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Hodgkin's Disease

A neoplastic disorder, Hodgkin's disease is characterized by painless, progressive enlargement of the lymph nodes, spleen, and other lymphoid tissue. This enlargement results from proliferation of lymphocytes, histiocytes, eosinophils, and Reed-Sternberg cells. The latter cells are the special histologic feature of Hodgkin's disease.

Hodgkin's disease occurs in all races but is slightly more common in whites. Its incidence peaks in two age-groups - 15 to 38 and after age 50. It occurs most commonly in young adults, except in Japan, where it occurs exclusively among people over age 50. It has a higher incidence in men than in women. A family history of Hodgkin's disease increases the likelihood of acquiring the disorder.

Untreated, Hodgkin's disease follows a variable but relentlessly progressive and ultimately fatal course. However, recent advances in therapy make Hodgkin's disease potentially curable, even in advanced stages. Appropriate treatment yields a 5-year survival rate of about 90%.

Causes

Although the cause of Hodgkin's disease is unknown, but we do know that it can't be caused by getting someone else's germs or by eating the wrong foods. People who have had Epstein-Barr virus, which can cause infectious mononucleosis (mono), may be at a slightly higher risk for Hodgkin's.

Signs and Symptoms

he following are the most common symptoms of Hodgkin's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • painless swelling of lymph nodes in neck, underarm, and groin
  • fever
  • night sweats
  • fatigue
  • weight loss
  • itching of the skin

The symptoms of Hodgkin's disease may resemble other blood disorders or medical problems, such as influenza or other infections. Always consult your physician for a diagnosis.

Diagnostic tests 

Tests must first rule out other disorders that enlarge the lymph nodes.

Lymph node biopsy confirms the presence of Reed­Sternberg cells, abnormal histiocyte proliferation, and nodular fibrosis and necrosis.

Lymph node biopsy also helps determine lymph node and organ involvement, as do bone marrow, liver, mediastinal, and spleen biopsies; routine chest X­rays; abdominal computed tomography scan and lung and bone scans; lymphangiography; and laparoscopy.

Hematologic tests show mild to severe normocytic anemia; normochromic anemia (in 50% of patients); and elevated, normal, or reduced white blood cell count and differential, showing any combination of neutrophilia, lymphocytopenia, monocytosis, and eosinophilia. Elevated serum alkaline phosphatase levels indicate liver or bone involvement.

Treatment

Depending on the stage of the disease, the patient may receive chemotherapy, radiation therapy, or both. Correct treatment allows longer survival and may even induce a cure in many patients.

A patient with stage I or stage II disease receives radiation therapy alone; a patient with stage III disease receives radiation therapy and chemotherapy. For stage IV, the patient receives chemotherapy alone, sometimes inducing a complete remission. As an alternative, he may receive chemotherapy and radiation therapy to involved sites.

Chemotherapy consists of various combinations of drugs. The well-known MOPP protocol (mechlorethamine, vincristine [Oncovin], procarbazine, and prednisone) was the first to provide significant cures for generalized Hodgkin's disease. Another useful combination is ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine). Treatment with these drugs may require concomitant administration of antiemetics, sedatives, and antidiarrheals to combat GI adverse effects.

Other treatments include autologous bone marrow transplantation or autologous peripheral blood sternal transfusions and immunotherapy, which by itself hasn't proved effective.

Prevention

While there are no preventive measures for Hodgkin's Disease, early diagnosis is important to a full recovery. Report any Hodgkin's-like symptoms that persist to your health care provider and be sure to follow the full course of treatment that is recommended.

After being treated for Hodgkin's lymphoma, the doctor may recommend follow-up examinations for several years to detect a return of the disease or the development of another cancer, a possible side affect of treatment. Advances in radiation therapy and chemotherapy are enabling many patients to survive this once dreaded disease.



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