Hodgkin lymphoma, also known as Hodgkin’s disease or lymphoma, is a malignant cancer of the lymphatic system. The disease was named after its discoverer, Thomas Hodgkin.
What is Hodgkin’s disease?
Schematic diagram showing the anatomy and structure of lymph nodes. Click to enlarge. In short, Hodgkin’s lymphoma means lymph node cancer. Although the disease is malignant, the chances of cure are very good, averaging 90 percent. Hodgkin’s disease is very rare: For every 100,000 people, on average only 2 to 3 mostly young people develop the disease each year. Hodgkin’s lymphoma can occur at any age, although there is a certain accumulation in the third and seventh decades of life. Children usually develop the disease between the ages of 10 and 14. More men than women are affected by Hodgkin lymphoma.
Causes
The specific causes of Hodgkin lymphoma are not known. However, the Epstein-Barr virus (EBV) is thought to promote an outbreak of the disease. This virus causes Pfeiffer’s glandular fever, which is particularly common in childhood. Patients who have already suffered from this lymph gland disease associated with fever are significantly more likely to develop Hodgkin’s lymphoma later on than healthy people. In addition, EBV viruses have already been detected in the Hodgkin and Sternberg-Reed cells typical of Hodgkin’s disease. However, this hypothesis is contradicted by the fact that the vast majority of the population is infected with EBV viruses without ever developing Hodgkin’s lymphoma. Accordingly, other causes would have to play a role.
Symptoms, complaints, and signs
Hodgkin’s disease is initially characterized by painless swelling of the lymph nodes. The lymph nodes in the neck area are particularly enlarged. However, enlarged lymph nodes are also seen in the groin, chest, abdomen, and armpits. In the chest area, they can possibly lead to chronic irritable cough. It is also typical that the swellings remain permanently and new ones are always added. As a rule, these do not cause pain. However, in rare cases, alcohol consumption can lead to a so-called alcohol pain of the lymph nodes. This is considered an almost certain sign of Hodgkin’s lymphoma. If B-symptomatics occur, the prognosis of the disease worsens. B-symptomatics are characterized by the additional occurrence of fever, night sweats and rapid weight loss of up to ten percent body weight in six months. Furthermore, about 30 percent of those affected also suffer from non-specific symptoms. These can manifest themselves as chronic fatigue, loss of performance, general weakness and itching all over the body. As the disease progresses, other organs are gradually affected. The spleen and liver may enlarge enormously, leading to pain in the left and right upper abdomen, abdominal swelling and indigestion. In the advanced stages of the disease, the nervous, hormonal and immune systems may then be disrupted and the lungs, skeleton or brain may be affected, with the onset of a wide range of symptoms. Without treatment, Hodgkin’s lymphoma is fatal. However, as part of cancer therapy, the chances of a complete cure are very good.
Diagnosis and course
In Hodgkin’s disease, the lymph glands initially swell, especially in the neck, armpits, and chest. Pain is not yet associated with this. So-called B-symptoms (secondary signs of the disease) are exhaustion, fatigue, an unexplained weight loss of more than 10 percent within 6 months, fever, night sweats and a drop in performance. In most cases – in about 70 percent of those affected – the lymph nodes in the neck swell. In one third of patients, the swelling first appeared behind the breastbone. In this case, irritable cough and pain in the chest area are added to the B symptoms. Organs of the abdominal area may also be affected by Hodgkin’s lymphoma. A feeling of pressure or pain in the upper and lower abdomen as well as unexplained diarrhea could indicate this type of cancer. An atypical cluster of viral and fungal infections caused by bacteria is also sometimes an indication of Hodgkin’s disease. If left untreated, Hodgkin’s lymphoma always leads to death.
Complications
Hodgkin’s disease results in decreased life expectancy for the patient.Since this is a tumor, in the worst case it can spread to other regions of the body and thus also lead to the death of the patient. Those affected suffer primarily from fever and night sweats. Furthermore, there is a strongly reduced resilience, which is based on a general weakness. Patients feel fatigued and tired and therefore no longer take an active part in life. Weight loss is also not uncommon. Furthermore, patients suffer from coughing and itching, which can occur in various parts of the body. Likewise, diarrhea and pain in the abdominal area may occur. Hodgkin’s disease is treated by surgical intervention. Complications usually do not occur. In many cases, patients are dependent on radiation or chemotherapy even after treatment. However, it is not uncommon for the cancer to recur and require treatment. Patients are therefore usually dependent on regular examinations.
When should you see a doctor?
Persistent swelling of the lymph or noticeably frequent irregularities of the lymph should be presented to a physician. If the swellings increase in size or intensity, a doctor is needed. If the swellings spread further in the organism or if they cause impairment of mobility, there is cause for concern and a visit to the doctor is advised. Enlargements of the lymph in the groin, armpit, chest or abdominal area should be examined and clarified. If unusual swellings occur on the body as a whole, a medical examination is also advisable. A characteristic feature of the disease is the absence of pain, despite the visual changes. If there is an irritating cough, a feeling of tightness or difficulty swallowing, a doctor should be consulted. If the swelling continues unabated for several weeks, this is a warning sign from the organism and must be examined. In case of fatigue, sleep disturbances or loss of the usual performance, a visit to the doctor is advisable. If there are digestive disorders, unwanted weight loss or general weakness, this should be clarified. Itching, irregularities of the hormonal system as well as abdominal pain are further signs of an existing disorder. Since Hodgkin’s disease has a fatal course in the worst case, a visit to the doctor should be made at the first signs of discrepancy.
