Hodgkin disease
What is Hodgkin disease?
Hodgkin disease was first described by Thomas Hodgkin in 1832. Hodgkin
disease (HD) is a cancer of the lymphoid system. It differs from other
cancers of the lymphoid system in how the cancer tissue looks under the
microscope as well as how it behaves and how it responds to different
treatment.
The pattern of spread of HD is slow and predictable
with extension to neighboring lymph nodes. Infiltration of organs other
than lymph nodes is rare. There are various tissue types of Hodgkin disease.
It is more common in males than females. Epstein Barr virus, the virus
that causes mononucleosis has been associated with Hodgkin disease. However
the exact cause of Hodgkin disease is unknown.
Symptoms
Ninety percent of all patients with Hodgkin disease present 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.
Sixty percent of patients have
abnormal lymph nodes in the chest or mediastinum
(the space between the lungs). These abnormal lymph
nodes may cause no symptoms or may cause a persistent nonproductive cough.
Sometimes they can block the veins entering in the heart and cause enlargement
of neck vessels, difficulty breathing, difficulty swallowing and accumulation
of fluid within the chest. An enlarged spleen is frequently present 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% within a 6 month period,
unexplained fevers above 100.6° F and drenching night sweats.
Incidence and Prevalence
Annually, 750-800 new cases of pediatric HD are diagnosed in the United
States. For children younger than 15 years, the incidence is 5.5 cases
per million children. For those aged 15-20 years, the incidence is 12.1
cases per million. Internationally, differences exist among countries
with different levels of economic development, with a higher incidence
in younger children of less developed countries. Over time, this observation
is becoming less pronounced.
The 5-year survival rate for HD of all stages
is 91%. Patients with lower-stage (less-advanced) disease have survival rates greater
than 90%, whereas those with higher-stage (more-advanced) disease have survival rates
as low as 70%. Within the United States, the incidence among white and
black people is essentially the same; however, the ratio is 1.4:1 in children
older than 10 years. A slight male predominance exists in children younger
than 15 years, which is 1.3:1. In children aged 15 years and older, the
male-to-female ratio decreases to 0.8:1.
Incidence of HD by age shows a
bimodal distribution. In industrialized nations, the first peak occurs
in people aged approximately 20 years, while the second peak is observed
in patients aged 55 years or older. In developing countries, the first
peak is shifted into childhood, usually before adolescence.
Treatment
Treatment depends on age, the location of disease, the extent of disease
and the amount of disease. Treatment may include chemotherapy alone or (most commonly) combined modality treatment. This treatment involves low dose
field radiation therapy and combination multi-agent chemotherapy regimens.
Examples of drugs used in regimens for Hodgkin disease include:
- Doxorubicin
- Bleomycin
- Vincristine
- Etoposide
- Prednisone
- Cyclophosphamide
- Dexomethosone
- Cytarbine
- Cisplatinum.
Possible medication side effects
Chemotherapy may cause a variety of side effects. Some drugs effect the
bone marrow
(the blood-producing tissue) thus impacting blood counts. White
blood cells, red
blood cells (that carry oxygen to the body) or platelets (that prevent bleeding
and bruising) may be affected by chemo. The result may
be increased risk of infection (if white blood cells are low), anemia
or fatigue (if red blood cells are low), or increased risk of bruising
and/or bleeding (if platelets are low). Other side effects of chemotherapy
may include:
- nausea and vomiting
- weight change
- diarrhea and constipation
- mouth sores
- fever
- pain
- temporary hair loss
- depression and anxiety
Radiation therapy may also result in side effects. Most of the side effects
of radiation go away soon after the treatment is over. However, some may
persist after treatment is complete. Nausea, fatigue, dry mouth, and skin
reactions in the treatment area are usually temporary side effects. Sometimes,
radiation therapy affects blood counts.
Hogkin, Part 1 — Introduction, incidence, symptoms and treatment
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305