Physicians classify this malignancy by a claimed 1,500 system of four "stages" (I-IV). Stage I represents early, localized disease; stage IV defines advanced, widely disseminated cancer involving many organs of the body. Stages II and III include more intermediate forms. Physicians further categorize Hodgkin’s disease by the letters "A" and "B." The designation "A" refers to patients without symptoms. The letter "B" identifies patients with symptoms such as fevers, chills, night sweats, and fatigue. Hodgkin’s, if untreated, is often rapidly fatal. "A single series of untreated patients reported by Croft in 1941," writes Devita, head of the National Cancer Institute, "leads us to believe that the course of patients with Hodgkin’s disease, if left untreated, regardless of the stage, is brief, measured in 1 to 2 years. In that series, the median survival was less than 1 year and most patients were dead by year 2, with fewer than 5% alive after 5 years." At present, the "MOPP" chemotherapy regimen is the most widely recommended treatment for Hodgkin’s. This protocol employs four drugs — nitrogen mustard, Oncovin (vincristine), procarbazine and prednisone — given once every twenty-eight days for at least six months. As Devita explains, "Unless chemotherapy is contraindicated for medical reasons, all patients treated with MOPP and other combinations should be given a minimum of six cycles (a dose) or as many cycles as needed to achieve a complete remission, plus additional cycles to consolidate the remission."(1) With protocols such as this, at least 50% of all patients will survive five years.

Michael Moreland

Mr. Michael Moreland is a 37-year old man from Washington State alive nine years since diagnosed with Hodgkin’s disease. In late 1977, Mr. Moreland developed mild fatigue and a tender swelling in his neck that rapidly increased in size. In January of 1978 he consulted his family physician, who suspected a low-grade infection and prescribed a course of Penicillin therapy. With treatment, the swelling did decrease slightly over a period of a week, but then worsened. In addition, Mr. Moreland began experiencing drenching night sweats as well as sharp pain in the upper part of his chest. Several weeks later, Mr. Moreland returned to his physician. A chest X-ray revealed a large upper mediastinal mass, and laboratory studies were significant for an elevated white blood count of 21,000 (upper limit of normal 10,000). Because of these findings, on February 6, 1978 Mr. Moreland entered Vancouver Memorial Hospital in Vancouver, Washington. On admission, Mr. Moreland was noted to have extensive lymphadenopathy in the cervical area, described in the records as: "A very large mass present in the left side of the neck with some surrounding smaller masses also present. There are some more discrete masses on the right side as well, measuring up to 3 to 4 centimeters in diameter. There is a bilateral auxiliary adenopathy present." The following day, Mr. Moreland went to surgery. Subsequent evaluation of the tissue specimen confirmed an aggressive form of Hodgkin’s disease, well-described in the official pathology report: "There is no question that nodules are being formed in this lymph node but in many areas the picture is more than a mixed cellularity type and there are remarkably large collections composed mainly of malignant reticulohitiocytic cells with lymphocyte depletion." With a diagnosis of Hodgkin’s confirmed Mr. Moreland was readmitted to Vancouver Memorial on February 13 for additional tests. A chest X-ray showed: "Mediastinal adenopathy which is a little more pronounced on the right. There is evidence of bilateral cervical nodes." A lymphangiogram, a dye study of the abdominal lymph node system, demonstrated extensive disease, as summarized in the records: "Abnormal lymphangiogram due to enlarged nodes caused by Hodgkin’s disease at L2, L3 and probably along the right iliac chain."