In 1832 Thomas Hodgkin described a progressively fatal condition characterized by enormous lymph node swelling that he believed to be one disease. Characteristic cells involved in this disease were identified microscopically by Sternberg and Reed in 1898 and 1902, respectively. The identification of these cells, now known as Reed-Sternberg cells, allowed for the initial classification of Hodgkin’s disease.
In the past two decades advances in histology and immunohistology have revealed that the Reed-Sternberg cell is B-cell lineage, and that Hodgkin’s disease is not a single cell, but instead two separate diseases. Hodgkin’s disease. The four stages of Hodgkin’s disease are based on factors such as location, whether cancer is found in more than one group of lymph nodes, or on one or both sides of the diaphragm. The potential curability of Hodgkin’s disease was first recognized in 1920, when patients with localized tumor with radiation were shown to have a 10% survival rate.
By the 1960s about one third of patients were being cured with radiation. In 1970, the National Cancer Institute (NCI) reported that patients with advanced Hodgkin’s disease could attain complete remission and long-term survival using a combination chemotherapy of nitrogen mustard, Oncavin (vincristine), procarbazine, and prednisone, known as Mopp. Lymphomas represent about 4% of new cancer cases diagnosed in the US each year. It is the fifth most common cancer diagnosis and the fifth leading cause of cancer death.
Although the incidence of most cancers is decreasing, lymphoma is one of only two tumors increasing in frequency, although the cause for this increase in unknown. The American Cancer Society (ACS) estimated that 63,740 new cases of lymphoma will be diagnosed in the United States in 2005: of these 7350 will be Hodgkin;s disease and 56,390 will be non-Hodgkin’s lymphoma. The incidence curve shows two peaks: The first comprises patients in their 20s and 30s, the second is Hodgkin’s Disease the elderly.
The disease is slightly more common in males than females, among young people who are well educated and within higher socioeconomic brackets. The cause of Hodgkin’s disease remains elusive. Although Epstein-Barr viru (EBV) is not proven cause of Hodgkin’s disease, specimens taken from patients with Hodgkin’s disease often contain multiple choices of the EBV genome. Hodgkin’s disease (HD) is a characterized by the presence of the typical, malignant Hodgkin X Reed-Sternberg (H-RS) cells in a hyperplastic background of normal reactive lymphocytes plasma cells, histiocytes, neutrophills, eosinophils and normal cells.
Hodgkin’s disease is typified by the presence of predominant cells, which are CD20+, CD15- and CD30- and are found scattered among small B-lymphocytes arrange in a nodular pattern. Patients typically are males presenting with localized, peripheral lymphadenopathy. Hodgkin’s disease spread continuously from one lymph node chain to another. Strong evidence indicates that Hodgkin’s disease begins in one lymph node, then spread to the adjacent nodes, until eventually the malignant cells invade the blood vessels and spread to other organs.
Involvement of retroperitoneal nodes, lungs, liver, spleen, and bone marrow usually occurs after HD is generalized. Because HD affects the lymphatic system, the body becomes less able to fight off infection as the disease progresses. The most common signs of HD are lymphodenopathy, fever, night sweats, weight loss, pruitus, and alcohol-induced pain. The most frequent indication is a mass or swelling at one of the lymph node sites in the neck, above the clavicle, under the arms, in the elbow region, or near the groin.
Mediastinal nodes may become enlarged to greater than 10 cm, and patients may complain of dry cough or shortness of breath, especially when lying down, as well as substernal pain. Since the lymphomas also can involve the bone marrow, the first warning may be anemia with bleeding related to decrease in platelet count or infection as a consequence of insufficient white blood cells. Diagnosis is confirmed with a biopsy of the enlarged node. An excisional node biopsy is preferred over a needle biopsy for a suspected lymphoma.
To stage the extent of the disease accurately, the following procedures should be initiated as soon as possible after a definite diagnosis of HD. Detailed history and physical exam with emphasis on history of “B symptoms” (fever, night sweat, weight loss), palpation of liver and spleen, evaluation of cardiac and pulmonary status. Radiology workup: (CT) scan of chest, abdomen, pelvis; chest x-ray exam; lymphangiograms Positron emission tomography (PET) Gallium-67 scan.
A laboratory workup: Complete blood count (CBC), differential, platelet count, erythrocytes sedimentation rate (ESR), liver and renal function tests, lactate dehydrogenase (LDH), B2-microglobulin (B2M) Bone Marrow biopsy and aspirate Percutaneous needle biopsy Staging laparotomy: Laparotomy includes splenectomy; biopsy of the ciliac, splenic, hilar, porta hepatic, para-aortic and iliac node; wedge and/or needle biopsy of live; and open iliac bone marrow biopsy if not done previously. Hodgekin’s disease is a disease of the immune system.
We have therefore examined the association between Hodgekin’s lymphoma and early development. Our hypothesis was that the disease would be associated with markers of poor fetal growth, specially small body size or small placental size at birth. According to the American Cancer Society, about 85 percent of people in the first two stages of Hodgkin’s lymphoma live for five years after diagnosis, as long as proper treatment is provided. According to Lymphoma. org, the five-year survival rate for those with non-Hodgkin’s lymphoma is 63 percent, and 30 to 60 percent of those with aggressive forms of the disease can be cured.
However, life expectancy for both types of the disease depends on many different factors, including the overall health of the patient, treatments used and the stage of the disease. References Mandle, C. (2010) Health Promotion Throughout the Life Span. Lois, Missouri: Mosby, Inc. Barker,D. & Osmond,, C. (2013) Hodgekin’s disease p1-1. 1p Columbia Electromic Encyclopedia. 6th edition Meyers, J. Life Expectancy With Lymphoma. http://www. ehow. com/about_5513496_life-expectancy-lymphoma. html.