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. Non-Hodgkin's lymphomas are the subject of another NCI booklet, What You Need To Know About™ Non-Hodgkin's Lymphoma. 

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 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: 

• X-rays: High-energy radiation used to take pictures of areas inside the body, such as the chest, bones, liver, and spleen. 
• CT (or CAT) scan:  A series of detailed pictures of areas inside the body.  The pictures  are created by a computer linked to  an x-ray machine. 
• 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. 

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. 

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. Several useful booklets, including Taking Time, are available from the Cancer Information Service and through  other sources listed  in the "National Cancer Institute Information Resources" section. 

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. 

Additional information about locating support services for people with cancer and their families is available through the Cancer Information Service and other sources described in the "National Cancer Institute Information Resources" section. 

 

Notes: Dr. Nelson Crumfield

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EditText of this page (last edited June 27, 2010)