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Q: Hodgkin's lymphoma ( Answered 5 out of 5 stars,   1 Comment )
Question  
Subject: Hodgkin's lymphoma
Category: Health > Conditions and Diseases
Asked by: narbguy-ga
List Price: $30.00
Posted: 26 Dec 2003 17:59 PST
Expires: 25 Jan 2004 17:59 PST
Question ID: 290515
Hi,  I am looking for useful sources on  "Nodular sclerosing Hodgkin's
lymphoma."  I am specifically interested in current information on
staging, nutrition and treatments.  I have read much on cancer.gov and
am in search of additional information.
Answer  
Subject: Re: Hodgkin's lymphoma
Answered By: crabcakes-ga on 27 Dec 2003 14:44 PST
Rated:5 out of 5 stars
 
Hello narbguy,

Through your own research, you probably already know that lymphomas
are comprised of cancers originating in the lymphatic system, and that
nodular sclerosing Hodgkin?s (NSHD) is the most common histologic
subtype, accounting for more than 60% of all cases. Nodular Sclerosing
Hodgkin's disease differs from the other varieties in its inclination
to involve the lower cervical, supraclavicular and mediastinal lymph
nodes  The neoplasms may stay confined to a single lymph group, or
spread to  the bone marrow, liver and spleen.
http://www.merck.com/mrkshared/mmanual_home2/sec14/ch177/ch177a.jsp

Symptoms of Hodgkin?s include jaundice, weakness, shortness of breath,
swelling of the face, neck and upper extremities, swelling of legs and
feet, itching skin, cough, and an impaired immune system.
http://www.merck.com/mrkshared/mmanual_home2/tb/tb177_1.jsp
http://www.mmhs.com/clinical/peds/english/oncology/hodgkns.htm

Illustration of the lymphatic system:
http://www.merck.com/mrkshared/mmanual_home2/fg/fg183_2.jsp

The likelihood of developing Hodgkin?s may be genetic, or due to
exposure to carcinogens such as pesticides and other environmental
pollutants. Some research indicates it may be caused by exposure to
certain viruses, such as HIV (AIDS), and Epstein-Barr (EBV), the same
virus that brings us mononucleosis, or mono. This is NOT to say a
patient with Hodgkin?s lymphoma will acquire HIV or mono. Patients who
already have HIV and patients who already have EBV have a greater
incidence of developing Hodgkin?s lymphoma!
http://www.information-on-hodgkins-disease.com/html/causes.php3
http://www.mmhs.com/clinical/peds/english/oncology/hodgkns.htm



Staging:
======================================

To determine the best method of treatment, Hodgkin?s disease is
classified into 4 separate stages, depending on the magnitude of the
disease. Two staging ?systems? can be used, the Ann Arbor method, or
the Cotswold system, a modified Ann Arbor system. MRIs, X-rays, PET
scans, blood tests, and a lymphangiogram  can be used to asses the
extent of the disease. The stages are I, II, III, and IV, then further
subdivided according to the presence or absence of one or more of the
following: FUO (Fever of unknown origin) greater than 1000 F  for more
than 3 consecutive days, night sweats, and weight loss on the previous
6 months.
An example from the Merck Manual explains the staging thus: ? For
example, a person with a stage II lymphoma who has experienced night
sweats is said to have stage IIB Hodgkin's disease. Several procedures
are used to stage or assess Hodgkin's disease. Basic blood tests,
including tests of liver and kidney function, along with computed
tomography (CT) scans of the chest, abdomen, and pelvis are standard.
CT scans are quite accurate in detecting enlarged lymph nodes or
spread of the lymphoma to the liver and other organs.? Occasionally, a
patient may need exploratory surgery to accurately determine whether
the disease has metastasized (spread), and to determine the correct
therapy. A splenectomy may be performed, or a biopsy of spleen and
liver may be taken, to see if the disease has affected these organs.
Merck Manual
http://www.merck.com/mrkshared/mmanual_home2/sec14/ch177/ch177b.jsp
and
Information on Hodgkin?s site
http://www.information-on-hodgkins-disease.com/html/types.php3


and
BC Cancer Agency
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Lymphoma/HodgkinsDisease.htm

and
The Oncology Channel
http://www.oncologychannel.com/hodgkins/staging.shtml

This site explains better the Ann Arbor staging system (Found on a
non-Hodgkin?s page, this is  the same system):
http://www.information-non-hodgkins-lymphoma.com/html/diagnosis.php3

