Hodgkins disease, lymphoma and Jacqueline Kennedy

Dr. Donohue webcomments@ngnews.ca
Published on December 27, 2007

DEAR DR. DONOHUE: Our family would like to know the difference between Hodgkin's disease and non-Hodgkin's lymphoma. Which did Jackie Kennedy have, why wasn't her condition diagnosed in time, and why wasn't it put into remission? How do we prevent these cancers?
ANSWER: Lymphomas - Hodgkin's disease is a lymphoma - are cancers of the lymph nodes and lymph-node-like tissues. They are divided into two main categories: Hodgkin's lymphoma and non-Hodgkin's lymphoma. The two categories have common symptoms, but they each have unique differences in the course of the illness, its outlook and its treatment.
Around 100 years ago, microscopic study of lymph-node cancers showed that some of these cancers had a very special kind of cell in them, the Reed-Sternberg cell. Doctors recognized that lymphomas that had this cell behaved differently from other lymphomas, and those cancers were designated as Hodgkin's lymphomas.
Non-Hodgkin's lymphoma strikes about 55,000 people yearly in the United States. It usually occurs around age 50. These cancers are subdivided into a number of varieties, each with its own slightly different characteristics. Common to all is lymph-node enlargement, especially nodes in the neck, under the arms and in the groin. Fever, night sweats, weight loss and fatigue are other common signs and symptoms.
Organs other than lymph nodes frequently are involved - brain, lungs, stomach and even skin. Non-Hodgkin's lymphoma is treated with radiation alone or in combination with chemotherapy.
In North America, Hodgkin's lymphoma happens to about 20,000 people each year. It appears in two peaks - one between the ages of 15 and 34, the other after age 50. Lymph-node enlargement is its salient feature too, and about a quarter of patients experience weight loss, night sweats and fever. Itching can be a major feature. Viruses may be involved in its genesis. It is treated with chemotherapy and sometimes radiation.
The outlook for both kinds of lymphoma often is good, and cure can be spoken of for both.
Jacqueline Kennedy suffered from non-Hodgkin's lymphoma. She was the exception to the rule. Her lymphoma was very aggressive and progressed rapidly, despite treatment. That happens in both forms to a few people. Specific prevention measures are not known.

DEAR DR. DONOHUE: I am 70. For several years I have had a problem that I need some help with. I have severe pain on my third and fourth toes on my right foot. The doctor says it's a Morton's neuroma. What is it, and what can be done for it?
ANSWER: A Morton's neuroma is a growth of scar tissue around a nerve that serves adjacent toes, usually the nerve between the third and fourth toes. People with one say it feels like they step on a stone when they walk, and they often complain of more or less constant burning pain in that area. Padding can alleviate the pain. So can an injection of a cortisone drug in the general area. If conservative measures fail, then a doctor can surgically remove the scar tissue.

DEAR DR. DONOHUE: I have been told by my doctor that I am anemic. He sent me to a hematology doctor, who has put me on Niferex. I am not familiar with that medicine and, apparently, neither was the druggist, because there was no information sheet included with it. Is it better than regular iron?
ANSWER: The hematology (blood) doctor has determined that you have an iron-deficiency anemia. Niferex is iron attached to polysaccharides - sugarlike substances. It is said to be easier on the stomach than the more commonly prescribed iron, and it is well-absorbed.
Now a bigger job faces your doctor. He or she has to find out why you're deficient in iron. One thing must be determined above all else: Are you losing iron because you're losing blood? Blood is the body's iron storage bin, and hidden blood loss is a common cause of iron deficiency.