Hodgkin's Disease

One day while shaving, Justin noticed a lump on the side of his neck. He didn't think much of it at first, assuming it would go away. But after a week, the lump was still there, so Justin went to see the doctor. He was a little surprised at the questions his doctor asked. Had Justin lost weight? Was he easily tired? Did he ever get night sweats? As Justin answered yes to these questions, he wondered what they had to do with the lump on his neck.

The doctor explained that the lump was a swollen lymph node and that he wanted to monitor it closely. He prescribed antibiotics because swollen lymph nodes are often caused by infections. But when the medicine did not decrease the swelling, the doctor recommended some tests, telling Justin and his mother that they were necessary to check for disease, including lymphoma.

What Is Hodgkin's Disease?

Hodgkin's disease is a type of cancer called a lymphoma, which is a cancer of the lymphatic system. (The disease is sometimes also referred to as Hodgkin's lymphoma.)

The lymphatic system helps the body's immune system to filter out bacteria, viruses, and other unwanted substances. The lymphatic system includes the lymph nodes (which are sometimes called glands), thymus, spleen, tonsils, adenoids, and bone marrow, as well as the channels (called lymphatics or lymph vessels) that connect them.

Most people don't notice the workings of their lymphatic systems; in fact, the only time you may be aware of your lymphatic system is when your lymph nodes swell up. This often happens when a person is sick — a sign that the lymphatic system is working hard to filter an infection out of the body.

Lymphoma is a disease in which cancer cells form in a person's lymphatic system and start to grow uncontrollably. There are several different types of lymphomas, and they are divided into two broad categories: Hodgkin's disease and non-Hodgkin's lymphoma.

Lymphomas that involve a particular type of cell, called a Reed-Sternberg cell, are classified under the heading Hodgkin's disease. There are several different subtypes of Hodgkin's disease, based on how the cancerous tissue looks under a microscope.

Lymphomas that do not contain Reed-Sternberg cells are classified under the heading non-Hodgkin's lymphomas.

No one really knows exactly what causes Hodgkin's disease. People who have a brother or sister who has had Hodgkin's disease seem to be slightly more likely to get the disease, as are people who have had an organ transplant or who have acquired immunodeficiency syndrome (AIDS). But just because you've had an organ transplant or have a compromised immune system doesn't mean you'll get Hodgkin's disease. Most people with Hodgkin's disease don't have any of these risk factors.

What Are the Signs and Symptoms?

The signs and symptoms of Hodgkin's disease vary from person to person. Some people may not notice symptoms at all or they may think their symptoms are caused by something else.

Some of the more common signs and symptoms are:

  • swollen lymph nodes in the neck, armpit, or groin area that don't go away
  • fever
  • night sweats
  • weight loss over several months despite eating normally
  • tiredness and weakness
  • coughing or shortness of breath
  • itching

The symptom that most people notice first is swollen lymph nodes. Of course, swollen lymph nodes usually don't mean cancer — they're most often a sign of a common illness, like an infection. In fact, all of the symptoms of Hodgkin's disease can also be caused by other conditions, which is why only a doctor can determine what's really wrong.

How Is It Diagnosed?

In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.

One of the things doctors might look for if they suspect lymphoma is enlargement of the lymph nodes. Doctors may try to treat swollen lymph nodes with antibiotics, because infections are the most common cause of swollen lymph nodes. But if the lymph nodes remain swollen, the doctor may order a biopsy.

A biopsy is a type of test in which a doctor removes a tiny bit of tissue or fluid from the body and sends it out to a laboratory for a specialist to examine under a microscope. There are several kinds of biopsies. In the case of Hodgkin's disease, a doctor usually orders one of two types:

  1. Fine needle aspiration. The doctor uses a very thin needle to suction out a small amount of tissue from the lymph node.
  2. Excisional or incisional biopsy. The doctor opens the skin to remove the entire enlarged lymph node (excisional) or only part of it (incisional).

A doctor may use either local anesthesia (where only a part of the body is numbed) or general anesthesia (where a person is asleep) to ensure the person doesn't feel any pain during these biopsies.

If your family doctor suspects Hodgkin's disease, he or she will refer you to an oncologist (pronounced: on-kah-luh-jist), a doctor who specializes in the treatment of cancer. The oncologist will do more tests to find out whether the cancer has spread. This process is called staging.

