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300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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My Child Has:
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Hodgkin's Lymphoma
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Hodgkin's lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections. The lymphatic system includes:
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- lymph - fluid containing lymphocyte cells.
- lymph vessels - thin tubes that carry lymph fluid throughout the body.
- lymphocytes - white blood cells that fight infection and disease.
- lymph nodes - bean-shaped organs, found in the underarm, groin, neck, chest, and abdomen, that act as filters for the lymph fluid as it circulates through the body.
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Hodgkin's lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection and cause swelling in the lymph nodes. Hodgkin's lymphoma cells can also spread to other organs and tissue. A cancer cell that has spread to other organs and tissue is called "metastasis." It is a rare disease, accounting for less than 3.5 percent of all cases of cancer in the United States. Hodgkin's lymphoma accounts for about 5 percent of childhood cancers. Hodgkin's lymphoma occurs most often in people between the ages of 15 and 34, and in people over age 55. The disease, for unknown reasons, affects males more than twice as often as females.
Hodgkin's disease is distinguished from other types of lymphomas by the presence of a particular type of diseased cell, called the Reed-Sternberg cell (named for the scientists who discovered and studied this type of cell). Another way physicians identify Hodgkin's disease is by the way it progresses. Hodgkin's disease usually begins in the lymph nodes of one part of the body, usually in the head, neck or chest. It then tends to spread in a predictable manner from one part of the lymph system to the next, and, in advanced stages, to the lungs, liver, bone marrow, bones, or other organs.
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The specific cause of Hodgkin's lymphoma is unknown. It is possible that a genetic predisposition and exposure to viral infections may increase the risk for developing Hodgkin's lymphoma. There is a slightly increased chance for Hodgkin's lymphoma to occur in siblings and cousins of patients.
There has been much investigation into the association of the Epstein-Barr virus (EBV) which causes the infection mononucleosis; as well as with human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). Both of these infectious viruses have been correlated with a greater incidence of children diagnosed with Hodgkin's lymphoma, although the direct link is unknown.
There are many individuals, however, who have infections related to EBV and HIV that do not develop Hodgkin's disease.
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Physicians may categorize Hodgkin's lymphoma based on how the individual cells look under a microscope. Diagnosis and treatment are similar for all of these subtypes, although the type and the stage (how far the cancer has progressed) will influence the specifics of your child's treatment. The subtypes are:
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- nodular sclerosing - the most common subtype, nodular sclerosing Hodgkin's disease tends to occur in adolescents and young adults, and affects more females than males. This subtype typically begins in the lymph nodes of the chest and other places above the diaphragm. Bulky tumors may arise in the mediastinum (the space in the chest between the lungs) and spread to lung tissue.
- lymphocyte depleted - the least common subtype, lymphocyte depleted Hodgkin's disease tends to arise in individuals who are older, have immune systems compromised by another disease, or come from a non-industrialized nation. This aggressive subtype affects more males than females. It usually begins in the lymph nodes of the abdomen and pelvis.
- lymphocyte predominant - accounting for 5 percent of Hodgkin's disease occurrence, the lymphocyte predominant subtype is usually a slow-moving disease that is more common in males than females. It usually affects young adults and begins in lymph nodes near the surface of the body, including the underarms, neck, ears and groin area.
- mixed cellularity - accounting for 15-30 percent of Hodgkin's disease cases, the mixed cellularity is the subtype that appears to be most associated with other disease such as the Epstein-Barr virus and HIV. This subtype affects all ages and is more common in males than females. It tends to arise in the lymph nodes of the abdomen and the spleen.
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The following are the most common symptoms of Hodgkin's lymphoma. However, each child may experience symptoms differently. Symptoms may include:
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- painless swelling of the lymph nodes in neck, underarm, groin, and chest
- difficulty breathing (dyspnea) due to enlarged nodes in the chest
- fever
- night sweats
- tiring easily (fatigue)
- weight loss/decreased appetite
- itching skin (pruritus)
- frequent viral infections (i.e., cold, flu, sinus infection)
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The symptoms of Hodgkin's lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.
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In addition to a complete medical history and physical examination, diagnostic procedures for Hodgkin's lymphoma may include:
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- blood and urine tests
- x-rays of the chest - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
- lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a microscope
- computerized tomography scan of the abdomen, chest, and pelvis (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- lymphangiogram (LAG) - dye is injected into lymphatic system to determine the extent of lymphatic involvement in areas that are otherwise difficult to visualize
- bone marrow biopsy/aspiration - a procedure that involves a small amount of bone marrow fluid and tissue to be taken, usually from part of the hip bones, to further examine the number, size, and maturity of blood cells and/or abnormal cells.