A staging table may be seen here:
http://www.merck.com/mrkshared/mmanual_home2/tb/tb177_2.jsp


Treatment:
===================================
From Information on Hodgkin?s site:
?Dr. Alan C. Aisenberg of the Department of Hematology and Oncology at
Massachusetts General Hospital, Boston, also believes that Hodgkin's
lymphoma "is highly curable . . . which is interesting because we
really don't understand Hodgkin's disease as well as the other
lymphomas . . . but we cure it best."
http://www.information-on-hodgkins-disease.com/html/treatment.php3


And 
 ??death rates from the disease have fallen by more than sixty percent
in recent years.The main cause of death during the first fifteen years
following treatment is a recurrence of Hodgkin's disease. After
fifteen to twenty years, death is more likely to be due to other
factors, such as a different type of cancer.?
http://www.information-on-hodgkins-disease.com/html/causes.php3


Radiation is an effective therapy (depending on the stage), which
shrinks tumor cells, and kills cancer cells. Before radiation therapy,
an oncologist will identify the areas of the body to irradiate,
outlining the area with semi-permanent markers. This process of
temporarily ?tattooing? the body is called ?simulation?, and lasts an
hour or two. The purpose of this simulation is to define the areas to
be irradiated, zoning in on the affected part, and protecting healthy
tissue. A window of 4-6 weeks is considered a ?standard?  radiation
treatment phase.

More on radiation:
http://www.lymphomainfo.net/hodgkins/treatment.html
http://www.lymphomainfo.net/therapy/radiotherapy/ports.html
http://www.lymphomainfo.net/therapy/radiotherapy/index.html
http://www.lymphomainfo.net/therapy/radiotherapy/dosage.html
Treatment for Hodgkin?s depends, of course, on the type and stage of
the disease, as well as the age and overall health of the patient.
Common therapies include chemotherapy and/or radiation, bone
marrow/stem cell transplants, surgery, steroids, and antibody-based
therapies.

Radiation therapy alone, or in conjunction with chemotherapy seems to
be a very effective ?cure? for many Hodgkin?s patients. From the Merck
Manual  ? Radiation therapy alone cures about 80% of people who have
stage IA or IIA disease. Treatments are usually given on an outpatient
basis over about 4 or 5 weeks. Radiation is beamed at the affected
areas and at the surrounding lymph nodes. Alternatively, chemotherapy
is used, followed by radiation therapy for those with stage IB or IIB
disease or for those whose chest lymph nodes are greatly enlarged.
With this dual approach, about 85% of people are cured.? Chemo drug
combinations are used for treating stage III and IV disease. ABVD
(doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine)
are commonly given for about one month, with a total treatment time of
6 or more months.  For patients with very large thoracic lymph nodes,
radiation and chemo is recommended.

Chemo side effects are common and can be serious. Increased risk of
infection, damage to vital organs, hair loss, sterility, and even a
form of leukemia years later, are among potential side effects.
 Autologous stem cell transplantation, which involves using the
person's own stem cells may be utilized after a remission occurs.
Before undergoing radiation, usually about 5 days, the patient?s blood
is passed through a pheresis machine, which collects very immature
cells (stem cells), while the rest of the blood is returned to the
patient. Several processes can remove any cancerous cells found in the
blood sample. Chemo drugs can kill the cancer cells. In one research
center I once worked, a ?magnetic? monoclonal antibody was mixed with
the blood; then passed through a tube with magnets. The cancer cells
?stuck? to the magnet, allowing only disease free cells to pass. Once
the blood sample has been cleared of cancer cells, it is processed,
and frozen. After the patient is done with radiation therapy, the
patient?s own ?clean? blood is returned via transfusion. The stem
cells migrate to the bone marrow to begin producing healthy cells,
free of disease. A bone marrow transplant works much the same, but
requires longer hospital stays and is more expensive.
 
