Hodgkin's Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections.

The lymphatic system includes the following:

• lymph - fluid containing lymphocyte cells.
• lymph vessels - thin tubes that carry lymph fluid throughout the body.
• lymphocytes - white blood cells that fight infection and disease.
• lymph nodes - bean-shaped organs, found in the underarm, groin, neck, chest, abdomen, and other parts of the body, that act as filters for the lymph fluid as it circulates through the body.

Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection and causing swelling in the lymph nodes. Hodgkin lymphoma cells can also spread (metastasize) to other organs and tissue. It is a rare disease, accounting for about 4 percent of all cases of childhood cancer in the US. Hodgkin lymphoma occurs most often in people between the ages of 15 and 40, and in people over age 55. About 10 percent to 15 percent of cases are found in children and teenagers. The disease, for unknown reasons, affects males more often than females.

What causes Hodgkin lymphoma?

The specific cause of Hodgkin lymphoma is unknown. It is possible that a genetic predisposition and exposure to viral infections may increase the risk for developing Hodgkin lymphoma. There is a slightly increased chance for Hodgkin lymphoma to occur in siblings of patients.

There has been much investigation into the association of the Epstein-Barr virus (EBV), which causes the infection mononucleosis. This virus has been correlated with a greater incidence of children diagnosed with Hodgkin lymphoma, although the direct link is unknown.

There are many individuals, however, who have infections related to EBV that do not develop Hodgkin disease.

What are the symptoms of Hodgkin lymphoma?

The following are the most common symptoms of Hodgkin lymphoma. However, each child may experience symptoms differently. Symptoms may include:

• painless swelling of the lymph nodes in neck, underarm, groin, and/or chest
• difficulty breathing (dyspnea) due to enlarged nodes in the chest
• fever
• night sweats
• tiring easily (fatigue)
• weight loss/decreased appetite
• itching skin (pruritus)
• frequent viral infections (i.e., cold, flu, sinus infection)

The symptoms of Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.

How is Hodgkin lymphoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Hodgkin lymphoma may include:

• blood and urine tests
• x-rays of the chest - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a microscope.
• computed tomography scan of the abdomen, chest, and pelvis (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.
• bone marrow aspiration and/or biopsy - a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

How is Hodgkin lymphoma staged?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that are used for Hodgkin lymphoma. Always consult your child's physician for information on staging. One method of staging Hodgkin lymphoma is the following:

• stage I - usually involves a single lymph node region or structure.
• stage II - involves two or more lymph node regions or structures on the same side of the body (above or below the diaphragm).
• stage III - involves lymph node regions or structures on both sides of the body and is further classified depending on the organs and areas involved.
• stage IV - involves wide spread of the disease in other areas (metastasis), in addition to the lymphatic system involvement

Stages are also noted by the presence or absence of symptoms of the disease:

• asymptomatic (A)
• symptomatic (B) - symptoms may include fever, night sweats, or weight loss

For example, stage IIIB is disease that is symptomatic, involves lymph node regions or structures on both sides of the body, and is further classified depending on the organs and areas involved .

Treatment of Hodgkin lymphoma:

Specific treatment for Hodgkin lymphoma will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent/stage of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include (alone or in combination):

• chemotherapy
• radiation
• bone marrow transplant
• supportive care (for pain, fever, infection, and nausea/vomiting)
• continued follow-up care (to determine response to treatment, detect recurrent disease, and manage side effects of treatment)

Aggressive therapy, while increasing long-term survival, also carries some serious side effects. Discuss with your child's physician a complete list of known side effects for treatment plans and therapies.

Long-term outlook for a child with Hodgkin lymphoma:

Prognosis greatly depends on:

• the extent of the disease.
• presence or absence of metastasis.
• the response to therapy.
• age and overall health of the child.
• your child's tolerance of specific medications, procedures, or therapies.
• new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with Hodgkin lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.

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