INFORMATION ON DIAGNOSIS AND TREATMENT

Hodgkin lymphoma (formerly called Hodgkin's disease) is one of several types of cancer of the body's lymphatic system. It is named after the British physician who first described the disease in 1832.  The lymphatic system is a network of lymph nodes; lymph nodes are small, pea-shaped organs that make and store lymphocytes, a type of white blood cell that fights infection. The thymus, spleen, and bone marrow are other organs in the lymphatic system.  In Hodgkin lymphoma, a cancerous tumor develops in a lymph node, usually in the neck or chest. If the disease spreads, it spreads first to adjacent lymph nodes, and then to the spleen, liver, or bone marrow.  As it progresses, Hodgkin lymphoma affects the body's ability to fight infection. 

Risk factors for Hodgkin lymphoma include age, Epstein-Barr virus history, family history, and immune deficiencies.  Most people with Hodgkin lymphoma are diagnosed after the patient or clinician notices a painless, enlarged lymph node in the neck. Enlarged nodes may also be found above the clavicle, in the armpit (axilla), or the inguinal (groin) area. Some people are diagnosed after a mass is seen with a chest x-ray, often done for other reasons. The person may also have symptoms such as fever, night sweats, and weight loss.  A diagnosis of Hodgkin lymphoma requires pathologic confirmation with biopsy, which usually requires removal of an enlarged lymph node.  Bone marrow biopsy, laboratory studies, and imaging exams (PET/CT scan or CT scan) are also done for complete workup.

Staging of Hodgkin lymphoma involves stages I to IV.  The results of the imaging exams and bone marrow biopsy help determine the stage of a patient, and thus helps guide treatment.

The mainstays of treatment for Hodgkin lymphoma are chemotherapy and radiation. Chemotherapy uses strong medicines to kill cancer cells while radiation therapy uses high-energy particles to slow or stop the growth of cancer cells. Decisions about whether to use chemotherapy, radiation, or both depend upon several factors, including the stage of the disease and the presence or absence of large tumor masses.

Chemotherapy refers to the use of medicines to stop or slow the growth of cancer cells. Chemotherapy works by interfering with the ability of rapidly growing cells (like cancer cells) to divide or multiply. Because most of an adult's normal cells are not actively dividing or multiplying, they are not affected by chemotherapy. However, the bone marrow (where the blood cells are produced), the hair follicles, and the lining of the gastrointestinal (GI) tract are all growing. The side effects of chemotherapy drugs are related to effects on these and other normal tissues.

Modern chemotherapy typically involves a combination of two or more drugs; these combinations are referred to as regimens. Most drugs are given intravenously (IV) rather than by mouth. They are not usually taken daily, but periodically, in cycles. A cycle of chemotherapy refers to the time it takes to give the drugs and the time required for the body to recover.
For example, two doses of ABVD chemotherapy (see below) are given 14 days apart to make up one cycle of treatment. If this regimen were repeated for a total of four cycles, it would take up to four months to complete.
Chemotherapy regimens are identified by their initials and include:

• ABVD — ABVD includes Adriamycin® (doxorubicin), bleomycin, vinblastine, and dacarbazine, and is the most commonly used chemotherapy regimen.
• Stanford V — Stanford V includes Adriamycin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, and prednisone.
• BEACOPP — BEACOPP includes bleomycin, etoposide, Adriamycin, cyclophosphamide, Oncovin®, procarbazine, and prednisone. This regimen is more commonly used in Europe.
• MOPP — MOPP includes mechlorethamine, Oncovin® (vincristine), procarbazine, and prednisone, and was one of the first chemotherapy regimens to be used for Hodgkin lymphoma. It is no longer recommended for most patients due to its serious toxic side effects.

Radiation therapy is administered to the region of affected lymph nodes with a carefully focused beam of radiation; this is called involved field radiation. Radiation therapy must be given in small daily doses over a period of weeks in order to minimize the side effects; the number of weeks depends upon the amount of radiation that is given.

The length of time of chemotherapy and the administration of radiation therapy depend on the stage of disease at diagnosis, as well as favorable/unfavorable features