Hodgkin's Disease

Risk: There may be a genetic predisposition toward Hodgkin's disease; about 1% of individuals with this condition will have a family history of the disease, and siblings of individuals with Hodgkin's disease have a greater risk of developing the disease ("Hodgkin's Disease").

The incidence of Hodgkin's disease is higher in men than in women by a ratio of 1.4 to 1 ("Hodgkin's Disease"). Hodgkin's disease is more common in whites than in blacks or Asians. Generally, Hodgkin's disease has a bimodal distribution, affecting predominantly young adults (15 to 34 years of age) or older individuals (50 years or older); peak incidence is between ages 20 and 24, and again between ages 80 and 84 ("Detailed Guide"; Kaufman 2620).

Incidence and Prevalence: Hodgkin's disease affects 2.9 per 100,000 people in the US (Argiris). About 8,000 cases are diagnosed in the US each year, compared to 800 in Canada (Kaufman 2620). The incidence rate has been declining for over 20 years at a rate of about 0.9% per year ("Hodgkin's Disease"). Because of advances in treatment, the death rate has fallen more than 60% in the past 30 years ("Detailed Guide"). Incidence of Hodgkin's disease is 59,000 individuals worldwide (Argiris).

History: Individuals are often asymptomatic. Some will report a painless, swollen lump in the neck, groin (ilioinguinal-femoral region), or under the arm. Other will report vague symptoms such as persistent fever, weight loss, night sweats, itching (pruritus), and fatigue. Characteristically, the fever is cyclic (Pel-Ebstein fever) and may recur at variable intervals of several days to many weeks.

Physical exam: Enlarged lymph nodes, nearly always in the neck or armpit but occasionally in the groin, are usually noted during physical examination. The nodes may be hard and stony or rubbery or soft. Enlargement of both the spleen (splenomegaly) and liver (hepatomegaly) may be noticed during palpation of the abdomen. If the cancer is advanced, large masses may appear on the neck, producing the "bull-neck" appearance characteristic of late-stage Hodgkin's disease.

Tests: Blood tests include complete blood count (CBC) to evaluate numbers of red blood cells (RBCs) and white blood cells (WBCs), hemoglobin, and platelets. RBCs and hemoglobin may be reduced due to anemia. WBCs may be elevated as part of the immune system response to disease or inflammation. Blood chemistries such as blood protein (serum albumin), uric acid, and liver enzymes will be performed. An erythrocyte sedimentation rate (ESR) may be done to determine if inflammation is present.

Definitive diagnosis of Hodgkin's disease requires taking a sample of tissue (biopsy) from an enlarged lymph node, staining the tissue cells (immunohistochemical staining), and examining them under a microscope. A pathologist will examine the stained cells to identify Reed-Sternberg cells typical of Hodgkin's disease; staging of the disease can be done at the same time by classifying cells from different sites. The cells may be stained to identify molecules called CD15 and CD 30.

If the biopsy confirms the diagnosis of Hodgkin's disease, additional tests will be conducted. Other tests may include a chest x-ray (radiographic examination) to identify enlarged lymph nodes in the middle of the chest (mediastinal mass). A CT scan, MRI, positron emission tomography (PET), gallium scan, or an exploratory abdominal surgical procedure (laparotomy) may help determine if the disease has spread outside the lymph system. A sample of bone marrow (bone marrow biopsy) may reveal bone involvement.