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Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that are used for Hodgkin's lymphoma. Always consult your child's physician for information on staging. One method of staging Hodgkin's lymphoma is the following:
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- stage I - usually involves a single lymph node region or structure
- stage II - involves two or more lymph node regions or structures on the same side of the body
- stage III - involves lymph node regions or structures on both sides of the body and is further classified depending on the organs and areas involved
- stage IV - involves disease that has spread to other areas (metastasis), in addition to the lymphatic system involvement
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Stages are also noted by the presence or absence of symptoms of the disease:
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- asymptomatic (A)
- symptomatic (B)
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For example, stage IIIB is disease that is symptomatic, involves lymph node regions or structures on both sides of the body, and is further classified depending on the organs and areas involved.
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Specific treatment for Hodgkin's lymphoma will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- the extent/stage of the disease
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
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Treatment may include (alone or in combination):
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- chemotherapy - a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone for some types of cancer or in conjunction with other therapy such as radiation. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat. While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells.
Chemotherapy can be given:
- as an injection into the muscle or fat tissue
- intravenously (directly to the bloodstream; also called IV)
- intrathecally - chemotherapy given directly into the spinal column with a needle
- radiation therapy - using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors. A carefully focused beam of radiation from a machine outside the body is usually used to treat Hodgkin's disease. This type of therapy is most effective when there is a bulky, localized tumor that will not respond completely to chemotherapy.
- surgery - surgery may be required to remove a tumor. This may be the case if, for example, the tumor originates in the mediastinum region of the chest, where it may compress the airway and/or the heart and major vessels. Surgery in this area may entail considerable risk, and must be carefully orchestrated between the surgeon, oncologist and anesthesiologist.
- stem cell transplant - a treatment involving stem cells, a specific type of cell from which all blood cells develop. Stem cells develop into red blood cells to carry oxygen, white blood cells to fight disease and infection, and platelets to aid in blood clotting. Stem cells are found primarily in the bone marrow, but some also circulate in the blood stream.
Treatment may begin with high-dose chemotherapy (perhaps combined with radiation therapy) to destroy all of the bone marrow, stem cells and cancerous cells, in the body. Then, healthy stem cells collected from patients themselves prior to intensive treatment can be used to supplement the recovery of the patient's own cells after particularly aggressive course of chemotherapy or radiation therapy. Through this procedure, stem cells are taken from the patient, treated in a laboratory to kill any remaining cancer cells, and kept in frozen storage for later use. After chemotherapy and/or radiation therapy, the saved stem cells are thawed and given back to the patient to grow new bone marrow and other stem cells. The use of a patient's own cells is referred to as autologous transplantation.
- supportive care - for pain, fever, infection, and nausea/vomiting
- continued follow-up care - to determine response to treatment, detect recurrent disease, and manage side effects of treatment
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Aggressive therapy, while increasing long-term survival, also carries some serious side effects. Discuss with your child's physician a complete list of known side effects for treatment plans and therapies.
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Prognosis greatly depends on:
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- the extent of the disease.
- presence or absence of metastasis.
- the response to therapy.
- age and overall health of the child.
- your child's tolerance of specific medications, procedures, or therapies.
- new developments in treatment.
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As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with Hodgkin's lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of Hodgkin's lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.
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Children's Hospital and Dana-Farber Cancer Institute are part of a national consortium of clinical trials that focus on decreasing the long-term effects of Hodgkin's disease and its treatments, and, ultimately, increasing cure rates for childhood Hodgkin's disease. The Dana-Farber/Children Hospital program is also part of the Children's Oncology Group, a national group of pediatric oncologists whose work includes investigational drug therapy for patients with Hodgkin's disease who experience relapse.
In the area of stem cell transplantation, the Dana-Farber/Children's Transplant Program is one of only eight institutions around the country that are investigating the use of umbilical cord transplantation. Also under study is a novel method for preventing graft versus host disease, a serious complication that occurs when transplanted cells do not recognize the tissues and organs of the recipient's body and react against the recipient's tissue. The result of this treatment approach, if it continues to be as successful, will be that the degree of match between donor and the recipient will not need to be particularly close, greatly increasing the pool of potential donors for each patient. This could also eliminate the need for long-term drug therapy traditionally needed to treat graft versus host disease.
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The information on this website should not be taken as medical advice,
which can only be given to you by your personal health care professional. |
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