Hodgkin's Disease, Part 1 — Introduction, Incidence, Symptoms and Treatment

What is Hodgkin's disease?

Hodgkin's disease was first described by Thomas Hodgkin in 1832. Hodgkin's disease (HD) is a cancer of the lymphatic system. It differs from other cancers of the lymphatic system based on its appearance under the microscope, its clinical behavior and how it responds to treatment.

The spread of HD is slow and predictable, with direct extension into neighboring lymph nodes. It rarely infiltrates organs other than lymph nodes. The tumor can be classified by the various tissue types involved. It is more common in males than females, and has been associated with Epstein-Barr virus, but the exact cause of HD is unknown.

Symptoms

Ninety percent of all patients with Hodgkin's disease first come to the doctor with painless swelling of a lymph node or a group of lymph nodes. When lymph node swelling persists despite treatment with antibiotics further tests are indicated. The enlarged lymph nodes are nontender, rubbery, firm and mobile.

Examining chest X-ray.

Sixty percent of patients have abnormal lymph nodes in the chest, particularly in the mediastinum (mee'-dee-uh-STEYE'-num), the space between the lungs surrounding the heart. These abnormal lymph nodes might cause a persistent nonproductive cough or cause no symptoms at all. Sometimes they will obstruct the veins entering the heart, which can cause enlargement of blood vessels in the neck, problems breathing, difficulty swallowing and accumulation of fluid within the chest. An enlarged spleen is frequently found on physical examination.

Thirty percent of all patients report intermittent fever, loss of appetite, fatigue, drenching night sweats and itching. Classic symptoms include an unexplained weight loss of more than 10 percent within a six-month period, unexplained fevers above 100.6 degrees F and drenching night sweats.

Incidence and Prevalence

Between 750 and 800 new cases of pediatric Hodgkin's disease are diagnosed in the U.S. every year. Among children younger than 15, the incidence is 5.5 cases per million. Between the ages of 15 and 20, the incidence is 12.1 per million. In other nations, the incidence seems to vary with the level of economic development, where the children of less-developed countries have a greater incidence of the disease. However, this difference has become less pronounced recently.

When graphed versus age, the incidence of HD reveals a "bimodal" distribution, or a curve with two high points, each indicating an age at which the incidence peaks. In industrialized nations, such as the U.S., the first peak occurs around age 20, and a second for ages 55 and older. In developing countries, the first peak is shifted into childhood, usually occurring before adolescence.

Treatment

Treatment depends on the age of the patient, the location of the tumor, and whether it has spread to other sites. Treatment frequently involves low-dose field radiation and multiple chemoththerapeutic regimens. Drugs used to treat HD include:

Research produces new drugs.
  • doxorubicin
  • bleomycin
  • vincristine
  • etoposide
  • prednisone
  • cyclophosphamide
  • dexomethosone
  • cytarabine
  • cisplatinum

Possible side effects from treatment

Side effects of chemotherapy include suppression of the bone marrow, the blood-forming tissue. This would cause a decline in the number of white blood cells (which fight off infections), red blood cells (which carry oxygen to other parts of the body) and platelet cells (which help form clots). The result might be increased risk of infection; increased risk of bruising or bleeding; or anemia and fatigue. Other possible side effects of chemotherapy include:

  • nausea and vomiting
  • weight change
  • diarrhea and constipation
  • mouth sores
  • fever
  • pain
  • temporary hair loss
  • depression and anxiety

Radiation therapy also has side effects. most will subside after treatment is finished, but some can persist. Nausea, fatigue, dry mouth, and skin reactions at the treatment site area are usually temporary. Radiation therapy, particularly whole-body irradiation, can affect blood counts. The doctor will watch for these side effects.


For more information

Part 2 — Restrictions and Implications for School

http://cancer.gov

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Contributed by:

Robert Trueworthy, M.D.
Professor
Chief of Pediatric Hematology and Oncology
University of Kansas Medical Center

Lavonne Ridder, ARNP, CPON
Clinical Nurse Specialist
Pediatric Hematology and Oncology
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center