Hodgkin's Lymphoma Facts

Hodgkin's lymphoma is also called Hodgkin's disease. It is one form of cancer of the lymph system.

Hodgkin's lymphoma accounts for less than 4 percent of all cancers in children up to age 14, but in the United States, is the most common cancer in teens from age 15 to 19 and occurs most often in people between the ages of 15 and 40 and after the age of 55. There are three categories based on age groups. The Childhood form is in children from birth to age 14; Young Adult form is considered from age 15 to 34; and the Older Adult form from ages 55 to 74.

The lymph system is made up of lymph nodes that are located all over your body, and lymphocytes, which are the type of cells in the nodes that make antibodies to help fight off bacteria and viruses. In some parts of the body, there are groups of lymph nodes. These can be found under your arms, in your neck, abdomen, groin area, and pelvis. Lymphocytes are made in your spleen, which filters blood, and in the thymus and tonsils.

Hodgkin's lymphoma most often starts in the neck and near the thymus, between the lungs, breastbone, and spine. But, because the lymph system runs throughout your body, Hodgkin's lymphoma can begin in any of your lymph nodes. If it spreads outside the lymph system, the organs most likely to be affected are the lungs, bones, bone marrow, and liver.

Symptoms

The symptoms for Hodgkin's disease in children are the same for other illnesses and may not indicate this type of cancer. If your child experiences any of these symptoms for a period of time and they don't seem to go away, please consult your doctor.

Symptoms include swelling of lymph nodes in the neck, underarm, or groin area that doesn't go away in a few weeks; fever without other signs of infection that doesn't go away; itching; tiredness; weight loss; and drenching night sweats.

Diagnosis and Staging

Because Hodgkin's lymphoma is so rare in children, your doctor may prescribe antibiotics to treat the swollen lymph nodes upon first examination. If the swelling doesn't respond to this therapy, a physical examination of the lymph node sites will help determine which areas are most inflamed and a biopsy and blood tests will likely be used to help make a determination. Hodgkin's lymphoma has a distinctive kind of abnormal cell that is easy to see with a microscope. This is the only way to make the diagnosis of Hodgkin's lymphoma.

After the initial diagnosis however, the doctor will perform other tests to see how far the disease has progressed and to stage the disease. There are four stages of Hodgkin's lymphoma and each patient isdivided into one of two categories based on whether the person has unexplained fever, drenching night sweats, or weight loss. Category "A" means the patient does not have these symptoms; Category "B" means that at least one of these symptoms is present.

The following tests are used to determine which of the four stages the patient's Hodgkin's disease may be:

X-ray is used to look at the chest area for any tumors.

CT (computed tomography) scan, often with a contrasting dye, will produce a 3-dimensional image of the body to see if the lungs, liver, or spleen have becoming involved.

PET (positron emission tomography) scan is given to monitor treatment. Before treatment starts, this scan uses a special radioactive dye that is absorbed by the cancer. It will show up on the scan when cancer cells are alive and well. However, after treatment, this scan is given again to indicate where cancer cells have died off. This scan alleviates the need for another biopsy and will show the entire body's response to the therapy.

Bone-marrow biopsy is performed only if your doctor suspects the lymphoma has spread into other organs. it is very rare for Hodgkin's lymphoma to enter a child's bone marrow.

Bone scan is only used if your doctor suspects the lymphoma has spread in the body. Bone metaastases is very rare in children for this cancer as well.

Four Stages are numbered one through four. Stage one indicates that cancer is only in one area of lymph nodes or one organ outside the lymph nodes; Stage two indicates two or more lymph node areas on the same side of the diaphragm are affected, or, one lymph node area and one area or organ adjacent to the lymph nodes; Stage three means cancer was found in lymph node areas above and below the diaphragm and may have spread to an area or organ near these lymph nodes and spleen. Stage four means that cancer has spread outside of the lymph system to the lungs, liver, bones, bone marrow, or other organs.

Hodgkin's Lymphoma Types

There are four types of Hodgkin's lymphoma:

Nodular sclerosis Hodgkin disease (NSHD) is the most common type and occurs most often in girls. Tumors begin in the neck, chest, or abdomen, and may spread to the lungs.

Mixed cellularity Hodgkin disease (MCHD) is diagnosed most often in people who have had the Epstein-Barr virus and occurs more frequently in boys. People who have human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), are also frequently diagnosed with this type of Hodgkin's lymphoma, which begins in the abdomen or spleen.

Lymphocyte predominant Hodgkin disease (LPHD) begins in the lymph nodes under the arm, in the neck, and in the groin area. This type of disease is found most often in boys and rarely in girls.

Lymphocyte depleted Hodgkin disease (LDHD) is very rare in children, yet it is an aggressive form of the disease. It occurs in the abdomen or pelvis usually.

Risk Factors

There are no known risk factors for Hodgkin's disease, although about one-third of children and teens who have had the Epstein Barr virus have developed Hodgkin's disease. Other children with immune problems have also been at slightly higher risk for developing this cancer.

References

Society of Clinical Oncology www.cancernet.com

Harrison's Principles of Internal Medicine (2008). McGraw Hill, New York, NY