Lymphedema and Hodgkins Lymphoma - Hodgkins Disease

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Lymphedema and Hodgkins Lymphoma - Hodgkins Disease

Postby patoco » Sun Jun 11, 2006 8:50 am

Lymphedema and Hodgkins Lymphoma - Hodgkins Disease

Our Home Page: Lymphedema People


To My Brother Steve

A 30 years Hodgkins Disease Survivor - and also just happens to be a very cool guy and a brother I love very much!


What Is Hodgkin's Disease?

Hodgkin's disease, sometimes called Hodgkin's lymphoma, is a cancer that starts in lymphatic tissue. Lymphatic tissue includes the lymph nodes and related organs that are part of the body's immune and blood-forming systems. The lymph nodes are small, bean-shaped organs found underneath the skin in the neck, underarm, and groin. They are also found in many other places in the body such as inside the chest, abdomen, and pelvis.

Lymph nodes make and store infection-fighting white blood cells, called lymphocytes. They are connected throughout the body by lymph vessels (narrow tubes similar to blood vessels). These lymph vessels carry a colorless, watery fluid (lymphatic fluid) that contains lymphocytes. Eventually the lymphatic fluid is emptied into the blood vessels in the left upper chest.

Other components of the lymphatic system include the spleen, the bone marrow, and the thymus. The spleen is an organ in the left side of the upper abdomen that is composed primarily of mature and immature lymphocytes. It removes old cells and other debris from the blood. The bone marrow is the spongy tissue inside the bones that creates new red and white blood cells including lymphocytes. The thymus is a small organ in the chest that is important in developing a special lymphocyte called a T cell.

Because lymphatic tissue is present in many parts of the body, Hodgkin's disease can start almost anywhere, but most often starts in lymph nodes in the upper part of the body. The most common sites are in the chest, neck, or under the arms. Hodgkin's disease enlarges the lymphatic tissue, which can then cause pressure on important structures. It can spread through the lymphatic vessels to other lymph nodes. This is the major way it spreads. Most Hodgkin's disease spreads to nearby lymph node sites in the body, not distant ones. It rarely gets into the blood vessels and can spread to almost any other site in the body, including the liver and lungs.

Lymph nodes enlarge for many reasaons. Although Hodgkin's disease is one cause, enlarged lymph nodes are more commonly a result of the body fighting an infection. Your doctor can help determine the cause.

Hodgkin's disease is a malignant lymphoma (cancer of lymphatic tissue). There are two kinds of lymphomas: Hodgkin's disease (named after Dr. Thomas Hodgkin who first recognized it in 1832) and non-Hodgkin's lymphomas. For information on non-Hodgkin's lymphomas see the document "Non-Hodgkin's Lymphomas".

The cancer cells in Hodgkin's disease are called Reed-Sternberg cells, after the two doctors who first described them in detail. Under a microscope they look different from cells of non-Hodgkin's lymphomas and other cancers. Most scientists now believe that Reed-Sternberg cells are a type of malignant B lymphocyte. Normal B lymphocytes are the cells that make antibodies that help fight infections.

Doctors have given names to different types and subtypes of Hodgkin's disease. The two main types are classical Hodgkin's disease (which has several subtypes) and nodular predominant Hodgkin's disease.

Classical Hodgkin's disease:

Lymphocyte predominance
Nodular sclerosis
Mixed cellularity
Lymphocyte depletion
Nodular lymphocyte predominant Hodgkin's disease

All of these types are malignant because as they grow, they may compress, invade, destroy normal tissue and spread to other tissues. There is no benign (noncancerous) form of Hodgkin's disease. ... tearea=cri

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Hodgkin's disease

By Mayo Clinic staff


Hodgkin's disease — also known as Hodgkin's lymphoma — is an uncommon cancer of the lymphatic system, which is part of your immune system. It's named after the British physician Thomas Hodgkin, who first described the disease in 1832 and noted several characteristics that distinguish it from other lymphomas.

In Hodgkin's disease, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's disease progresses, it compromises your body's ability to fight infection.

Hodgkin's disease most commonly affects people between the ages of 15 and 40 and people older than age 55. It's one of two common types of cancers of the lymphatic system. Non-Hodgkin's lymphoma, the other type, is far more common. In the United States in 2004, there were about 7,880 new cases of Hodgkin's disease, compared with 54,320 new cases of non-Hodgkin's lymphoma.

Each year, about 1,300 Americans die of Hodgkin's disease. However, death rates for this disease have dropped by 60 percent since the 1970s. Advances in diagnosis, staging and treatment of Hodgkin's disease have helped to make this once uniformly fatal disease highly treatable with the potential for full recovery.

For complete article including:

Signs and Symptoms
Risk Factors
Screening and Diagnosis
Coping Skills


Hodgkins Disease - Hodgkins Lymphoma Resources and Information

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Arm and Leg Swelling After Hodgkins Disease Hodgkins Lymphoma

With the advent of better and more effective cancer treatments, the survival rate for all cancers has risen dramatically. With this progress, a new and often misunderstood and misdiagnosed complication has arisen.

