February 26, 2013 PRINT Bookmark and Share

What is Hodgkin Lymphoma?

Goulakos' Prospects Strong in Cancer Fight

by Avash Kalra/Senior Writer

In January, Colgate sophomore Spiro Goulakos, who turned 23 last week, was diagnosed with Hodgkin lymphoma, leaving the team to undergo chemotherapy in his hometown of Montreal. But in what has been the most inspirational story in college hockey this year, Goulakos returned for his first home game last weekend, scoring the game-winner in the Raiders’ contest against defending ECAC champion Union at Starr Rink.

“Spiro is a huge part of this team both on and off the ice,” coach Don Vaughan had told the Colgate Maroon News prior to Goulakos’s return. “His absence on the ice was felt immediately since he played in all situations – power plays, penalty kills, late game minutes, etc. – but his presence away from the rink will also be missed since he is a developing leader on this team.”

This is not the first time that hockey fans have encountered the diagnosis of Hodgkin lymphoma. Famously, just over 20 years ago, in January 1993, Pittsburgh Penguin great and coincidentally another Montreal native, Mario Lemieux – at age 28 – announced to the hockey community and the world that he had been diagnosed with Hodgkin lymphoma.

Like Goulakos, Lemieux too enjoyed an inspirational on-ice comeback; his dramatic return after two months of treatment memorably led the Penguins to an NHL record 17 consecutive wins and 119 regular season points, still a franchise record.

Two inspirational comebacks from the same diagnosis. So what is Hodgkin lymphoma? And why – and how – do young, otherwise healthy people get diagnosed with it?

Hodgkin lymphoma – formerly called Hodgkin’s disease – is a type of cancer caused by an abnormal growth of lymphocytes, a type of white blood cell that usually compromises about 30 percent of the white blood cells in our bodies. Even more specifically, the abnormal lymphocytes in Hodgkin lymphoma are our B lymphocytes, the type that form antibodies to recognize – and therefore fight – the antigens presented to them by viruses and bacteria. The malignant cells are called Reed-Sternberg cells, one of many pieces of trivia that tends to appear on exams in medical school.

Diagnosed usually by a lymph node biopsy, Hodgkin lymphoma accounts for about 10 percent of all lymphomas and about 0.6 percent – or 1 in 165 – of all cancers diagnosed in the world annually, amounting to 9060 cases and about 1190 deaths due to Hodgkin lymphoma in the United States each year.

Classically, Hodgkin lymphoma presents with a “bi-modal” distribution, meaning there are two peaks in age that appear to develop the diagnosis. There is one peak in young adults like Goulakos and Lemieux – at approximately 20 years of age – and another one in older adults, at approximately 65 years of age.

Much of the medical literature examining risk factors for Hodgkin lymphoma varies from describing complex genetic factors – there is a component of family history – to implicating, as described in a 1989 research article in the New England Journal of Medicine, prior exposure to the Epstein-Barr Virus, the same virus that causes, among other things, mononucleosis, or “mono.”

Hodgkin lymphoma can present symptomatically with systemic symptoms called “B symptoms” – fever, night sweats, weight loss – but in fact the vast majority present with a non-tender and otherwise asymptomatic enlarged lymph node in the neck. The malignancy then spreads to adjacent lymph nodes; this spread determines the “stage” of the cancer and therefore the treatment, which in most cases consists of chemotherapy and radiation. Current data suggest that Hodgkin lymphoma is curable in about 75 percent of cases. Advanced stage disease is present if there is cancer in lymph nodes on both sides of the diaphragm, the muscle at the bottom of the rib cage that helps us breathe.

Now that anyone reading this is sufficiently frightened at the prospect of potentially developing a cancer that tends to present fairly silently, it is important to cite the data from the National Cancer Institute, which reports that only 1 in 436 men and women will be diagnosed with Hodgkin lymphoma in their lifetime – a figure that is drastically lower than the rates for cancers of, for instance, the breast, lung, and colon – incidentally, in that order, the three most common types of cancer in women that can potentially be prevented by age-appropriate screening (for breast and colon cancer) and with not smoking (for many cancers, especially lung).

In Goulakos’s case, his diagnosis – according to reports — resulted from a routine blood test showing an abnormal number of white blood cells, cluing his doctors in to the possibility of an underlying lymphoma.

Goulakos’s return has understandably provided inspiration to many, especially in the Colgate community, where the Raiders will push this week to clinch the final home playoff spot in the ECAC – but that’s a storyline that, as Goulakos continues his off-ice fight against cancer, has proved decidedly trivial by comparison.

Avash Kalra is an Internal Medicine resident physician at the University of Colorado.

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