Missy's Story

Hodgkin's Disease

It's no use going back to yesterday, because I was a different person then. 
Alice, Alice in Wonderland


    What is Hodgkin's Disease?

    Hodgkin's lymphoma is a rare cancer of the lymphatic system and comprises less than 1% of all cancer diagnosises each year.  New research shows that viruses and bacteria may play a role in initiating the disease. In about half of patients with Hodgkin's disease the tumors can be shown to express proteins associated with the Epstein-Barr (mono) virus. In most cases the cause of the disease is not known. About 1 in 100,000 people will be diagnosed with Hodgkin's Lymphoma. Lymphomas are more common in men than in women. Hodgkin's occurs mainly in young adults.

    A person with Hodgkin's disease has abnormal cells in their lymph nodes.  Pathologists have named these cells Reed-Sternberg cells. They are cancer cells which don't just look different, but act differently too. They grow faster than normal cells, sometimes destroying good cells, and can also spread to other parts of the body. Depending on the type of lymphoma and whether it is confined to a single group of lymph nodes or affects many lymph nodes, treatment for the disease may include radiation therapy, chemotherapy, or, in serious cases, a bone marrow transplant or stem cell transplant. 

    Like leukemias, lymphomas are cancers of white blood cells, not of lymph nodes.  "Lymphoma" is a misnomer left over from the days before scientists could see cancerous cells accurately with a microscope. Hodgkin's affects the lymphatic system. This system is a network of organs, ducts, and nodes that interacts with the blood's circulatory system to transport a watery clear fluid called lymph throughout the body. The lymphatic system produces lymphocytes, important immune factors, and is a major line of defense against infectious organisms. The lymphatic system restores 60% of the fluid that leaks out from blood capillaries back into circulation, and its ducts provide transportation for fats, proteins, and other substances that it collects from the body's tissues.  Lymphocytes develop in the thymus gland or bone marrow.

    Signs of Hodgkin's

    Possible signs of adult Hodgkin's lymphoma include swollen lymph nodes, fever, itching, night sweats, and weight loss. 

    The prognosis (chance of recovery) and treatment options depend on:

    • The patient's symptoms. 
    • The stage of the cancer. 
    •  The type of Hodgkin's lymphoma. 
    •  Blood test results. 
    •  The patient's age, gender, and general health. 
    •  Whether the cancer is recurrent or progressive.

    Types of Hodgkin's Lymphoma

    Pathologists currently use the World Health Organization (WHO) modification of the Revised European-American Lymphoma (REAL) classification for the histologic classification for adult Hodgkin's lymphoma.

    There are two main types of Hodgkin's Disease :  Classical Hodgkin's lymphoma, which accounts for 95 percent of the cases and Nodular lymphocyte-predominant Hodgkin's lymphoma, which accounts for 5 percent of the cases of Hodgkin's disease.

    1.  Classical Hodgkin's lymphoma. (There are 4 Reed-Sternberg subtypes.)

    • Nodular sclerosis Hodgkin's lymphoma.  (accounts for 60%-75% of cases) It occurs most frequently between the ages of 15 and 34 and is seen more in young women than in young men. 
    • Mixed cellularity Hodgkin's lymphoma.  (accounts for 5%-15% of cases) It is more common in men between the  ages of 30 and 40. 
    • Lymphocyte-rich classical Hodgkin's lymphoma. (accounts for 5%-10% of cases) It is more commonly seen in people who are between the ages of 40 and 50.
    • Lymphocyte depletion Hodgkin's lymphoma. (accounts for less than 5% of cases) This type is the most aggressive of the subtypes and nearly always occurs in elderly people.
    2.  Nodular lymphocyte-predominant Hodgkin's lymphoma. (accounts for 5% of cases) The cells in LPHD are known as lymphocytic and histiocytic cells and are proving to be distinctly different from classic Reed-Sternberg B-cells.  This type is more commonly seen in young men who have no symptoms. There is a risk, however, that LPDH will transform itself into non-Hodgkin's lymphoma, and this type of Hodgkin's disease may eventually be defined as a non-Hodgkin's lymphoma.

    Staging of Hodgkin's Disease

    Once physicians have collected all of the information available from diagnostic tests that have been done on the patient, they will stage the disease which means that they have determined the extent of its spread. 

    Physicians stage Hodgkin's disease using the Modified Ann Arbor Staging system. 

    Stage I: Disease is limited to one site or group of lymph nodes. 
    Stage II: Disease is found in more than one site, but is limited to one side of the diaphragm. 
    Stage III: Disease is found in lymph nodes both above and below the diaphragm.
    Stage IV: Disease has spread outside the lymph nodes to other organs (for example, lung, liver, bone marrow). 

    Adult Hodgkin's lymphoma may also be staged as follows:

    • A: The patient has no symptoms. 
    • B: The patient has symptoms such as fevers of over 100.5° F, weight loss of more than 10% of body weight, and drenching night sweats. 
    • E: "E" stands for extranodal and means the cancer is found in an organ or tissue other than the lymph nodes or extends to tissues beyond, but near, the major lymphatic areas. 
    • S: "S" stands for spleen and means the cancer is found in the spleen. 
    • Bulky disease: The patient has a tumor larger than 10 centimeters.

    • Stages I and II, and III A are considered early-stage disease. Stages III B and IV are considered advanced-stage disease.

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      For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future. - Jeremiah 29:11