Many cancer survivors , having overcome cancer, find themselves with sudden and often unexplained swelling, usually of the arms or of the legs.

This swelling occurs because of one of several factors.

First, the swelling begins after lymph nodes have been removed for cancer biopsies.

Second, the swelling may start as a result of radiation damage to either the lymph nodes and/or the lymph system.

Due to either the removal of lymph nodes or damage to the lymph system, your body is no longer able to rid itself of excess fluids. The fluids collect in the limbs effected and swelling beings.

This swelling is called lymphedema. The swelling that occurs is permanent, and while it is not curable it is treatable.

Permanent Leg or Arm Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg or arm swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg or arm swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg or arm swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg or arm swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

What are the symptoms of Lymphedema?

If you are an at risk person for arm lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the arm

2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown arm lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the hand, or between the elbow and hand. This is an indication of early lymphatic malfunction.

4.) Any arm inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the arm.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

For extensive information on lymphedema, please visit our home page:

Lymphedema People

(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted. It must be available free and without charge and not used for financial renumeration or gain. Please include an acknowledgement to the author and a link to Lymphedema People.


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For information about Lymphedema ... hedema.htm

For Information about Lymphedema Complications ... ations.htm

For information about Lymphedema Wounds ... evised.htm

For information about Lymphedema Treatment Options ... evised.htm

For information about Children's Lymphedema ... iatric.htm
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Treatment-related cardiotoxicity persists Hodgkin's disease

Postby patoco » Thu Jul 05, 2007 7:39 am

Treatment-related cardiotoxicity persists for Hodgkin's disease survivors

Reuters Health
Last Modified: March 20, 2007

Last Updated: 2007-03-20 16:22:34 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The improved prognosis for patients diagnosed with Hodgkin's lymphoma is challenged by the long-term cardiovascular sequelae of treatment. Multiple manifestations of cardiovascular disease (CVD) remain up to 5-fold higher than in the general population for more than 25 years, investigators report in the March 1st issue of Blood.

The risk of fatal heart disease after treatment for Hodgkin's lymphoma is well documented, Dr. Flora E. van Leeuwen, from The Netherlands Cancer Institute in Amsterdam, and her associates note, but cardiac morbidity has been neglected, they add.

They therefore assessed the long-term CVD risk in a cohort of 1474 five-year survivors of Hodgkin's lymphoma who were treated between 1965 and 1995. Median follow-up was 20.1 years for the 1017 patients still living at the end of the study.

Records showed that 84% of patients were treated with radiotherapy that included the mediastinum, and 29% had both radiation and chemotherapy with anthracyclines. Median age at start of treatment was 25.7 years, although 314 patients were age 20 or younger.

Dr. van Leeuwen's group observed 160 instances of valvular disorders, 134 cases of angina pectoris, 102 MIs and 52 cases of congestive heart failure. Standardized incidence ratios were 3.6 for MI and 4.9 for congestive heart failure.

The median time between start of treatment for the lymphoma and the diagnosis of CVD was close to 19 years. However, the risk for MI was significantly elevated beginning 9 years earlier. "Standardized incidence ratios of all CVDs combined remained increased for at least 25 years," the investigators report.

Among subjects treated before age 20, the risk for angina pectoris and congestive heart failure were significantly higher than for those treated when they were older, suggesting that "immature cardiovascular tissue may be more vulnerable to radiation and chemotherapy."

Dr. van Leeuwen and her team hope that the outlook for survivors of Hodgkin's lymphoma will brighten over time, as fewer patients are receiving radiation therapy, and when they do, target volumes are reduced and patients' hearts are at least partially shielded.

For now, "especially in young survivors of Hodgkin's lymphoma at increased risk of cardiovascular disease," the researchers conclude, "physicians should consider appropriate risk-reducing strategies such as treatment of hypertension and hypercholesterolemia, and lifestyle advice such as refraining from smoking."

Blood 2007;109:1878-1886. ... &year=2007

Last edited by patoco on Thu Jul 05, 2007 7:42 am, edited 1 time in total.
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Hodgkin's disease therapy increases MI risk for decades

Postby patoco » Thu Jul 05, 2007 7:42 am

Hodgkin's disease therapy increases MI risk for decades

Reuters Health
Last Modified: February 6, 2007

Last Updated: 2007-02-06 16:00:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Survivors of Hodgkin's disease may have an increased risk of fatal MI for up to 25 years after undergoing treatment, a British research team reports in the Journal of the National Cancer Institute for February 7. Most of the cardiotoxicity can be attributed to supradiaphragmatic radiotherapy, anthracyclines and vincristine.

Although increased mortality has been associated with radiotherapy, no studies have examined the hazard associated with specific chemotherapeutic agents, Dr. Anthony J. Swerdlow, from the Institute of Cancer Research, Sutton, and his associates note.

To delve more deeply into the causes of excess cardiac mortality, Dr. Swerdlow's group extracted data from the British National Lymphoma Investigation and private databases of several hospitals. The earliest that patients were registered was 1967, with enrollment and follow-up usually lasting until 2000.

