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The diagnosis and prognosis of Hodgkin's disease includes the following:
The doctor will ask about your symptoms and medical history. He or she will inquire about past infections and if you have had an organ transplant. People with decreased immune function are at greater risk of developing Hodgkin’s lymphoma. Drugs ordered after an organ transplant to reduce the chance of rejection decrease immune function. Hodgkin’s disease also seems to occur in people who are infected with the human immunodeficiency virus (HIV) or who have been infected with the Epstein-Barr virus, which causes infectious mononucleosis.
The doctor also will ask about any nonspecific symptoms you may be having. For instance, feeling tired, changes in appetite, or sweating at night.
The doctor will perform a physical exam, including a check of your temperature. He or she will carefully palpate, which means feel while applying pressure to, the areas where lymph nodes are found. Most enlarged or swollen lymph nodes are caused by an infection, not lymphomas. If infection is suspected, you may be given an antibiotic medication and instructed to return for re-examination. If swelling persists, your doctor may order a lymph node biopsy.
The main test done to check for Hodgkin's lymphoma is a lymph node biopsy. This involves the removal of all or part of one of your lymph nodes. Then, a pathologist will examine this tissue sample under a microscope. The biopsy can show whether or not there is cancer and what type of cells are present.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
A specific type of cell, called Reed-Sternberg cell, is associated with Hodgkin’s lymphoma. Several other types of cells are usually present as well. The pathologist will look for Reed-Sternberg cells within the sample. In a rare type of the disease called lymphocyte-predominant Hodgkin's disease, fewer Reed-Sternberg cells are present than are found in traditional Hodgkin’s disease.
Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (e.g., surgery vs. chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0 – 1) imply a favorable prognosis, whereas high staging classifications (4 – 5) imply an unfavorable prognosis.
Your doctor considers the following factors to determine the stage of Hodgkin's disease:
Additional tests to determine staging may include:
Stage I – cancer is found only in a single lymph node area, in the area immediately surrounding that node, or in a single organ.
Stage II – cancer involves more than one lymph node area on one side of the diaphragm.
Stage III – cancer involves lymph node regions above and below the diaphragm.
Stage IV – cancer involves one or more organs outside the lymph system or a single organ and a distant lymph node site.
Stages have an “A” and a “B” level. In Stage B, a person with Hodgkin's lymphoma experiences general symptoms from the disease—fever, night sweats, or significant weight loss. If these specific symptoms are not present the classification is "A."
An “X” after the stage number refers to bulky disease. This means the cancer is 1/3 the width of the mediastinum, an area in the chest; or the cancerous lymph node is greater than 10 centimeters (cm) across.
An “E” is added after the stage number if the disease has spread to an adjacent organ.
Relapsed/Refractory – this is the term used for a cancer that has persisted or returned following treatment.
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation.
A lower stage usually means a better prognosis. The five-year survival rates for each stage are as follows:
Sources:
National Cancer Institute, National Institutes of Health
The Leukemia & Lymphoma Society
American Cancer Society
Goldman L. Cecil Textbook of Medicine , 21st ed. St. Louis, MO: W.B. Saunders Company; 2000: 969-976.
Rakel R. Conn's Current Therapy 2002 , 54th ed. St. Louis, MO: W.B. Saunders Company; 2002: 403-408.
Last reviewed February 2003 by Francine Foss, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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