American Medical Association Family Medical Guide - American Medical Association [378]
Treatment
If you have Hodgkin’s disease, your treatment will depend on the results of your diagnostic tests and the form of Hodgkin’s you have. Radiation therapy is often used to treat Hodgkin’s disease at an early stage. Radiation therapy can have a success rate higher than 90 percent for some forms of Hodgkin’s disease in young people. However, many doctors recommend a combination of chemotherapy drugs for most stages of Hodgkin’s disease. Occasionally, both chemotherapy and radiation therapy are recommended.
If the cancer is at an advanced stage when it is detected, combination chemotherapy is given. Combination chemotherapy can cure the majority of cases of Hodgkin’s disease. Radiation therapy is sometimes given after chemotherapy to eliminate specific areas of disease. The entire course of treatment usually takes about 6 months. High-dose chemotherapy and a stem cell transplant (see page 624) are recommended for people whose Hodgkin’s disease returns after treatment or whose disease has not responded completely to other treatments. Once your treatment is completed, you will need to have regular checkups for several years to make sure the cancer has not returned and to watch for any long-term complications of the chemotherapy or radiation therapy, such as heart disease, thyroid disease, lung cancer, or breast cancer.
Disorders of the Bone Marrow
The marrow inside your bones is an active tissue with a rich blood supply. Blood cells inside the bone marrow, called stem cells, make all the different types of blood cells in the body, including red cells (which deliver oxygen to tissues), platelets (which enable blood to clot), and white cells (which fight infection). Blood that flows through the marrow moves the newly produced blood cells into the bloodstream. In adults, active blood-forming marrow is found only in the bones of the trunk. The marrow inside the bones of the arms and legs is fatty and, in adults, is usually inactive, but it can become active and produce new blood cells when necessary. In young children, all the bones have active, blood-forming marrow. Disorders of the bone marrow such as polycythemia and aplastic anemia can affect all types of blood cells, while disorders such as multiple myeloma and agranulocytosis affect only one type of blood cell.
Multiple Myeloma
Multiple myeloma is a cancer that affects plasma cells, a type of white blood cell in blood and bone marrow. Plasma cells produce proteins called antibodies to fight infections. Normally, plasma cells make up only a small percentage of the cells in the marrow but, if a plasma cell undergoes genetic changes that cause it to multiply excessively, the result is a cancer called multiple myeloma. The overproduction of plasma cells inside the marrow disrupts the production of red blood cells (which deliver oxygen to tissues). This disruption in red blood cell production can lead to anemia (see page 610). The antibodies produced by the cancerous plasma cells can accumulate and injure the kidneys. This accumulation of plasma cells usually overtakes the production of normal infection-fighting antibodies by healthy plasma cells. The excess of plasma cells can cause painful destruction of bone.
Multiple myeloma makes up about 10 percent of all blood cancers but, for unknown reasons, appears to be increasing in the United States. The cancer affects mostly people over 50 and is slightly more common in men than in women and is more common in blacks than in people of other races.
Symptoms
The most common symptom of multiple myeloma is pain in your bones,