. Side effects may not be the same for everyone, and
they may even change from one treatment to the next. Doctors and nurses
can explain the possible side effects of treatment. They can also lessen
or control many of the side effects that may occur during and after
treatment.
Radiation Therapy for Hodgkin's Disease
The side effects of radiation depend on the treatment dose and the part
of the body that is treated. During radiation therapy, people are likely
to become extremely tired, especially in the later weeks of treatment.
Rest is important, but doctors usually advise patients to try to stay as
active as they can.
It is common to lose hair in the treated area and for the skin to
become red, dry, tender, and itchy. There may also be permanent darkening
or "bronzing" of the skin in the treated area.
When the chest and neck are treated, patients may have a dry, sore
throat and some trouble swallowing. Sometimes, they have shortness of
breath or a dry cough. Radiation therapy to the abdomen may cause nausea,
vomiting, diarrhea, or urinary discomfort. Often, changes in diet or
medicine can ease these problems.
Radiation therapy also may cause a decrease in the number of white
blood cells, cells that help protect the body against infection, or
platelets, cells that help the blood to clot. If that happens, patients
need to be careful to avoid possible sources of infection or injury. The
doctor monitors a patient's blood count very carefully during radiation
treatment. If necessary, treatment may have to be postponed to let the
blood counts return to normal.
Although the side effects of radiation therapy can be difficult, they
can usually be treated or controlled. It may also help to know that, in
most cases, side effects are not permanent. However, patients may want to
discuss with their doctor the possible long-term effects of radiation
treatment on
fertility
(the ability to produce children) and the increased chance of second
cancers after treatment is over.
Loss of fertility may be temporary or permanent, depending on if
the testes or ovaries received radiation and the patient's age. For men,
sperm
banking before treatment may be a choice. Women's menstrual
periods may stop, and they may have hot flashes and vaginal dryness.
Menstrual periods are more likely to return for younger women.
Hodgkin's Disease Treatment - Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs
and the doses the patient receives. As with other types of treatment, side
effects may vary from person to person.
Anticancer drugs generally affect cells that divide rapidly. In
addition to cancer cells, these include blood cells, which fight
infection, help the blood to clot, and carry oxygen to all parts of the
body. When blood cells are affected, the patient is more likely to get
infections, may bruise or bleed easily, and may feel unusually weak and
tired.
Cells in hair roots also divide rapidly; therefore, chemotherapy may
lead to hair loss. Hair loss is a major concern for many patients. Some
anticancer drugs only cause the hair to thin out, while others may result
in the loss of all body hair. People may cope with hair loss better if
they decide how to handle hair loss before starting treatment.
Cells that line the digestive tract also divide rapidly, and are often
damaged by chemotherapy. As a result, side effects may include poor
appetite, nausea and vomiting, and/or mouth and lip sores.
Most side effects go away gradually during the recovery periods between
treatments or after treatment is over. Sometimes, however, chemotherapy
results in a permanent loss of fertility.
Nutrition During Hodgkin's Disease Treatment
Eating well during cancer treatment means getting enough calories and
protein to help prevent weight loss and regain strength. Good nutrition
often helps people feel better and have more energy.
Some people with cancer find it hard to eat a balanced diet because
they may lose their appetite. In addition, common side effects of
treatment, such as nausea, vomiting, or mouth sores, can make eating
difficult. Often, foods taste different. Also, people being treated for
cancer may not feel like eating when they are uncomfortable or tired.
Doctors, nurses, and dietitians can offer advice on how to get enough
calories and protein during cancer treatment.
Recovery and Outlook
It is natural for anyone facing cancer to be concerned about what the
future holds. Understanding the nature of cancer and what to expect can
help patients and their loved ones plan treatment, anticipate lifestyle
changes, and make quality of life and financial decisions.
Cancer patients frequently ask their doctors or search on their own for
statistics to answer the question, "What is my
prognosis?"
Prognosis is a prediction of the future course and outcome of a disease
and an indication of the likelihood of recovery from that disease.
However, it is only an estimate. When doctors discuss a patient's
prognosis, they are attempting to project what is likely to occur for that
individual patient. The prognosis for Hodgkin's disease can be affected by
many factors, particularly the stage of the cancer, the patient's response
to treatment, and the patient's age and general health.
Sometimes people use statistics to try to figure out their chances of
being cured. However, statistics reflect the experience of a large group
of patients. They cannot be used to predict what will happen to a
particular patient because no two patients are alike; treatment and
responses vary greatly. The doctor who is most familiar with a patient's
situation is in the best position to help interpret statistics and discuss
the patient's prognosis.
When doctors talk about surviving cancer, they may use the term
remission
rather than cure. Although many people with Hodgkin's disease are
successfully treated, doctors use the term remission because cancer can
return. It is important to discuss the possibility of
recurrence
with the doctor.
Hodgkin's Disease Followup Care
People who have had Hodgkin's disease should have regular followup
examinations after their treatment is over and for the rest of their
lives. Followup care is an important part of the overall treatment
process, and people who have had cancer should not hesitate to discuss it
with their health care provider. Patients treated for Hodgkin's disease
have an increased chance of developing
leukemia;
non-Hodgkin's lymphoma; and cancers of the colon, lung, bone, thyroid, and
breast. Regular followup care ensures that patients are carefully
monitored, any changes in health are discussed, and new or recurrent
cancer can be detected and treated as soon as possible. Between followup
appointments, people who have had Hodgkin's disease should report any
health problems as soon as they appear.
Support for People with Hodgkin's Disease
Living with a serious disease is not easy. People with cancer and those
who care about them face many problems and challenges. Coping with these
problems is often easier when people have helpful information and support
services.
Friends and relatives can be very supportive. Also, it helps many
patients to discuss their concerns with others who have cancer. Cancer
patients often get together in support groups, where they can share what
they have learned about coping with cancer and the effects of treatment.
It is important to keep in mind, however, that each person is different.
Treatments and ways of dealing with cancer that work for one person may
not be right for another -- even if they both have the same kind of
cancer. It is always a good idea to discuss the advice of friends and
family members with the health care provider.
People living with cancer may worry about what the future holds. They
may worry about holding their jobs, caring for their families, personal
relationships, or continuing with daily activities. Concerns about tests,
treatments, hospital stays, and medical bills are also common. Doctors,
nurses, and other members of the health care team can answer questions
about treatment, working, or other activities. Meeting with a social
worker, counselor, psychologist, or member of the clergy can be helpful to
people who want to talk about their feelings or discuss their concerns.
Often, a social worker can suggest groups that can help with
rehabilitation, emotional support, financial aid, transportation, or home
care.
Keeping on top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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