Some of these tests are:

  • blood tests
  • a chest X-ray
  • a computed tomography (CT or CAT) scan, a type of X-ray that rotates around the patient and creates a picture of the inside of the body from different angles
  • a magnetic resonance imaging (or MRI) scan, which uses magnets and radio waves to allow doctors to see inside the body (the person lies inside the machine while it takes images)
  • a bone marrow biopsy to check for cancer in the bone marrow
  • a gallium scan, which uses the injection of a chemical called gallium to detect tumors and inflammation
  • a positron emission tomography (PET) scan, which can tell the difference between normal and abnormal cells based on their metabolic activity

These tests don't usually hurt. If the tests will be uncomfortable, doctors give their patients anesthesia or other pain-reducing medications. In some cases, doctors may perform surgery to determine the stage of the cancer. One such surgical test is a laparotomy, in which the person is put to sleep and a surgeon operates to examine the internal organs. But these surgical procedures are becoming rare given the wide variety of imaging technologies available today.

How Is It Treated?

Treatment for Hodgkin's disease is very effective for most people. The type and length of treatment varies, depending on the stage and type of the disease; where the disease is found in the body; and the person's age, physical maturity, and overall health.

The most common treatment for non-Hodgkin's lymphoma is chemotherapy. Chemotherapy kills or stops the growth of cancer cells. Patients are also sometimes treated with radiation therapy. In addition, some people may have surgery to remove tumors.

For some patients who are getting very aggressive chemotherapy or radiation treatments, doctors may perform bone marrow or stem cell transplants to replace cells that have been damaged by the treatment. These procedures involve taking the cells from bone marrow or blood that has either been taken from the patient or donated by another person. These cells are then inserted into the patient's bloodstream to replace those that have been damaged or destroyed.

Researchers are constantly working on new treatments for cancer. Some people decide to participate in clinical trials, which are ways to test new cancer treatments or compare their effectiveness with existing treatments. If you have Hodgkin's disease, your doctor can tell you whether this is a good idea for the particular type you have.

What to Expect

Treatment for Hodgkin's disease is powerful. It destroys good cells along with bad, which can create certain side effects.

Although the side effects depend on the individual and the medicine that a doctor prescribes, the most common short-term side effects of chemotherapy are nausea, vomiting, and a flu-like feeling. Some people feel weak or dizzy after their treatments, or they run a fever. Others get sores in their mouths or suddenly don't feel much like eating. It's also common for people to lose some or all of their hair.

The short-term side effects of radiation can be similar to those of chemotherapy, although the side effects of radiation are usually more localized, meaning they affect only the area that receives the radiation treatment. People can continue to feel side effects for weeks after their treatment ends.

Chemotherapy and radiation treatments can weaken the immune system. If you're getting one of these treatments, steer clear of friends and family with colds, the flu, or other infections. You also need to avoid cuts and other injuries. It's best to put sports and the more strenuous forms of physical activity on hold, but you can still stay active with gentle forms of exercise, like walking.

Tell your doctor if you experience any side effects of treatment. Your doctor can also tell you about possible long-term side effects of the type of treatment you are having.

It can be hard to deal with the side effects of treatment. Perhaps you feel tired and nauseous, and you have to deal with losing your hair. It's important to lean on your parents, other family, and friends. If you want, ask to talk to a psychologist, who will listen to your feelings privately and without judgment. You also can join a support group, where you'll meet and talk to people who have Hodgkin's or other cancers and are dealing with the same problems you are.

If you have or have had Hodgkin's disease, it's important to see your doctor regularly for the years following treatment. Occasionally, cancer may return, and follow-up appointments with your cancer specialist can help you catch it early if it does.

After Hodgkin's disease is gone, most people never get it again. However, some do. The term "recurrent" describes Hodgkin's disease that returns after treatment to the same area or a new one. If you have symptoms, tell your parents and your doctor. Some people can also develop other cancers after being treated for Hodgkin's, which will require more treatments.

Most people survive Hodgkin's disease and go on to live normal, productive lives.

Reviewed by: Donna Patton, MD
Date reviewed: December 2009

Kids Health

Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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