Hodgkin's disease
Hodgkin's disease is a type of lymphoma described by Thomas Hodgkin in 1832, and characterized by the presence of Reed-Sternberg cells.
Epidemiology
Unlike other lymphomas, whose incidence increases with age, Hodgkin's lymphoma has a bimodal lymph nodes are the most common sign of Hodgkin's disease, often occurring in the neck. The lymph nodes of the chest are often affected and these may be noticed on chest X-ray.
About one-third of people with Hodgkin's disease may also notice some systemic symptoms, such as low-grade fever, night sweats, weight loss, itchy skin, or fatigue.
Diagnosis
Hodgkin's disease must be distinguished from non-cancerous causes of lymph node swelling (such as various infections) and from other types of cancer. Definitive diagnosis is by lymph node biopsy (removal of a lymph node for pathological examination).
Hodgkin's disease can be sub-classified by histological type. The cell histology in Hodgkin's lymphoma is not as important as it is in non-Hodgkin's lymphoma: the treatment and prognosis in Hodgkin's lymphoma depend on the stage of disease rather than the cell type.
Types
Hodgkin's disease has 4 variants depending upon the relative presence of the lymphocytic elements on the lymph node biopsy specimen. There are small but clear differences in prognosis between the various form.
- Nodular sclerosing form
- Lymphocyte predominant form
- Lymphocyte depleted form
- Mixed-cellularity form
Staging
After Hodgkin's disease is diagnosed, a patient will be staged: that is, they will undergo a series of tests and procedures which will determine what areas of the body are affected. These procedures will always include documentation of their histology, a physical examination, blood tests, chest X-Ray, CT scans or MRI (magnetic resonance imaging) scans of the chest, abdomen and pelvis, and a bone marrow biopsy. Some patients will also require liver biopsy, lymphangiograms, gallium scans, bone scans, and surgical laparotomy, which involves opening the abdominal cavity and visually inspecting for tumors.
On the basis of this staging, the patient will be classified according to a staging classification (the radiation therapy. Patients with later disease (III, IVA, or IVB) are treated with combination chemotherapy alone. Patients of any stage with a large mass in the chest are usually treated with combined chemotherapy and radiation therapy.
Currently, the ABVD chemotherapy regimen is the gold standard for treatment of Hodgkin's disease. The abbreviation stands for the four drugs adriamycin, bleomycin, vinblastine, and National Cancer Institute.
