Hodgkin’s disease is a malignant cancerous disease of the lymphatic system. Being confronted with such a diagnosis, people understandably enough experience very strong feelings, such as fear, panic, rage, sadness or helplessness and resignation. It is important to accept and express these changing feelings in order to gain courage and strength to face and fight the disease. In such situations help and support from the affected person’s partner, parents and other family members and from friends is very important. The process of accepting such a diagnosis and to prepare for the required treatment and therapy is very demanding for all people involved, particularly with regard to strength and patience. Patients with this disease should be accompanied by an experienced medic whom they trust. Being well informed about all aspects of the disease is a helpful factor to prevent a feeling of helplessness and subjection and to actively control the process and success of the therapy.  

Hodgkin’s disease, also referred to as lymphogranulomatosis, malignant granuloma or granulomatous lymphoma is a malignant disease of the lymphatic system. It was named after the English physician and pathologist, Thomas Hodgkin, who first described this disease in 1832. Hodgkin’s disease is a rather rare disease, amounting to approx. 2 to 3 new cases per 100,000 people per year.   

Unfortunately it is not exactly clear what causes this disease. However, it is known that Hodgkin’s lymphoma originates from degenerated B-lymphocytes. B-lymphocytes are the so-named "white blood cells" that play an important role in immuno-defence. B-Lymphocytes are predominantly located in the lymphatic system in order to fulfil their tasks there. The lymphatic system includes all lymphatic vessels as well as the lymphatic organs such as spleen, thymus gland, the lymph nodes and lymphoid tissue, e.g. in the intestinal tract or the pharyngeal area.   

The disease mostly originates in the lymph nodes in the throat and neck region and spreads from there from one node to the next. The mostly painless enlargement of lymph nodes is accompanied by non-specific general symptoms, such as fever, night sweat and weight loss of more than 10% of the patient’s body weight within 6 months.   

The histologically safe characteristic of Hodgkin’s lymphoma is the presence of Hodgkin and Reed-Sternberg giant cells. In order to treat the disease appropriately the stage of the disease must first be determined. During the so-named staging process the actual stage of the disease is analysed and determined. For this purpose, a number of findings and results are used, e.g. anamnesis, documentation of laboratory examinations, and imaging procedures such as computer tomography or ultrasonic scans. On the basis of this staging, the patient will be classified according to the Ann-Arbor staging classification scheme (I, II, III and IV), depending on how many regions in the body are affected.  

In contrast to many other malignant tumours Hodgkin’s lymphoma is very sensitive to both radiation therapy and chemotherapy. This is a prerequisite for effective treatment and curing of the majority of patients. Upon the initial diagnosis, treatment will be by means of chemotherapy and/or radiation therapy, with chemotherapy generally being carried out as a first step followed by radiation therapy. 

Therapy should be implemented immediately after the diagnosis and should only be carried out by experienced physicians in specialised clinics or practices with a focus on haemato-oncologic aspects. Chemotherapy for Hodgkin’s lymphoma comprises a combination of various medical agents (poly-chemotherapy) that have either a cytotoxic (cell-damaging) or growth-inhibiting effect and are grouped under the term cytostatics. Combined chemotherapy is administered in a specific dosage and cycle.   

In Germany, today it is mostly the so-named ABDV scheme and the BEACOPP scheme that is used. In these chemotherapy regimens, each letter represents a specific drug. The application of the schemes is repeated until the determined number of cycles is achieved. It is strongly dependent on the stage of the disease, which type of therapy regimen is employed, and how many cycles must be completed.

Radiation therapy is a locally limited form or treatment and makes use of the fact that tumour tissue is much more sensitive to radiation than healthy tissue.  

Both chemotherapy and radiation therapy cause a number of side and adverse effects. Such effects may occur acutely or delayed years after the end of therapy.

The most frequent side effects are vomiting, hair loss, modifications of the blood count and infections resulting thereof. Other side effects may be disorders of the heart and lung functions, of the thyroid gland and fertility disorders. Chronic fatigue and also new tumours may occur. Today, some of the side and adverse effects can be effectively prevented or fought. For example, precautions can be made to maintain fertility of most men and women affected before starting treatment of a malignant disease.
 

After-care is absolutely necessary and should be undergone in any case. After the end of the therapy, during the first year after-care will be every 3 months, from the second year every 6 months and from the fifth year once per year.
 

Unfortunately, recurrence of Hodgkin’s disease has been reported in a number of cases (recidivation). If a disease occurs again, there are various options for treatment available that depend on various factors, e.g. how much time has passed until a new outbreak of the disease.  The attending physician will consider all individually required options for therapy and adjust the treatment accordingly.  

The German Hodgkin Study Group (DHSG) with its headquarters in Cologne has been performing systematic research for therapy and treatment possibilities of Hodgkin's lymphoma since 1978. And during recent years the survival rates of patients have been significantly increased, which was particularly due to the successful work of the German Hodgkin Study Group.    

Although being a malignancy, Hodgkin’s lymphoma is a curable and controllable disease with good chances of recovery. Meanwhile five-year survival rates of more than 90% can be achieved for extensive or advanced stages.  And after 10 years, the high survival rate of 86% is nearly unchanged.  

In case of cancer, a good nutritional condition is a prerequisite of a better quality of life and, as the case may be, of a more favourable course of the disease. At the same time, nutrition has to take into account the particularities of the disease and the patient’s condition. Chemotherapy as for Hodgkin’s disease often has undesirable effects on the digestive organs that, even if temporarily, affect the patient’s appetite and food intake. In this context, a diet that is wholesome, i.e. contains all important nutrients, and at the same time constitutes no strain on the digestive organs is most beneficial for the patient.  

You also have to keep in mind that strong drugs as used for chemotherapy may have an influence on certain food components in the body. For example, ripened, preserved or fermented (treated by fermentation) food contains a relatively large amount of the substance tyramine that raises the blood pressure. Normally, tyramine is decomposed quickly in the body. If decomposition is delayed by drugs, the blood pressure may rise excessively. Please discuss with your attending physician which foodstuffs you should avoid or consume less frequently during chemotherapy of Hodgkin’s disease. But you should also take into account our recommendations for a low-tyramine or wholesome bland diet.  

In cooperation with Germany’s youngest Michelin-starred chef – Susanne Vössing – sigma-tau has prepared great and delicious recipes for you that you can          see here as video and as a recipe download  . Have fun cooking!