http://www.lymphomainfo.net/therapy/transplants/bmt.html

http://www.siteman.wustl.edu/patient/other_specialized/bone_marrow.shtml

and

NYU Stem Cancer Unit
http://www.med.nyu.edu/nyuci/patients/services/stemcell.html

Merck Manual
http://www.merck.com/mrkshared/mmanual_home2/sec14/ch177/ch177b.jsp

and
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Lymphoma/HodgkinsDisease.htm

and
The Oncology Channel
http://www.oncologychannel.com/hodgkins/treatment.shtml


The BC Cancer Agency recommends that Hodgkin?s patients receive
adequate vaccinations, particularly the flu and pneumonia vaccines:
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Lymphoma/AppendixIII.htm

Drugs:
 
Rituximab: monoclonal antibody treatment. On the surface of each cell,
are proteins called ?antigens?. Monoclonal antibodies are proteins
that are developed to recognize a specific antigen ?marker?. In the
case of Hodgkin?s, the antibody attaches to the surface antigen of
Reed-Sternberg cells, those associated with Hodgkin?s and attempts to
destroy the cell. So far, in clinical trials of Rituximab, this
monoclonal antibody has been effective in locating tumor cells, while
ignoring healthy cells.
http://www.information-on-hodgkins-disease.com/html/treatment.php3


Bexxar, a radiolabeled monoclonal antibody
http://www.lymphomainfo.net/therapy/immunotherapy/bexxar.html

Zevalin: A raddioactive monoclonal antibody, given by IV, caused a 50%
tumor shrinkage in all patients.
http://www.lymphomainfo.net/therapy/immunotherapy/zevalin.html

Oncolym, another radiolabeled monoclonal antibody. In phase I and II
trials, 56% of patients that had failed conventional chemotherapy
achieved partial or complete remission

http://www.lymphomainfo.net/therapy/immunotherapy/oncolym.html

http://www.information-on-hodgkins-disease.com/html/treatment.php3


Germany has been doing research on lymphomas for years, but most of
what I found was for NHL. You may be interested in reading these:
Das kompentenznetz offers consultations with other doctors:
http://www.lymphome.de/Netzwerk/Vorstellung/KurzdarstellungEnglisch.jsp
Annals of Oncology
http://www.annonc.oupjournals.org/cgi/content/abstract/8/2/143
Annie Appleseed Project
http://www.annieappleseedproject.org/fatinlonsuro.html


Nutrition:
=======================================

There is no diet specific to lymphoma. All nutritional recommendations
are general for cancer patients. Lymphoma patients need to eat a
healthy diet, including lots of fruits and vegetables. As the
Hodgkin?s will increase your energy needs, add plenty of proteins and
whole grains to your diet. The Lymphoma.org.uk site recommends using
whole milk or cream in place of skim milk, adding extra cheese to
pizza, and eating full fat foods such as full fat yogurt, salad
dressings and mayonnaise. If radiation causes a sore mouth, use a
straw when drinking, avoid spicy foods, and try drinking nutritious
drinks such as Ensure or Boost. If your appetite is poor, you may need
a vitamin supplement.

When a patient has a low white count (lowered immunity), meats and
fish should be well cooked, and soft serve ice cream avoided.
http://www.lymphoma.org.uk/support/Newsletter/Spring2003/NutritionandLymphoma.htm

Avoid or minimize alcohol intake, and avoid processed foods.
http://www.lymphomation.org/CAM-diet.htm

This Lymphoma Focus site has a short video on Lymphoma and Nutrition.
Click on ?Fighting Cancer with Nutrition? .  If you don?t have or
don?t want to install Real Player, you can click on the ?Transcript?
and read instead of watch the video. This particular transcript
recommends lots of fruits and veggies, grains, and to be cautions of
food-borne illnesses. Recommended also are ground flaxseeds.
http://www.lymphomafocus.org/focus_index.asp?f=lymphomacoping&b=lymphoma

