Mysterious Disease—Hodgkin’s Lymphoma

  Contributed by: Gage Swanson, Pharm.D.  Candidate

                        UMKC School of Pharmacy
Text Box: What is Hodgkin’s lymphoma? This term can be used interchangeably with “Hodgkin’s Disease.” This mysterious disease of the lymph system bears Thomas Hodgkin’s name because he first described it in 1932. Hodgkin’s disease is a type of lymphoma. Hodgkin’s lymphoma is a type of cancer that arises from a malignant transformation of the body’s protective immune cells, most commonly found in lymph tissues, into destructive cancer cells. How many people are diagnosed yearly? There will be an estimated 7,400 to 10,000 new cases of Hodgkin’s disease diagnosed in the United States this year alone. This only represents < 1% of all known cancers. An estimated 1,300 deaths will occur in this one year time period. What gender and age groups are most commonly diagnosed? Hodgkin’s disease occurs slightly more frequently in males than in females. This disease occurs most commonly in persons aged 25-30 years old and again in those older than 55 years old. What are the risk factors for Hodgkin’s lymphoma? All of the factors of this disease have not been fully discovered and understood. Environmental risk factors have been linked with Hodgkin’s, but only appear to play a minor role. Farmers, wood workers, and meat workers appear to be at a slightly increased risk. Viruses have emerged as the leading candidates for an infectious cause. Some studies have suggested that persons who have had mononucleosis caused by the Epstein-Barr virus and HIV Text Box: infected men are at an increased risk. Genetic factors also predispose people to Hodgkin’s disease. How does Hodgkin’s lymphoma present itself in a person? Patients with lymphoma typically present with some form of lymph node enlargement. It is generally not possible to differentiate between various lymphomas by the physical characteristics of the lymph node itself. A clinician will have to look more specifically at the distribution of the enlarged lymph nodes. Most commonly the lymph node enlargement is localized in and around the neck region and is painless and rubbery to the touch. Forty percent of patients with Hodgkin’s lymphoma will experience symptoms such as fever, drenching night sweats, and weight loss. Once properly diagnosed, what treatment options are available for the patient? The treatment is stage specific. In general, early stage Hodgkin’s lymphoma is usually treated with radiation therapy. Extended-field radiotherapy or subtotal nodal irradiation is considered to be treatment of choice for stage IA and IIA disease. This treatment can produce disease-free survival rates ranging from 65% to 85% and overall survival rates ranging from 75% to 93%. Advanced-stage disease is usually treated with combination chemotherapy. Mid- to late-stage or bulky disease is usually treated with combined chemotherapy and radiation therapy. The combination of chemotherapy and radiation holds the promise of decreasing the number of patients who relapse as well as minimizing toxicity, depending on radiation and cheText Box: motherapy selected. Unfortunately, in most trials no statistically significant difference was found in increasing survival rates when using combination therapy. Prevention is the key, what can I do to minimize the risk of all types of cancer? 1) Abstinence from chewing and smoking tobacco 2) Minimizing second-hand smoke exposure 3) Protection from ultraviolet light exposure by applying strong sunscreens and sun block (use SPF-15 or greater) 4) Taking vitamins such as vitamin A and related retinoids, vitamins C and E, calcium, and selenium 5) Follow American Cancer Society Dietary Recommendations ▪ Eat five or more servings of fruits and vegetables daily ▪ Eat other foods from plant sources, such as breads, cereals, grain products, rice pasta, or beans several times a day ▪ Choose foods low in fat ▪ Limit consumption of meats, especially high-fat meats ▪ Be at least moderately active for 30 minutes or more most days of the week ▪ Stay within your healthy weight range ▪ Limit consumption of alcoholic beverages, if you drink at all For more information visit Text Box: Next Page Text Box: Previous Page

ANN ARBOR CLASSIFICATION CLINICAL STAGES OF HODGKIN’S LYMPHOMA

STAGE

DISTRIBUTION OF DISEASE

I

Involvement of a single lymph node region (I) or involvement of a single extralymphatic organ or tissue (IE)

II

Involvement of two or more lymph node regions on the same side of the diaphragm alone (II) or with involvement of limited contiguous extralymphatic organs or tissue (IIE)

III

Involvement of lymph node regions on both sides of the diaphragm (III), which may include the spleen (IIIS), limited contiguous extralymphatic organ or site (IIIE), or both (IIIES)

IV

Multiple or disseminated foci of involvement of one or more extralymphatic organs or tissues with or without lymphatic involvement

*All stages are further divided on the basis of the absence (A) or presence (B) of the following systemic symptoms: significant fever, night sweats, unexplained loss of more than 10% of normal body weight.

From Carbone PT, et. al: Symposium (Ann Arbor): staging in Hodgkin disease.  Cancer Res 31:1707, 1971.