Disease Description (Causes and Symptoms)
- Definition and pathophysiology: Hodgkin lymphoma is a malignant tumor arising in the lymphatic system and is histologically characterized by Reed–Sternberg cells (large binucleated cells). It develops through the combined effects of genetic predisposition and environmental factors (certain viral infections, immunosuppression, etc.), and may be associated with Epstein–Barr virus (EBV). It often begins in a single lymph node and spreads to adjacent lymph nodes along the flow of lymph.
- Major causes and risk factors: History of EBV infection, immunocompromised status (e.g., AIDS, immunosuppressive treatment), family history, radiation exposure, etc.
- Major symptoms: Painless enlargement of the lymph nodes in the neck, armpits, groin, etc. (most common); B symptoms (unexplained fever, night sweats, loss of 10% or more of body weight within 6 months); itching (pruritus); cough or chest symptoms (when the mediastinum is involved). Related symptoms may occur when the peripheral blood or bone marrow is involved, or when parenchymal organs (lungs, liver, bone marrow, etc.) are involved.
Treatment Methods and Precautions
- Evaluation before and after diagnosis: Definitive diagnosis is made by excisional biopsy (lymph node tissue examination), and staging is performed with PET-CT, chest and abdominal CT, and, if necessary, bone marrow biopsy. A treatment plan is established according to the Ann Arbor stage and the presence or absence of B symptoms.
- Standard treatment (adults):
- Early-stage and localized disease (I–II, limited lesions): Generally, combination chemotherapy (e.g., ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine) ± localized radiation therapy. Recently, attempts have also been made to reduce the radiation field through PET-guided treatment.
- Advanced-stage disease (III–IV): Mainly systemic chemotherapy (ABVD or intensive regimens such as BEACOPP). Additional radiation therapy may be considered depending on the treatment response.
- Relapsed/refractory disease: Autologous hematopoietic stem cell transplantation (after high-dose chemotherapy), targeted therapy (brentuximab vedotin — CD30-targeted), immune checkpoint inhibitors (e.g., nivolumab, pembrolizumab), etc., may be used.
- Children and adolescents: There is a tendency to minimize or avoid the radiation field, considering the effects of radiation on growth and development. The treatment plan should be discussed with a specialized pediatric oncology team.
- Precautions regarding adverse effects and complications:
- Treatment-related: Bone marrow suppression (infection, bleeding, anemia), long-term toxicity of anticancer drugs and radiation (pulmonary toxicity, cardiotoxicity, thyroid and cardiovascular disorders), and secondary cancers (long-term risk after treatment).
- Disease-related: Severe infection, superior vena cava syndrome (venous compression), intestinal obstruction, etc.
- Self-care recommendations:
- Seek medical attention immediately if fever, chills, or bleeding occurs during treatment.
- Consultation regarding fertility preservation (sperm, egg/ovulation preservation) is recommended, especially for patients of reproductive age.
- Vaccines: Live vaccines are contraindicated during periods of immunosuppression; consult medical staff about the timing of vaccination.
- Lifestyle: Quit smoking, prevent infection (handwashing, avoiding crowded places), maintain balanced nutrition, and get adequate rest.
Checklist Before an Outpatient Visit (Including Preparation Items and Sample Questions)
- Items to prepare:
- A list of all medications currently being taken (prescription, nonprescription, herbal medicines, etc.)
- History of past diseases, surgeries, and treatments (especially history of chemotherapy or radiation therapy)
- Copies or CDs of recent test results (blood tests, chest X-ray/CT, PET-CT, etc.)
- Symptom records: Changes in lymph node size, fever, night sweats, and weight changes (duration and severity), itching, shortness of breath, pain, etc.
- Information regarding the possibility of pregnancy or plans for pregnancy (women)
- Whether fertility preservation is desired
- Sample questions to organize in advance for the outpatient visit (patient memo):
- When the symptoms started and how they have changed (size and whether there is pain)
- Recent weight changes (duration and percentage)
- Frequency and severity of fever and night sweats
- Allergies to medications or previous experiences of adverse effects
Sample General Questions to Ask the Doctor
- What is the current stage of this disease, and what does it mean?
- What treatment plan (medications, radiation, or surgery) do you recommend, and why?
- What is the expected treatment duration, and what are the main adverse effects of each treatment?
- What is the long-term prognosis after treatment (possibility of cure and risk of recurrence)?
- If I want to preserve fertility, when and what procedures should I undergo?
- What preventive measures should I take to reduce the risk of infection during treatment?
Sample Disease-Specific Questions
- I (or the patient) am young. Is it possible to reduce radiation therapy? What are the long-term effects of radiation on growth, the heart, and the thyroid?
- If the disease relapses or is refractory, what targeted therapy or immunotherapy options (brentuximab vedotin, PD‑1 inhibitors, etc.) are available, and what are their adverse effects and efficacy?