(February 24, 2009 - Insidermedicine) At the American Society of Hematology meeting in San Francisco, we spoke with Dr. Jonathan Friedberg, who is Associate Professor and Chief, Department of Medicine at the University of Rochester School of Medicine. Dr. Friedberg is also Associate Professor at the James P. Wilmot Cancer Center.
What is Hodgkin lymphoma?
Hodgkin lymphoma is generally not an emergent evaluation, but I think you want to quickly be evaluated by a medical oncologist or hematologist with expertise in treating blood cancers. Hodgkin lymphoma is a blood cancer. The evaluation would definitely include what's called staging--which tells where the lymphoma is in the body.
What does the evaluation consist of?
Patients with Hodgkin lymphoma often have symptoms that can be traced back for many months. These symptoms are often referrable to where the Hodgkin lymphoma is in the body. Frequently, chest involvement is present, so patients may have a cough or occasionally shortness of breath. Other symptoms to look for are fever, chills, sweats, weight loss, very rarely, sometimes after drinking alcohol patients may feel pain the lymph node that is involved with Hodgkin lymphoma.
What tests will be ordered?
Tests might include blood tests that are looking for some routine things as well as some prognostic markers. Tests of other organ functions such as how well the heart works, because many of the treatments might injure the heart or lungs and its important to get baseline heart and lung function. And then staging evaluation--pictures to determine exactly where the lymphoma is in the body. And those staging tests often include a CT scan (which is a fancy x ray of the chest, abdomen and pelvis), a PET scan (which is a way to look at active lymphoma cells on a very specialized scanner), and a bone marrow biopsy.
Are there any therapeutic options?
Therapeutic options for Hodgkin lymphoma are critically dependent upon where the lymphoma is in the body. For localized Hodgkin lymphoma, frequently, chemotherapy alone or combinations of chemo and radiation therapy are used. And the outcome is excellent with cure rates that exceed 85-90%. For patients with more advanced Hodgkin lymphoma, which means the Hodgkin lymphoma is in many places of the body, radiation is less useful--but patients are still often curable with chemotherapy regimens.
Are there any complications associated with treatment?
Complications of treatment is a very critical issue in Hodgkin lymphoma. What we've learned over the last 20 years is that overly aggressive treatment of Hodgkin lymphoma can result in late problems. These are not only annoying problems, but serious, even life-threatening problems like second cancers, breathing problems, heart problems, and so forth. So many of our new treatments are designed to minimize those late effects by trying to decrease the dose of chemotherapy, shrink the radiation fields.
What is the prognosis of a natural history patient vs. one who is treated?
If you aren't treated for Hodgkin lymphoma within months to years it is likely you would die of the disease. This used to be a uniformly fatal disease and we've converted this, due to the success of science over the last 30 years, to a disease where in all of patients more than 80% are cured.
Is genetic testing important?
It does not appear to be an inherited disease. There really isn't a genetic test that would be helpful.
If I had recent onset night sweats and an enlarged painless lymph node above my collarbone...
If I had recent onset night sweats and an enlarged painless lymph node, I would want to get a good biopsy of this lymph node that is evaluated by an expert. If Hodgkin lymphoma is established, I would then want to be seen by a medical oncologist and expect staging evaluations and a full history and physical exam, and I would want my treatment to be as modern as possible to minimize late effects of therapy.