A few days ago a court decision was made that ruled in favor of treating Daniel Hauser’s Hodgkin’s lymphoma, in spite of his parents’ objections. Since then, his mother took him and fled, putting the boy at risk.

We’ll explain the disease here, as well as the implications of treatment and of not treating it.

Danger level: High

What is it?

Hodgkin’s disease is a type of lymphoma – a cancer of the lymphatic system. The lymphatic system in our body is involved in draining fluid and waste products from the body, as well as producing white blood cells which protect the body from infections.

Who gets it?

In the US there are about 7,500 new cases of Hodgkin’s each year. It happens to about 3 out of 100,000 people. It’s more common in America and Europe than in Japan and China.

Hodgkin’s disease is more common in males than females, especially in children.

It tends to occur in two age groups: in people 15-35 years old and in those age 50 and more.

What causes it?

The white blood cells which are created in the lymphatic system are called lymphocytes. Their role is to fight infections. In lymphoma, these cells begin to multiply uncontrollably, which produces malignant cells. These cells can invade other tissues in the body.

A lymphocyte. These cells take over the body in lymphoma.

How does it feel?

Our lymphatic system contains organs called lymph nodes. They are found throughout the body, and act as “traps” for germs and other foreign things. When germs enter the body, some of them reach the lymph nodes. There they are presented to the lymphocytes, which learn that the body has an infection, and start multiplying in order to fight the infection in other places in the body. When they multiply, the lymph nodes enlarge. This is why, for example, when we have an inflammation in our throat, a lump can be felt in our neck – the white blood cells there multiply, which causes the lymph node to enlarge.

The lymphatic system. The green circles are the lymph nodes (you can click the picture for a bigger version).

Since in Hodgkin’s the lymphocytes multiply as well, the lymph nodes will get bigger. They are usually not painful, but one interesting feature is that they might hurt after you drink alcohol (for unknown reasons).

Other things which happen in the disease:

1. Enlargement of the spleen – As you can see in the picture above, the spleen is also part of our lymphatic system (in the picture it’s the oval shaped green mass on the right of the picture). It gets larger too in the disease. In some cases, the liver can enlarge as well.
2. “B symptoms” – This is a group of symptoms which characterize lymphomas. They include 3 things:
   a. Weight loss – Usually of more than 10% of the body weight over 6 months.
   b. Fever – Of more than 38 degrees Celsius (or 100.4 Fahrenheit).
   c. Night sweats – This doesn’t mean the sweat you usually experience on hot days. This sweating is profuse, often causing you to change sheets during the night.
   Sometimes an itchy skin may be present as well.
3. Cyclical fever – Some people will have fever that goes up for a few days, then goes down for several days or weeks, and then up again, in cycles. This phenomenon is called “Pel-Ebstein” Fever.

Since the lymphatic organs grow, they can press other organs in the body, which may cause:

1. Difficulty breathing – If the tumor presses the airways.
2. Back pain and even paralysis – When the tumor presses the spinal cord.

And others.

How is it discovered?

When one of the lymph nodes is enlarged and the doctor suspects you have Hodgkin’s disease, they will take a sample of that node, in a process called a biopsy. It can be done by cutting a piece of that node or taking the whole node out.

The sample of the node will be looked at under the microscope. One of the most characteristic things that can be seen under the microscope in Hodgkin’s are cells called Reed-Sternberg cells, which look like the eyes of an owl (if you have good enough imagination), as in this picture:

Once the microscope shows it’s Hodgkin’s, additional tests are done, including blood tests, and images of the body (X-rays, CT scans, etc.) to see where the tumor has spread to.

How is it treated?

Therapy for Hodgkin’s disease may include the following, depending on how severe the disease is:

1. Chemotherapy
2. Radiation therapy
3. Sometimes bone marrow transplantation

What happens after treatment?

In patients in whom the disease is discovered early, more than 90% are cured as a result of treatment. Even in people with an advanced disease, more than 75% of them can live for years without the disease.

There is currently no known way to prevent the disease.

What next?

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