Included were 7033 patients, among whom 2441 died during an average follow-up of 11.1 years. MI was the cause of death in 166 patients. Compared with the general population, the overall standardized mortality ratio (SMR) for MI death was 2.5.

"We found that the risk of death from MI was high in the year after first treatment, peaked 15-19 years after treatment was first received and remained statistically significantly increased 20-24 years after treatment, with some evidence suggesting that the increased risk may persist for even 25 years or longer after treatment," the authors write.

Any type of supradiaphragmatic radiotherapy was associated with increased cardiac mortality, whereas infradiaphragmatic radiotherapy appeared to be the safest.

Dr. Swerdlow's team found that any regimen that contained an anthracycline was associated with increased risk (SMR = 2.9), especially the regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (SMR = 9.5). Excluding these factors, the only other agent that seemed to be cardiotoxic was vincristine, with an SMR of 2.0.

After 20 years or longer, the MI risk remained especially high for patients who underwent supradiaphragmatic radiotherapy plus vincristine, with an SMR of 14.8.

However, the likelihood of a fatal MI declined as age at first treatment increased and as patients aged, they report.

"The goal of keeping these patients alive has been achieved," Dr. John D. Boice, Jr. of Vanderbilt University in Nashville, comments in an editorial.

"The effects of treatment for Hodgkin lymphoma appear to be life-long," he adds, "and cancer survivors should be monitored for late cardiac abnormalities throughout their lives."

J Natl Cancer Inst 2007;99:186-187,206-214. ... &year=2007
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Smoking risk Epstein-Barr virus-positive Hodgkins lymphoma

Postby patoco » Thu Jul 05, 2007 7:44 am

Smoking increases risk of Epstein-Barr virus-positive Hodgkin lymphoma

Reuters Health
Last Modified: January 19, 2007

Last Updated: 2007-01-19 13:47:02 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Smoking increases the risk of Hodgkin lymphoma in general and the risk of Epstein-Barr virus-positive Hodgkin lymphoma in particular, a study published in the January issue of Epidemiology shows.

Dr. Eleanor V. Willett of the University of York, UK and colleagues assessed the link between tobacco smoking, alcohol consumption, Epstein-Barr virus-positive and Epstein-Barr virus-negative Hodgkin lymphoma in patients between the ages of 16 and 66 with lymphoma living in a defined region of the UK around Yorkshire and Leeds.

The study involved 262 cases of white patients with Hodgkin lymphoma, who were matched 1-to-1 with population-based controls by age, not allowed and race. A further 875 controls from a non-Hodgkin lymphoma study were also used for comparison.

Ever-smokers had odds ratio of Hodgkin lymphoma of 1.4 compared with nonsmokers, and for current smokers the OR was 1.7. Risk fell back to that of nonsmokers after a period of not smoking for 10 years "Associations were suggested for Epstein-Barr virus-positive Hodgkin lymphoma" but not for virus-negative cases, Dr. Willett's team says.

The investigators found no association between alcohol consumption and Hodgkin lymphoma.

Smoking tobacco is known to have an immunosuppressant effect, and this could allow B cells harboring latent Epstein-Barr virus to proliferate, the investigators speculate. They propose other immunomodulatory effects of tobacco smoke that could allow growth of Epstein-Barr virus-containing cells or to preferentially allow survival of the virus.

Whatever the reason, "the public health message is that smoking may be a preventable risk factor for Epstein-Barr virus-positive Hodgkin lymphoma tumors," they conclude.

Epidemiology 2007;18:130-136. ... &year=2007
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I am so Green

Postby bo dupre » Thu Dec 20, 2007 10:13 pm

Hey Guys Please forgive my Ignorance, but I am really green at this. I've had LE since birth (some 52 years ago). But haven't really seen a doc about it until recently, and now it's more of a skin issue than the Lymphedema cause the docs really don't know.

My question is this. is Cancer a possible complication of LE, or is LE only a result of of various treatments for cancer. I think I'm getting confused :?: :?: :!:

Thanks for the info.

I hope you all have a great holiday, and a Merry Christmas!!
Take Care
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Location: Rochester, NY

Postby patoco » Fri Dec 21, 2007 12:32 am

Hey Bo :)

The leading cause of secondary lymphedema in the industrial world is from cancer treatment/diagnosis

This can be as a result of lymph node removal, radiation therapy which destroys (fries) lymph nodes, and chemotherapy.

BTW, there are also many other causes of secondaary lymphedema, but cancer treatment us the #1 cause.

Now, with hereditary lymphedema, there are cancers that can be a complication of lymphedema itself.

These cancer (thank goodness) are rare and most LE'er's will never get them. Some of us (like myself) have.

Generally these cancers are (from my studies) are lymphomas. There are also angiosarcomas and most dreaded of all lymphangiosarcoma (Stewart Treves Syndrome). We have pages on the left on these as well.

Bo, thereis also strong indication that in some families like mine, we may have a genetic predispostion towards this.

The rate of hereditary lymphedema and lymphomas/lymphatic cancer is astounding.

Read through the pages on cancers in this section - lymphoma, hodgkins - that will give you an idea.

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