Hodgkin's the Disease

In Hodgkin's disease, cells in the lymphatic system become abnormal. They divide too rapidly and grow without any order or control. Because lymphatic tissue is present in many parts of the body, Hodgkin's disease can start almost anywhere. Hodgkin's disease may occur in a single lymph node, a group of lymph nodes, or, sometimes, in other parts of the lymphatic system such as the bone marrow and spleen. This type of cancer tends to spread in a fairly orderly way from one group of lymph nodes to the next group.
For example, Hodgkin's disease that arises in the lymph nodes in the neck spreads first to the nodes above the collarbones, and then to the lymph nodes under the arms and within the chest. Eventually, it can spread to almost any other part of the body.

Understanding Hodgkin's Disease

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. To understand Hodgkin's disease, it is helpful to know about normal cells and what happens when they become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy.
Sometimes cells keep dividing when new cells are not needed, creating a mass of extra tissue. This mass is called a growth or tumor. Tumors can be either benign (not cancerous) or malignant (cancerous).

What is Hodgkin's disease?

Hodgkin's disease is one of a group of cancers called lymphomas. Lymphoma is a general term for cancers that develop in the lymphatic system. Hodgkin's disease, an uncommon lymphoma, accounts for less than 1 percent of all cases of cancer in this country. Other cancers of the lymphatic system are called non-Hodgkin's lymphomas.
The lymphatic system is part of the body's immune system. It helps the body fight disease and infection. The lymphatic system includes a network of thin lymphatic vessels that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are small organs called lymph nodes. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen.
Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue is also found in other parts of the body, including the stomach, intestines, and skin.

What Affects the Biopsy Test

You may not be able to have the test if you:

• Have bleeding problems or are taking blood thinners such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
• Can't be still during the procedure.

Sometimes not enough bone marrow fluid is collected in a bone marrow aspiration. This is called a dry tap. If this happens, a biopsy to obtain bone marrow tissue is usually done
     

• If you have an infection, a culture and sensitivity test of the bone marrow sample can be done. If the infection is caused by a bacteria or fungus, the sensitivity test will show which antibiotics will work best to treat the infection.
• Normal bone marrow in one site does not mean that all sites in the body are normal.

  

The Results of the Biopsy

A bone marrow aspiration and biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow). It is often done to find the reason for many blood disorders and may be used to find out if cancer or infection has spread to the bone marrow.

Biopsy results are usually ready in 1 to 7 days. But it may take several weeks to get the results if genetic tests are done on the sample. The bone is put into a solution that breaks down its calcium before it is stained. The bone marrow sample is often treated with special dyes (stains) to see any changes in the blood cells more clearly.

Bone marrow biopsy and aspiration

Normal:	The marrow has normal amounts of fat, connective tissue, and iron. Normal numbers of both mature and immature (growing) bone marrow cells are present.
	No signs of infection are seen.
	No cancer cells, such as leukemia, lymphoma, or multiple myeloma, are seen.
	No cancer cells have spread from other cancer sites, such as breast cancer.
Abnormal:	The cells in the bone marrow do not look normal.
	There are too many or too few bone marrow cells. The bone tissue does not look normal.
	Too much iron or too little iron (iron deficiency anemia) is seen in the bone marrow.
	Signs of infection are seen in the bone marrow.
	Cancer cells, such as leukemia, lymphoma, or multiple myeloma, are seen.
	The bone marrow has been replaced by scar tissue.

After the Biopsy

You will lie down for 30 to 60 minutes after the biopsy so the site can be checked for bleeding. If you had a sedative, you will need someone to drive you home after the biopsy.

You may feel sore at the biopsy site for several days. Ice packs to the site, walking, and pain medicine, such as acetaminophen (Tylenol), can be used to help you feel better.

Call your doctor immediately if you have:

• More tenderness, pain, redness, or swelling at the biopsy site.
• A fever.
• Bleeding or drainage, such as pus, from the biopsy site. If you are bleeding, put pressure on the site and call your doctor.

Risks involved with the Biopsy

Serious problems from a bone marrow aspiration or biopsy are not common. Problems may include:

• Bleeding from the biopsy site. People with bleeding problems have a higher chance for this. If you have bleeding problems, pressure will be put on the biopsy site for at least 10 minutes after the biopsy. In rare cases, you may be given a blood product (clotting factor or platelets) in a vein in your arm before the biopsy to prevent bleeding after the biopsy.
• Infection of skin or the bone (osteomyelitis) at the biopsy site.
• Injury to your heart, a lung, or a major blood vessel if the sample is taken from the breastbone (sternum). This complication is very rare. Samples are not often taken from the breastbone, so most people do not have to worry about this risk.