Treatment and therapy
To treat Hodgkin’s disease, in most cases the enlarged lymph node must first be removed and examined for suspicious cells. Local anesthesia is often sufficient for this biopsy. However, if the suspicious lymph node is in a difficult-to-reach location – such as the chest area – the patient will receive a general anesthetic. Through chest X-ray or, an ultrasound tomography, the body is X-rayed and the spread of Hodgkin’s lymphoma is examined in detail. Hodgkin’s lymphoma is typically treated with chemotherapy and/ or radiation to the affected lymph glands. Chemotherapy and radiation are usually used as a combination treatment, with radiation usually following chemo. Hodgkin’s lymphomas are very sensitive to both types of treatment, which explains the above-average cure rate. However, surgical removal of the tumors does not cure Hodgkin’s lymphoma and is therefore performed only for diagnostic purposes. Inpatient hospitalization is usually not necessary. However, both chemotherapy and radiation have serious side effects. Within two years, most relapses occur, but they can usually be treated well. Relapses more than 5 years after the initial disease, on the other hand, are very rare. However, to ensure that any relapse is detected in good time, patients are strongly advised to take advantage of lifelong screening. In the first year after therapy, this takes place quarterly, between the second and fifth year every six months, and thereafter once a year. These examinations are also about being able to diagnose and treat any late effects of Hodgkin lymphoma therapy.
Outlook and prognosis
Hodgkin’s disease is one of the malignant tumor diseases, but it has the highest chance of cure. Nowadays, more than 80 percent of those affected can be cured. In earlier stages, this even exceeds 90 percent.In about 11 percent of patients, the disease relapses or progresses despite therapy. The prognosis for these patients depends primarily on the time at which the relapse occurs and also on how intensive the therapy was for the first disease. Despite this, even in the case of a relapse of Hodgkin’s lymphoma, good therapeutic results and chances of cure are still possible. However, this requires optimal as well as consistent therapy in an experienced specialist center. This also includes taking into account all aspects of long-term therapy-related side effects as well as the quality of life of those affected. Why some rare cases of Hodgkin’s lymphoma cannot be treated is currently not sufficiently understood. However, research is striving to uncover causes for this, so that these sufferers can also be helped by suitable therapies. Therefore, alternative treatment approaches are already being researched. The effectiveness of various antibody preparations, such as the “anti-CD30” preparation, which specifically attacks tumor cells, should be mentioned here in particular. In the near future, such immunotherapies may represent an effective addition to therapy.
Prevention
Hodgkin’s disease cannot be prevented. However, going for regular cancer screenings and maintaining a healthy lifestyle will help.
Follow-up care
Tumor diseases carry a high risk of recurrence. It is not uncommon for neutumors to form after some time, which can even spread to other organs via metastases. The consequence is a sometimes severely shortened life expectancy. Doctors counteract this with follow-up care. Scheduled follow-up examinations are usually arranged at the end of the initial therapy. In Hodgkin’s disease, follow-up takes place every three months during the first year. Then the rhythm widens. From the fifth year of freedom from symptoms, annual follow-up examinations are sufficient. The check-up usually takes place in a clinic. Patients should keep their appointments. This is because diagnosis of a tumor at an early stage leads to far better treatment success. A follow-up appointment first includes a discussion about the patient’s symptoms. Subsequently, a sonography and a blood test are arranged. After some time, some doctors also order an X-ray and CT scan. A tumor can be clearly identified via the imaging procedures. Many patients take part in a rehabilitation program after the strenuous initial therapy. There they are specifically prepared for a return to everyday life at work and at home. Depending on the symptoms, permanent drug treatment may be necessary.
What you can do yourself
The standard therapies used for Hodgkin’s lymphoma are associated with a high level of physical stress. Because of the immunosuppression caused by the drugs, contact with strangers, especially in public, should be avoided whenever possible. However, occasional exposure to fresh air, away from large crowds, can strengthen circulation and alleviate nausea. A diet rich in whole grains and fresh vegetables provides vitamins and minerals that can support healing. Vitamin D plays an important role in the treatment of lymphoma and is not present in sufficient amounts in the diet of most Europeans. Oily fish are an important source of vitamin D. In addition, fish ensures the supply of essential fatty acids such as docosahexaenoic acid and eicosapentaenoic acid. The body can only produce these two fatty acids itself in small quantities. However, they are important for the brain, the cardiovascular system and the mobility of cell membranes. However, caution is advised with therapies and preparations that are intended to stimulate the immune system. The cells degenerated in Hodgkin’s lymphoma are part of the immune system. This applies to mistletoe therapies and all preparations derived from mistletoe. It is also advisable to use sugar and sweet foods sparingly. Cancer cells often have an increased need for sugar.
