Pressure on the superior vena cava may produce SVC syndrome, a swelling of the head and arms. SVC syndrome involving the brain can be fatal and must be treated immediately. But enlarged lymphatic tissue in the chest cavity generally tends to displace -- rather than press upon or encase -- adjacent structures. Therefore, compromised breathing and SVC syndrome are relatively uncommon signs of lymphoma. (Hodgkin's Disease, 1998-2008)
Effects on Bone Marrow
Night sweats, fevers or anemia (a low red-blood-cell count), fevers may indicate Hodgkin's disease has spread to an individual's bone marrow. In these scenarios, a physician may order bone marrow aspiration and biopsy. In biopsy, medical staff uses a large needle to remove a narrow, cylindrical piece of the patient's bone. In another option, medical staff performs an aspiration, a process utilizing a needle to remove small bits of bone marrow. Generally, in both instances, to help determine cancer spread, physicians remove the marrow from the back of the patient's hip or other large bone. (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007)
Other Extreme Effects Itching related to Hodgkin's disease produces much more severe sensations than those accompanying dry skin. In some reported cases, patients actually scratched through their skin with their fingernails attempting to secure some relief. Sometimes HD or NHL patients experience night sweats so severe they completely soak their sheets and blankets. (Hodgkin's Disease, 1998-2008)
Ages of Individuals and Prevalence of Hodgkin
Although most individuals do not develop Hodgkin's at any specific age, the majority are 15-40 years old and/or past 55 when diagnosed with this disease. Hodgkin is more prevalent in boys than girls, with approximately 10-15% of cases diagnosed in children under 17 years old. Hodgkin is rarely diagnosed in children under five years old. (Carson-DeWitt and Alic, 2002)
When Lymph Nodes Swell When the lymph nodes of a person with Hopkin's disease swell, they may exert pressure on other structures, potentially leading to a myriad of symptoms, such as:
pain due to pressure on nerve roots loss of function in muscle groups served by compressed nerves coughing or shortness of breath due to compression of the windpipe and/or airways, by swollen lymph nodes in the chest kidney failure from compression of the ureters, the tubes that carry urine from the kidneys to the bladder swelling in the face, neck, or legs, due to pressure on veins paralysis in the legs due to pressure on the spinal cord (Kaeseoglu; Senayli;
Bicakci; Onuk-Filiz; Et al, 2007)
As Hodgkin's disease advances, an individual's immune system weakens so that he/she can no longer effectively fight infection. In time, Hodgkin's lymphoma patients become more susceptible to bacteria-based infections, as well as, unusual (opportunistic) infections. In addition, symptomatic tumors later develop as Hodgkin's disease progresses. (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007)
Hodgkin's Disease Stages Contemporary treatments for Hodgkin's disease reportedly possess serious short- and long-term side effects. With accurate staging, nevertheless, physicians and patients may frequently opt for minimum treatment that affectively cures this challenging disease. "The staging system for Hodgkin's disease is the Ann Arbor Staging Classification, also called the Cotswold System or the Revised Ann Arbor System." (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007)
The following four stages denote stages and additional substages of Hodgkin's, along with effects from the disease:
Stage I: The disease is confined to one lymph node area
Stage IE: The disease extends from the one lymph node area to adjacent regions
Stage II: The disease is in two or more lymph node areas on one side of the diaphragm (the muscle below the lungs)
Stage IIE: The disease extends to adjacent regions of at least one of these nodes
Stage III: The disease is in lymph node areas on both sides of the diaphragm
Stage IIIE/IIISE: The disease extends into adjacent areas or organs (IIIE) and/or the spleen (IIISE)
Stage IV: The disease has spread from the lymphatic system to one or more other organs, such as the bone marrow or liver. (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007)
The stage of Hodgkin, along with whether symptoms present, determines its treatment.
If no symptoms are present, stages are labeled with an a. When symptoms are present, the stage receives a B. label. Symptoms include:
loss of more than 10% of body weight over the previous six months;
fevers above 100 degrees F; drenching night sweats. (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007)
Treatments and Side Effects
Hodgkin's treatments may range from standard treatments such as radiation therapy and/or chemotherapy (drug therapy), to bone marrow and peripheral blood stem cell transplantations, to alternative and complementary therapies, "designed to stimulate the immune system to destroy cancer cells and repair normal cells that have been damaged by treatment....used in conjunction with standard treatment." (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007) Currently, due to the experimental status of a number of immunotherapies for treatment of Hodgkin's disease, along with potential negative side effects, some are only available through clinical trials.
New treatments for Hodgkin's disease currently utilized in clinical trials include:
new drugs new chemotherapies monoclonal antibody therapy interferon, interleukin-2, and interleukin-12 vaccine made from cancer cells that contain the Epstein-Barr virus bone marrow and umbilical cord blood transplantations
PBSCT various combinations of treatments (Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007)
You Never Know
Because few known risk factors forewarn individuals about Hodgkin's disease, as Senator Specter notes at the start of this paper, "You never know...." ("Sen. Specter Comments...," 2008) a family history of Hodgkin's disease, however, along with the presence of the Epstein-Barr virus, however, link to an individual's risk of contracting the cancer. Also, individuals with acquired immunodeficiency syndrome (AIDS) are reportedly more susceptible to Hodgkin's disease. Kaeseoglu; Senayli; Bicakci; Onuk-Filiz; Et al, 2007) Even though one may not know until he/she is diagnosed with Hodgkin's disease, that he/she was ever at risk for this cancer, one poignant point by Senator Specter aptly applies to this particular life challenge. "You deal with it as it comes up." ("Sen. Specter Comments...," 2008) This researcher contends that this particular point could also be considered "good medicine" for an individual diagnosed with Hodgkin's disease, as well as, his/her family when confronted with what is known and/or not known about how best to contend with the effects of this uncertain cancer. The following figure (3) relates a comparison of person-years of life lost (PYLL) due to various kinds of cancer in 2004. The numbers represent thousands.
Figure 3: Figure E5. Person-years (in thousands) of life lost (PYLL) due to cancer - 2004 (adapted from "progressreport...," 2007)
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