Hodgkin’s Disease

What is Hodgkins’s Disease?

This is a malignant disease of the lymphoreticular system, the regions that produce certain white blood cells. It is also known as lymphadenoma or lymphogranulomatosis.

Hodgkin’s Disease Causes

The cause is unknown, although over the past few years the medical journals have been suggesting a possible infective agent. They point out that the disease often occurs in clusters, families and groups of people living in close proximity frequently being involved. Research also indicated that doctors treating these patients run a higher-than-average risk of contracting the disease themselves. Hodgkin’s disease is more common in males, and the two ages of greatest incidence peak at 25 years and at 70 years.

Hodgkin’s Disease Symptoms

Generally the first noticeable symptom is a painless enlargement of the lymph glands in the neck. It may include those in the armpits or in the groin. There may be a mass in the abdomen as the spleen enlarges, or the liver increases in size in the upper-right side of the abdomen. X-rays may show a mass in the chest as glands there increase in size. As the glandular masses enlarge they tend to press on surrounding structures and give rise to additional symptoms through mechanical pressure.

But with the progress of time, the disease spreads and may involve almost any organ of the body. The skin may be affected, as may also the gastrointestinal system, the lungs, kidneys, but seldom the nervous system.

Strange to say, the swollen lymph glands are seldom painful, but after taking even small quantities of alcohol, they may become extremely painful. In addition to these symptoms, there may be constitutional changes. A generalized itch may occur, irregular fevers may take place. There is general lassitude, loss of weight and feeling of being unwell. Anemia and the symptoms attributed to this may also be evidenced.

All these symptoms usually indicate a poor outlook. Other infections commonly take place, as the system’s general immunity wanes. Herpes zoster (shingles) in some parts of the world is much more common in patients with Hodgkin’s. Also, tuberculosis may be a relatively common associated disease.

Diagnosis is confirmed when specimens are examined from the lymph glands, the liver or bone marrow. Special cells called Reed-Sternberg cells are a diagnostic feature.

Hodgkin’s Disease Treatment

If a diagnosis is made in the early stages, many patients may now be cured of this disease that until fairly recently was considered to be uniformly fatal. Major advances in the use of radiotherapy and in available chemotherapy have made this contribution, which now enables many patients to live many more years of useful and relatively comfortable life.

In the early stages, large doses of radiotherapy are claimed to “allow over 80 per cent of such patients to survive for five years, and if they are free of disease at that time they are almost certainly cured,” one modern textbook states.

Chemotherapy is used in two ways. It may be complementary to radiotherapy; or it may be given as the first choice, particularly if the disease is more widespread. Drugs used in the treatment of acute leukemia are also effective in Hodgkin’s disease. These include the nitrogen mustard group – mustine hydrochloride, chlorambucil and cyclophosphamide. Also used are the vinca alkaloids – vincristine and vinblastine.

It is claimed that these drugs used either singly or in combination will control the disease in most patients. It may produce remissions in 25 per cent of cases, and partial remission in a further 50 per cent.

The corticosteroids are also used in some cases, but high doses are necessary, and their beneficial effect may be short-lived. However, with various combinations of these drugs it is estimated that 90 per cent of patients derive benefits, and 80 per cent will return completely back to normal.

Treatment differences will take place in various centers. A routine referred to as MOPP is popular in Britain. As time passes, it is inevitable that better methods will be devised, more competent combinations will be worked out, and the outlook for the patient with Hodgkin’s – considered to be hopeless a short time ago – will improve further with the progress of medical knowledge.