Hodgkin’s Lymphoma: rare and curable

At 27 years old, Julie Taber was loving life. She was young, beautiful, a dance performer on the Strip, but what started off as flu-like symptoms and fatigue landed Taber in the hospital on a Valentine’s Day, and at that moment Taber’s life changed forever.

After weeks of testing, Taber was diagnosed with Hodgkin’s Lymphoma, a disease she had never heard of. In fact, it’s one of those cancers that you may have heard of but don’t know anything about. Little recognition of Hodgkin’s Lymphoma probably has to do with the fact that the disease is extremely rare — according to Clinical Connections only 1 in every 25,000 were diagnosed with the disease last year.

Hodgkin’s lymphoma is a cancer of the lymphatic system, which is part of the immune system. The disease causes cells in the lymphatic system to grow abnormally and sometimes spreads beyond the lymphatic system, which includes the lymph nodes. The spleen, thymus gland and bone marrow are also part of the lymphatic system.

According to Mayo Clinic fact sheets, when Hodgkin’s disease forms it develops abnormal B cells, lymph cells that are key to the body’s immune system. When the cells develop into large abnormal cells (cancerous cells), instead of dying off as is the normal cell cycle they continue to produce abnormal B cells in a malignant process.

As complicated and serious as the disease sounds when Taber was finally diagnosed with Hodgkin’s disease she remembers being glad.

"I remember I kept saying ‘Please let it be Hodgkin’s.’ When we found out, it was a big fest of happy tears," said Taber.

That’s because after weeks of testing doctors narrowed it down to two diseases: Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma. The latter is fatal and meant a bleak outcome for Taber.

"I remember they told me that if it was Non-Hodgkin’s I would only have six months to two years to live. A lot of things start going through your head when they tell you that," said Taber.

Luckily for Taber it was Hodgkin’s disease, which, as she put it, "if you’re going to get cancer it’s the probably one of the best to get." That’s because the survival rate is very high, 95 percent survival rate according to Mayo Clinic and 60 to 70 percent at the later stage of cancer.

"We’ve actually done very well (curing Hodgkin’s) if we knew more about it maybe we could completely eradicate it all together but the dollars are not there to investigate it that much further," said Dr. Kenneth Foon, head of the Leukemia section of the Nevada Cancer Institute. Foon conducts research and specializes in blood cancers.

Foon says the disease is very rare, in fact he says he only sees about five to ten new patients a year and at any given time he’ll have 25 patients overall.

"Just like any other cancer we have no idea what causes it and we have no idea how to prevent it," said Foon.

Foon described Hodgkin’s as a peculiar disease with odd patterns of consistency such as the fact that it is most common in the late teens to mid 20’s and then again in the fifty and sixty-year-olds.

"We have no idea why there are humps in the age group. It is interesting that there are subtype trends that are different in different age groups," Foon said.

The disease is not necessarily hereditary either and oddly enough Foon points out an interesting phenomenon as research has indicated that Hodgkin’s disease tends to be more prevalent in more affluent socioeconomic areas.

But what is not known about the disease pales in comparison to the importance of what is known, according to Foon. The predictability of the disease allows for the high survival rate.

"It’s very predicable," said Foon. "It doesn’t spread very early and the tissue is quite accessible. It spreads from one lymph node to the other and if it presents itself in the neck the next area would be the clavicle area and then goes around the chest. It moves in a very predictable pattern."

The treatment for Hodgkins varies depending on the severity but Foon says treatment for Hodgkin’s has become somewhat of a controversy among medical experts because the disease is so curable. The standard care for the cancer is a combination of radiation and chemotherapy for about six to eight courses, sometimes more or less depending on the stage. Sometime it requires surgery and a bone marrow transplant if the cancer has spread that far.

Foon says that because Hodgkin’s is so curable some doctors are opting to give fewer treatments if the patient responds well and other therapies have reduced the combination or eliminated the combination entirely.

"Now we are wondering with new patients with early disease if we can just do two cycles and scan them. If they are negative give them two more and stop and then hopefully they have the same cure rate. Those are some of the things that are being looked at today," said Foon.

For reduced treatment to even be an option the cancer has to be in its early stages as it is expected that an advanced cancer would require more intensive care.

To be diagnosed earlier a patient has to understand the symptoms, which are pretty discreet and can be confused with the flu — such as a fever, fatigue and night sweats. Other symptoms of the disease are painless swelling of the lymph nodes in the neck, armpits or groin, unexplained weight loss, loss of appetite and itching.

Researchers at the Mayo Clinic explain that because the symptoms are so vague and discreet and sometimes victims have none of the symptoms the abnormality is found on a chest X-ray done for non-specific symptoms. If an abnormality is detected a physician will submit further screenings such as a CT scan, an MRI, a Gallium scan which uses radioactive substance that indicates areas in your body where Hodgkin’s disease may be present, a biopsy and blood tests.

Even then, because the disease is so uncommon, several biopsies are performed and tested multiple times, as was the case with Taber.

"They did so many tests, for days. It was never black and white. Sometimes it would lean more to one disease than to the other. They just weren’t so sure at first," said Taber.

In Tabers case, her cancer was well advanced and she required the full eight sessions of combined therapy but just as the statistics predicted she survived and is currently in remission. Now Taber is 28, still loving life (now more than ever) and is back on the main stage.

"I was off stage for almost a year and a half. I recently went back on stage about a month ago and it was great I missed it more than anything and I told my doctor that I’d do anything to be well again because I didn’t want to stop dancing, it’s a big part of me," said Taber.