Hodgkin's Disease Health Article

Definition

Hodgkin's disease is a rare lymphoma, a cancer of the lymphatic system.

Description

Hodgkin's disease, or Hodgkin's lymphoma, was first described in 1832 by Thomas Hodgkin, a British physician. Hodgkin clearly differentiated between this disease and the much more common non-Hodgkin's lymphomas. Prior to 1970, few individuals survived Hodgkin's disease. Now, however, the majority of individuals with this cancer can be cured.

The lymphatic system

The lymphatic system is part of the body's immune system, for fighting disease, and a part of the blood-producing system. It includes the lymph vessels and nodes, and the spleen, bone marrow, and thymus. The narrow lymphatic vessels carry lymphatic fluid from throughout the body. The lymph nodes are small organs that filter the lymphatic fluid and trap foreign substances, including viruses, bacteria, and cancer cells. The spleen, in the upper left abdomen, removes old cells and debris from the blood. The bone marrow, the tissue inside the bones, produces new red and white blood cells.

Lymphocytes are white blood cells that recognize and destroy disease-causing organisms. Lymphocytes are produced in the lymph nodes, spleen, and bone marrow. They circulate throughout the body in the blood and lymphatic fluid. Clusters of immune cells also exist in major organs.

Hodgkin's lymphoma

Hodgkin's disease is a type of lymphoma in which antibody-producing cells of the lymphatic system begin to grow abnormally. It usually begins in a lymph node and progresses slowly, in a fairly predictable way, spreading via the lymphatic vessels from one group of lymph nodes to the next. Sometimes it invades organs that are adjacent to the lymph nodes. If the cancer cells spread to the blood, the disease can reach almost any site in the body. Advanced cases of Hodgkin's disease may involve the spleen, liver, bone marrow, and lungs.

There are different subtypes of Hodgkin's disease:

• nodular sclerosis (30-60% of cases)
• mixed cellularity (20-40% of cases)
• lymphocyte predominant (5-10% of cases)
• lymphocyte depleted (less than 5% of cases)
• unclassified

Demographics

The American Cancer Society estimates that there will be 7,400 new cases of Hodgkin's disease in the United States in 2001—3, 500 in females and 3,900 in males. It is estimated that 700 men and 600 women in the United States will die of the disease in 2001.

Hodgkin's disease can occur at any age. However, the majority of cases develop in early adulthood (ages 15-40) and late adulthood (after age 55). Approximately 10-15% of cases are in children under age 17. It is more common in boys than in girls under the age of 10. The disease is very rare in children under five.

Causes and symptoms

The cause of Hodgkin's disease is not known. It is suspected that some interaction between an individual's genetic makeup, environmental exposures, and infectious agents may be responsible. Immune system deficiencies also may be involved.

Early symptoms of Hodgkin's disease may be similar to those of the flu:

• fevers, night sweats, chills
• fatigue
• loss of appetite (anorexia)
• weight loss
• itching
• pain after drinking alcoholic beverages
• swelling of one or more lymph nodes

Sudden or emergency symptoms of Hodgkin's disease include:

• sudden high fever
• loss of bladder and/or bowel control
• numbness in the arms and legs and a loss of strength

As lymph nodes swell, they may push on other structures, causing a variety of symptoms:

• pain due to pressure on nerve roots
• loss of function in muscle groups served by compressed nerves
• coughing or shortness of breath due to compression of the windpipe and/or airways, by swollen lymph nodes in the chest
• kidney failure from compression of the ureters, the tubes that carry urine from the kidneys to the bladder
• swelling in the face, neck, or legs, due to pressure on veins
• paralysis in the legs due to pressure on the spinal cord

As Hodgkin's disease progresses, the immune system becomes less effective at fighting infection. Thus, patients with Hodgkin's lymphoma become more susceptible to both common infections caused by bacteria and unusual (opportunistic) infections. Later symptoms of Hodgkin's disease include the formation of tumors.

Significantly, as many as 75% of individuals with Hodgkin's disease do not have any typical symptoms.