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Lymphoma - Hodgkin's; Hodgkin's lymphoma; Hodgkins disease; HD
Hodgkinâ ' s disease is considered one of the most curable forms of cancer, especially if it is diagnosed and treated early. Unlike other cancers, Hodgkin's disease is even potentially curable in late stages Five-year survival rates for patients diagnosed with stage I or stage II Hodgkinâ ' s disease are 90 - 95%. With advances in treatment, recent studies have indicated that even patients with advanced Hodgkinâ ' s disease have 5-year survival rates of 90%, although it is not yet certain if their cancer will return. Patients who survive 15 years after treatment are more likely to later die from other causes than Hodgkinâ ' s disease.
Survival rates are poorest for:
The International Prognostic Factors Project on Advanced Hodgkin's Disease uses seven factors to help determine which patients with advanced Hodgkin's disease have a more serious prognosis and could benefit from more aggressive chemotherapy. These factors are also used to predict success in patients with relapsed or persistent HD who are undergoing stem cell transplantation.
The more of these factors that are met, the worse the outlook and the more likely the patient needs to be treated aggressively:
The good news about Hodgkin's disease is that treatment can cure the disease. The bad news is that survivors face a higher than average risk for long-term complications of these treatments, some very serious.
Many patients may experience chronic fatigue that could persist for years. The most serious complications are secondary cancers and heart disease, which occur over the 2 - 3 decades following treatments. Secondary cancers include non-Hodgkin's lymphoma, leukemia, melanoma, stomach and lung cancers, and breast and uterine cancers. Heart disease complications include coronary artery disease, stroke, heart valve problems, and cardiomyopathy (weakening of the heart muscle). Thyroid disorders are also a potential complication. Combinations of radiation and chemotherapies are especially associated with these problems.
Studies of adult survivors of various childhood cancers have found that, 30 years after treatment, patients with Hodgkinâ ' s disease have among the highest risk of developing serious health problems. Female survivors have a significantly greater risk than male survivors. In particular, women who received chest radiation are at very high risk for developing breast cancer.
Patients with Hodgkinâ ' s disease should get a written record of the treatments they received as children, and the potential risks of these treatments. These records can help the doctors who later oversee their care monitor for potential health problems. Survivors of Hodgkinâ ' s disease should receive regular screening tests for cancer and heart disease. They may need to get these tests at a younger age than most patients. In particular, patients who were treated with chest radiation should get blood tests every 5 years to measure their cholesterol levels. Female patients who received chest radiation should get early and frequent mammograms.
American Cancer Society. Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008.
Brenner H, Gondos A, Pulte D. Ongoing improvement in long-term survival of patients with Hodgkin disease at all ages and recent catch-up of older patients. Blood. 2008;111 (6): 2977-83.
FermĂ© C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27.
Horning SJ. Hodgkinâ€™s lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 111.
Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007 Feb 10;25(5):571-8. Epub 2007 Jan 22.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hodgkin Disease / Lymphoma. V.2.2009.
Oeffinger KC, Ford JS, Moskowitz CS, Diller LR, Hudson MM, Chou JF, et al. Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer. JAMA. 2009 Jan 28;301(4):404-14.
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