Hodgkin’s Disease

Hodgkin's disease - lymph node histologyHodgkin's disease - lymph node histology– A chronic, progressive cancer of the lymphoid tissue. (Also see Cancer.)

Causes and Incidence

The cause of Hodgkin’s disease is unknown. Current theory holds that it is a low-grade graft-versus-host reaction with some type of infectious agent as a cause. Each year more than 7,000 new cases are diagnosed in the United States, and 1,600 deaths occur. Hodgkin’s disease is the most common cancer in young adults. It occurs most often in two age groups, 15 to 35 and 60 to 80, and it is more common in men.

Disease Process

The disease begins with an abnormal proliferation of histiocytes (Reed-Sternberg cells) in one lymph node, which replaces the normal cellular structure and causes tissue necrosis and fibrosis. The disease spreads through the lymphatic channels to lymph nodes throughout the body and eventually metastasizes to the liver, spleen, bronchi, and vertebrae.

Symptoms

Most individuals first notice a swelling in the cervical lymph nodes. It may be accompanied by itching, fever, night sweats, and weight loss. Later signs may include cough, dyspnea, chest and bone pain, ascites, and jaundice.

Potential Complications

The prognosis for long-term survival is excellent with treatment. About 95% of individuals with stage I or stage II disease are cured with treatment. Untreated or advanced disease causes multiple organ failure and death.

Diagnostic Tests

The definitive diagnosis is made by lymph node biopsy, which shows the presence of Reed-Sternberg cells.

Treatments

Surgery
Excision of tumors in advanced disease; therapeutic splenectomy.

Drugs
Systemic combination chemotherapy used with radiation.

General
Radiation is the primary therapy, used alone or in combination with chemotherapy, particularly for stage III and stage IV disease.