14 Jul 2011

Hodgkin’s lymphoma

Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma

Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites.
Causes, occurrence, and risk factors
The first sign of Hodgin's lymphoma is often a swollen lymph node, which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.
The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Past infection with the Epstein-Barr virus (EBV) is thought to contribute to some cases. Patients with HIV infection are more at risk than the general population.
    Fever and chills that come and go
    Itching all over the body that cannot be explained
    Loss of appetite
    Soaking night sweats
    Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
    Weight loss that cannot be explained
Other symptoms that may occur with this disease:
    Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
    Excessive sweating
    Pain or feeling of fullness below the ribs due to swollen spleen or live
    Pain in lymph nodes after drinking alcohol
    Skin blushing or flushing
Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms.
Cipher and tests
The disease may be diagnosed after:
    Biopsy of suspected tissue, usually a lymph node biopsy
    Bone marrow biopsy
If tests reveal you do have Hodgkin's lymphoma, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.
The following procedures will usually be done:
    Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level
    CT scans of the chest, abdomen, and pelvis
    Complete blood count (CBC) to check for anemia and white blood count
    PET scan
In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary.
Action - Treatment
Treatment primarily depends on the following:
    The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
    The stage (where the disease has spread)
    Whether the tumor is more than 4 inches (10 cm) wide
    The patient's age and other medical issues
    Other factors, including weight loss, night sweats, and fever
Tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Staging is necessary to determine your treatment plan. Stages of Hodgkin's lymphoma range from I to IV. The higher the staging number, the more advanced the cancer.
Treatment depends on your age and stage of the cancer.
    Stages I and II (limited disease) can be treated with radiation therapy, chemotherapy, or both.
    Stages III is treated with chemotherapy alone or a combination of radiation therapy and chemotherapy.
    Stage IV (extensive disease) is most often treated with chemotherapy alone.
People with Hodgkin’s lymphoma that returns after treatment or does not respond to treatment may receive high-dose chemotherapy followed by an autologous bone marrow transplant (using stem cells from yourself).
Additional treatments depend on other symptoms. They may include:
    Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia
    Antibiotics to fight infection, especially if a fever occurs
    Horning SJ. Hodgkin’s lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:Chap 111.
    Armitage JO. Early-stage Hodgkin's lymphoma. N Engl J Med. 2010 Aug 12;363(7):653-62.

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