Home Page>Hodgkin's Disease
Hodgkin’s DiseaseDr Kingsley’s comments Hodgkin’s Disease.Hodgkin’s disease is considered to be a blood cancer, so in some respects it is related to the leukaemias and multiple myeloma. However, as its name is fairly well known, I am describing it as a separate entity. Like some other cancers, it tends to occur in two different age groups, one in young adults and the other after the age of 55, although most of those I have seen have been in the younger age group. There seems to be some sort of connection with the Epstein Barr virus, which is more commonly known as the cause of glandular fever or the kissing disease. Symptoms and Signs. The usual first symptom or sign of Hodgkin’s disease is the appearance of a painless lymph gland, or group of glands, usually in the neck area. The person may also feel more tired than usual, or may seem to suffer from infections more often than previously. The diagnosis is often suspected if a person complains of a few strange episodes of otherwise unexplained fevers lasting a few days, then settling spontaneously. As the blood lymphocytes are involved in Hodgkin’s disease, they probably function less efficiently. Patients may also complain that they itch all over for no particular reason, without any obvious rash. In the later stages, if enlarged lymph glands have developed in the chest behind the sternum (the breast bone), there may be a dry, irritant cough. Any problem in the chest, such as the above, or tuberculosis, seems to induce night sweats, so that symptom should lead to a chest X-ray. Having previously not had any problems with alcohol, it may start to cause pain in swollen lymph glands. If a doctor examines a patient with Hodgkin’s disease, he may well find the liver and spleen swollen, as can occur in the leukaemias. Investigations. Routine blood tests will include liver enzymes as well as ESR (Erythrocyte Sedimentation Rate – an indication of inflammation somewhere in the body). The body will be examined everywhere there are lymph glands, a biopsy of one of them being taken. More specific tests are an X-ray of the chest and a CT scan of the abdomen, chest and pelvic area. A sample will also be taken of the bone marrow, not only to confirm the diagnosis, but also to analyse the status of the condition and check it is Hodgkin’s disease and not another condition, like leukaemia. The bone marrow is diagnostic if very large white blood cells, with many nuclei, called Reed-Sternberg cells, are found. There are various different categories, sometimes mainly lymphocytes, sometimes very few lymphocytes, so, even though the condition is called Hodgkin’s disease, the bone marrow reacts differently in different people. Conventional Treatment. In the earlier stages, whether there are any symptoms or not, radiotherapy will be applied to any areas where lymph glands can clearly be shown to be involved, either by simply feeling them or as a result of any scans that are done. In later stages, a course of chemotherapy, usually of more than one drug, will be followed by radiotherapy applied to the areas where lymph glands were particularly active. Stem cell therapy is offered in some of the more severe situations or sometimes in high-risk cases when the patient goes into a relapse, i.e. the condition returns after a period of apparently successful treatment. Stem cell therapy is itself a very high- risk form of treatment. Hodgkin’s disease has been very successfully treated in many patients for the past 20 years, but there is a significant risk in the younger age group of patients of developing a second cancer many years later. For example, young women who were given radiation to anywhere in their chest area are at great risk of developing breast cancer later on, perhaps 15 – 20 years later. Anyone who was irradiated in the throat area should be checked regularly for an inefficient thyroid, especially if symptoms of hypothyroidism develop. Young men and women may need to consider what approach to follow before they have radiotherapy or chemotherapy, if there is a chance they may wish to have a family in due course. An Explanation by Dr Kingsley Before Your Consultation about your Hodgkin’s Disease Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having Hodgkin’s Disease. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and they were probably seen by a junior doctor who not only took a short history of any symptoms they had, but also examined them to look for any signs of Hodgkin’s Disease, but, by then, they were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat the condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. 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