Hodgkin’s Disease

Hodgkin’s Disease is a form of cancer affecting the body’s lymph nodes which form part of the general circulatory system. The main role of this lymphatic system is its ability to fight infection on our behalf.

Symptoms

Hodgkin’s Disease usually begins as a painless swelling in one or more lymph nodes, often the neck, although the armpits and the groin are also favourite sites for the first appearance of enlarged lymph glands.

These lymph glands manufacture lymphocytes, which are white blood cells concerned in the fight against the spread of infection. In Hodgkin’s Disease these white cells grow rapidly in a variety of abnormal forms; this growth takes place at the expense of the normal lymphocytes and leaves the body with too few to fight infection. The patient with Hodgkin’s Disease is therefore prone to contracting infectious illnesses such as flu or the common cold far more readily than the average healthy person.

It is assumed that Hodgkin’s Disease starts in one lymph node and spreads from there to affect other lymph-node areas. As it progresses the patient becomes weaker, anaemic and less able to combat infection.

Any enlarged lymph node, particularly if situated in the neck, armpits or groin, remaining swollen for more than three weeks, should be investigated, as it may well be due to early Hodgkin’s Disease. Other illnesses can also start with lymph node enlargement such as glandular fever. It is therefore most important to establish the actual cause of such lymph node enlargement at an early date so that appropriate treatment can be started promptly. All other symptoms of Hodgkin’s Disease are late ones and include fever, tiredness, loss of weight, itching and night sweats, the latter two signs being of particularly serious significance.

Diagnosis

The diagnosis is usually made as a result of special X-rays, blood tests and biopsy. Once the nature of the disease has been confirmed, the extent of lymph node enlargement throughout the body must be found out. This is called staging and its accuracy determines the degree of long-term success of treatment.

Treatment

The type of treatment is chosen according to the stage of the disease. Usually the patient is submitted to a CAT scan which reveals previously invisible structures such as enlarged lymph nodes in the abdomen. It is particularly important to check the presence of glands along the spine in what is called the retro-peritoneal space. If this is uncertain the patient is subjected to a laparotomy, a diagnostic operation during which an incision is made in the skin over the abdomen; this enables the surgeon to examine the whole abdominal cavity. A smaller operation of the same kind is called peritoneoscopy, during which a slender fibre-optic instrument is inserted through a slit in the skin of the abdomen to examine the internal organs and take tissue samples of suspect areas.

Once staging is completed the crucial decision about treatment can be made. The disease is classified into four stages according to its extent. When enlarged lymph nodes are confined to one area it is classified as stage one. When two adjacent areas are involved it is called stage two. Stage three has been reached when the disease affects the lymph node regions above and below the diaphragm. Once Hodgkin’s Disease is found to have spread to other organs such as lung, bone, liver or kidney - that is stage four. Each of these stages is subdivided into groups A and B, according to whether or not the patient experiences such general symptoms as weight loss, fever or night sweats.

Stages one and two are usually treated by radiotherapy alone. Stages three and four are usually treated by chemotherapy but a combination of both treatments can be used, depending on the response of the disease.

Hodgkin’s Disease is eminently curable in the early stages and up to 77 per cent of stage one cases have remained permanently cured. As in all cases of malignant disease, follow-up examinations at an early date, when the disease is still confined and treatable, are of vital importance to detect any renewed flare up.

Patients with Hodgkin’s Disease may remain immunologically deficient for many years after treatment and may therefore be subject to more frequent infections. To remain permanently free of the disease they will have to take special care of both their physical and mental well-being and try not to run unnecessary risks by over-straining their physical or spiritual resources.