?The National Cancer Institute estimates that at least 35% of all
cancers have a nutritional connection. When lifestyle factors such as
smoking and exercise are included the associated risk becomes much
stronger and may be as high as 85%.? This site emphasizes the 80/20
rule. The rule is: eat healthy foods 80% of the time, and eat
?pleasure? foods 20% of the time!
http://www.cancernutrition.com/

Lymphoma Focus on nutrition and supplements
http://www.lymphomafocus.org/webcast_transcript.asp?f=lymphomacomplementary&b=lymphoma&c=nutrition


Fatigue and depression can be combated with adequate rest and a healthy diet.
http://health.allrefer.com/health/fatigue-info.html

You can subscribe to a Cancer Nutrition Newsletter, $35 USD for a one
year subscription, (4 issues) on this page. Just click ?Newsletter?
near the top of the page.
http://www.oncologynutrition.org/

More Resources:

Lymphoma Information Network:

Adult Hodgkin?s
http://www.lymphomainfo.net/hodgkins/description.html

Childhood Hodgkin?s
http://www.lymphomainfo.net/childhood/hodgkins.html

The Oncology Channel
http://www.oncologychannel.com/hodgkins/types.shtml

University of Pennsyvania OncoLink
http://www.oncolink.upenn.edu/types/subsection.cfm?c=10&s=35&ss=280

The Body
http://www.thebody.com/Forums/AIDS/Cancer/Archive/othertypes/Q96612.html

Stanford University is recruiting Hodgkin?s patients for studies:
http://www.clinicaltrials.gov/ct/show/NCT00026208?order=17

Studies at Baylor College of Medicine
http://www.bcm.tmc.edu/genetherapy/clinical/hodgkins.html

From ?Clinical Lymphoma?, about  stem cell transplants. 
http://www.euchromatin.net/Carella1.htm

More on Monoclonal antibodies:
http://www.lymphomainfo.net/therapy/immunotherapy/mab.html

American Institute for Cancer Research, on nutrition
http://www.aicr.org/index.lasso

This site has a short video on monoclonal therapies.(They mention
Non-Hodgkin?s, but the theory is the same, and this can help you
understand monoclonal antibodies better). Just click onto ?Smarter
Lymphoma Drugs? , under Featured Programs.  The entire page has links
to useful videos about vaccines, drugs, and radiotherapy. (You will
need Real Player installed to see them. The web site will prompt you
to download Real Player if it is not installed on your computer).
Again, you can click the ?Transcripts? to simply read the content.
http://www.lymphomafocus.org/focus_index.asp?f=lymphomatreatment&b=lymphoma


A personal story of someone diagnosed in the mid ?70s with Hodgkin?s:
http://www.information-on-hodgkins-disease.com/html/personal-story.php3

What is a splenectomy?
http://www.ich.ucl.ac.uk/factsheets/test_procedure_operations/splenectomy/

A photo of cell morphology of nodular sclerosing Hodgkin's tissue in a lymph node.
http://www.hmds.org.uk/insets/nshd_1.htm


There you go, narbguy. Since you have been reading the Cancer.gov
site, which is an excellent site, by the way, I purposely left it out
of my research.  I hope this is the information you were seeking and
is helpful to you. If not, please request an Answer Clarification
before rating. This will enable me to assist you further, if possible.

Regards,
crabcakes-ga

Search Stategy:
Hodgkin?s lymphoma
Hodgkin?s lymphoma nutrition diet
Hodgkin?s lymphoma therapy
narbguy-ga rated this answer:5 out of 5 stars and gave an additional tip of: $5.00
Thankyou for the deep digging.

Comments  
Subject: Re: Hodgkin's lymphoma
From: crabcakes-ga on 28 Dec 2003 12:42 PST
 
I'm happy you were pleased with the information! Thank you for the
stars and the nice tip! crabcakes-ga

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