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WebMagic's Lymphoma.com™ is a comprehensive guide to online resources about Hodgkin's disease and non-Hodgkin's lymphoma.

What is Hodgkin's disease?

Hodgkin's lymphoma or Hodgkin's disease represents about eight percent of all lymphoma, according to the Leukemia Society of America, but it is the more well-known form of lymphoma and all other forms of lymphoma are grouped as non-Hodgkin's lymphoma.

In 1666, the lymphatic disease that later became known as Hodgkin's disease was first described by the "father of microscopical anatomy," Marcelle Malpighi, an Italian professor of medicine. In 1832, it was a paper by Dr. Thomas Hodgkin that provided the first solid documentation on actual cases of the lymphatic disease. In 1865, Samual Wilks published a paper that confirmed the disease and credited Hodgkin with the name.

Hodgkin was an English scholar and Quaker physician born in Tottenham, Middlesex, England in August 1798. Educated at the University of Edinburgh, he joined the staff of Guy's Hospital in London in 1825. He devoted his life to medical practice, reform and education and was one of the foremost humanitarians in 19th century England. After a life dedicated to the service of those around him, Hodgkin died in April 1866 in Palestine (later known as Israel).

The primary difference between Hodgkin's disease and non-Hodgkin's lymphoma is the presence of a specific abnormal cell: Reed-Sternberg cells (named after the doctors that first described them in detail). These large, malignant cells are found in diseased tissues and are thought to be a type of malignant B lymphocyte. Normal, healthy B-cells produce antibodies that guide the immune system in fighting and killing harmful bacteria. As the number of Reed-Sternberg cells increases, the disease advances, destroying healthy normal cells.

There are different names for Hodgkin's disease: lymphocyte predominance, nodular sclerosis, mixed cellularity, lymphocyte depletion and unclassified.

What causes Hodgkin's disease?

Risk factors are anything that can increase the chance of developing a disease. They may be lifestyle-related, genetic (inherited) or environmental. The risk factors that a relate to other cancers such as diet, smoking and unprotected sun or pesticide exposure are not related to Hodgkin's disease. In fact, there are few risk factors that link directly to the development of Hodgkin's disease.

Age/Sex:
The disease occurs more often in males in the primary age categories, early adulthood (15-40) and late adulthood (after 55).

Genetic:
Brothers and sisters of Hodgkin's disease patients have an above-average chance of developing the disease but the significance of the family relationship as the primary cause is not known.

Infection:
The Epstein-Barr virus (EBV), which causes mononucleosis, may be linked to an increase in the risk of developing Hodgkin's. EBV is a virus that infects B-lymphocytes, causing them to grow and live longer. If the body's T-cell production is compromised, then the B-cells continue to accumulate, increasing the chance for the disease to develop. However, more than half of all Hodgkin's patients have no evidence of a previous EBV infection so a definitive relationship is still unclear.

Medical Conditions:
People with compromised immune systems are at greater risk for Hodgkin's disease but Hodgkin's disease is less common than other cancers such as NHL in these patients.

  • Human immmunodeficiency virus (HIV or AIDS virus) infection poses a risk factor for developing Hodgkin's disease
  • Organ transplant patients undergo drug therapy that suppress their immune system (T-cells) to keep it from attacking the new organ(s). Depending on the drugs used, this intentional suppression poses a significant risk to the patient of developing Hodgkin's disease.
  • Unfortunately, the bottom line is that most patients with Hodgkin's disease have no known risk factors, therefore the true cause of Hodgkin's disease is still unknown. However, it is important to note that Hodgkin's is NOT contagious so patients pose no health risk to others at any time and possessing a risk factor does not mean a person will develop Hodgkin's disease.

    Prevention

    Since most people with Hodgkin's disease have no known risk factors, there is no way to prevent lymphomas from developing. By working to prevent the one potential significant risk factor, HIV, we are able to reduce the chances of developing lymphomas but not prevent them entirely. As for the other potential factors, not enough is known about their relationship with Hodgkin's to provide practical means of prevention.

    Treatment

    There are many individual factors that are key in determining the right course of treatment for you. Treatment for Hodgkin's disease depends not only on its stage and location in the body, but also on your age, health status and other personal preferences. Staging refers to the degree to which the cancer has spread beyond its original site to other parts of the body. For additional information on staging, please visit the American Cancer Society site at www3.cancer.org/cancerinfo/load_cont.asp?st=ds&ct=20.

    As with all treatment decisions, be sure to evaluate the whole picture. Learn all you can about the duration, side effects and long-term impact of each option presented. Do not hesitate to seek a second opinion. Because of the tremendous progress made in the treatment of Hodgkin's disease, the main goal of your cancer care team should be a total cure.

    There are two main methods to treat Hodgkin's disease: chemotherapy and radiation therapy.

    Because the goal of Hodgkin's treatment is to completely kill the cancer, chemotherapy treatment usually involves more than one type of drug because different drugs kill cells differently. The combinations of drugs used to treat Hodgkin's may be referred to in an abbreviated form using initials of the more pronounceable names such as MOPP and ABVD.

    External beam radiation usually is used to treat Hodgkin's when the disease is localized to one area of the body or is so large in mass that even chemotherapy cannot completely kill all the cancerous cells. In this treatment, a concentrated beam of high-energy rays (or particles) is delivered to the infected body part from a machine outside the body. The radiation slows cell growth or destroys the cells altogether. Previously, it was the protocol to treat surrounding lymph node areas to make sure the disease had not spread but because radiation may severely damage nearby healthy skin, today doctors prefer an "involved field radiation" method where only the diseased area is treated. Many doctors choose an integrative approach which combines chemotherapy and radiation methods. If the cancer is resistant to chemotherapy and radiation, then a bone marrow or stem cell transplant may be called for. Further details on the treatment of Hodgkin's disease may be found at the American Cancer Society site at www3.cancer.org/cancerinfo/load_cont.asp?st=tr&ct=20.

    Surgery is only used for a biopsy and to determine the stage of Hodgkin's disease. It is not a treatment method for Hodgkin's as it may be with other more localized cancers.

    On a positive note, according to the American Cancer Society about 90% of newly diagnosed patients are cured with chemotherapy.

    Some facts and figures

    • According the to the American Cancer Society, 7,400 new cases of Hodgkin's disease will be diagnosed in 2000 with 3,200 cases affecting women and 7,400 cases affecting men.
    • Hodgkin's is more common in two adult age groups: early adulthood (ages 15-40, and usually around 25-30) and late adulthood (after 55).
    • Hodgkin's disease is rare in children under 5 and an estimated 10-15% of cases are diagnosed in children under 16.
    • Treatment has improved so much in the last 30 years that death rates have declined over 60% and Hodgkin's disease is considered one of the most curable forms of cancer. Even so, an estimated 1,400 people will die from Hodgkin's disease this year.



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