hodgkin's disease

Hodgkin's disease

Hodgkin's disease is a malignant disease of the lymphatic system observed especially in the large child, adolescent and young adult. It accounts for 15 to 30% of the child's malignant lymphomas, and children account for 5-10% of patients with Hodgkin's disease all ages. Hodgkin's disease is exceptional before the age of 2 years and its frequency increases with age. It is twice as frequent after 10 years as between 2 and 10 years. It is a rare tumor in the child. It is 5 to 10 times less common than non-Hodgkin lymphomas. More than 90% of children with Hodgkin's disease have a favorable evolution of their disease under treatment.

Radiotherapy now used in combination with chemotherapy has transformed the evolution of this disease in a parallel way in adults and children. The treatment regimens aim to maintain these same healing rates with therapeutic de-escalation, in favorable forms, and the improvement of healing rates, in more advanced forms.

Diagnosis
Hodgkin's disease will be mainly evoked in front of suspicious lymph nodes at the neck level. A ganglion biopsy is also necessary for the diagnosis. Sometimes there is a shortness of breath in the effort, a cough. In an exceptional way, there are signs of compression that combine swelling and purplish coloration of the skin of the face and neck and difficulty breathing. The diagnosis can also be evoked in the face of general signs such as fever, night sweats, general fatigue with weight loss. More rarely, the disease can be revealed by misleading signs: a large and palpable ganglionic mass under the diaphragm, neurological complications, such as spinal cord compression or a large nerve, or an unexplained need for Scratching.

Therapeutic Strategy
The prognosis of Hodgkin's disease is generally very good with overall survival at 5 years after diagnosis, in children and adults under 20 years of age, by 91%. This is the result of an evolution of the therapeutic strategy towards a predominant and tailor-made chemotherapy, coupled with radiotherapy reserved for large ganglion masses.
Recent progress has made it possible to:

To improve survival in the few forms that remain severe,
To reduce the heaviness of treatments in the usual forms.
The therapeutic follow-up will understand, for the first two years, the research, although rare, of a possible recurrence. Subsequent surveillance includes the search for thyroid damage, related to cervical irradiation, cardiac or pulmonary damage related to chemotherapy. Although exceptional, a second tumor, solid or hematopoietic, must be sought.