Hodgkin’s lymphoma

Hodgkin’s lymphoma is also known as Hodgkin’s disease and originates in the white blood cells of the lymphatic system, from which it spreads to other groups of lymph nodes.

This disease can occur in people between 15 and 35 years of age or older than 55 years.
This rare type of lymphoma affects men more often than women.

Lymphoma is not a benign tumor.


Types of Hodgkin’s lymphoma

Classical Hodgkin’s lymphoma (cHL) is diagnosed when abnormal lymphocytes, also known as Sternberg-Reed cells, are found.
The cHL can be divided into 4 different subtypes:

1. Nodular sclerosing type: This is the most common form, affecting up to 80% of people diagnosed with cHL. It occurs mainly in adult females. In addition to the Sternberg-Reed cells, there are also connective tissue bands in the lymph nodes. This type of lymphoma often includes the reactive lymph nodes of the mediastinum (breast).

2. Lymphocyte-rich type: About 6% of people with cHL have this subtype.
It occurs more frequently in men and involves various areas of the mediastinum. In addition to the Sternberg-Reed cells, the tissue contains many normal lymphocytes.

3. Mixed type: This subtype of lymphoma occurs in the elderly and most often in the abdominal area. It has different cell types, including a large number of Sternberg-Reed cells.

4. Lymphocyte-poor type: this is the least common subtype in cHL (present in about 1% of cases).
It mainly affects the elderly, people with human immunodeficiency virus (HIV, the virus that causes autoimmune deficiency syndrome or AIDS) and people in non-industrialized countries.
The lymph nodes contain Sternberg-Reed cells.

There is another type of Hodgkin’s lymphoma that does not belong to the group of cHL. At the genetic and protein level, it is similar to non-Hodgkin’s B-cell lymphoma, the lymphocyte predominant Hodgkin’s lymphoma: about 5% of people with Hodgkin’s lymphoma have this tumorous form, which is often found in the lymph nodes of the neck or groin.
It is increasingly found in adolescents. People with this type of lymphoma have Sternberg-Reed cells, but also a marker, called CD20, on the surface of the tumor cells.
CD20 is a protein commonly found in people diagnosed with non-Hodgkin’s B-cell lymphoma.

Difference between leukemia and lymphoma:

  1. In leukemia, the tumor cells originate in the bone marrow and then spread through the bloodstream; this cancer affects white and red blood cells.
  2. In lymphoma, the tumor is limited to the lymphatic system, i.e. found in lymph nodes, bone marrow, spleen and rarely in other organs. Here, a mass of tumor cells is formed, while leukemia does not form a cell mass. Lymphoma affects only the B and T lymphocytes.

Causes of Hodgkin’s lymphoma

Doctors are unable to determine the exact cause of lymphoma.
However, the factors that can increase the likelihood of lymphoma are known:

  • Infections;
  • Age: older people are more likely to be affected by lymphoma;
  • contact with harmful chemicals such as herbicides or pesticides;
  • autoimmune diseases that lead to the weakening of the immune system;
  • familial predisposition to lymphoma.

Symptoms of Hodgkin’s lymphoma

Pain: Although the enlarged lymph nodes are painless, the surrounding tissues are unable to tolerate the increased pressure exerted by the abnormally large lymph glands.
This can cause moderate to severe pain.
For example, lymphoma that affects the stomach can cause abdominal pain. If the tumor mass develops in the thymus, a lymph gland located in front of the heart, this can lead to chest pain.

Night sweats
The body sweats to regulate temperature.

Fatigue and weight loss: Extreme fatigue and severe unwanted weight loss characterize Hodgkin’s and non-Hodgkin’s lymphoma. This happens because most of the energy provided by the body is consumed by the cancer cells. The proliferation of these cells makes it difficult to meet the body’s growing energy needs.

Itching: About 34% of patients diagnosed with Hodgkin’s lymphoma experience itching, usually of the hands, feet and calves.

Difficulty breathing: In most cases, there is swelling of the lymph nodes in the thoracic area.
This leads to shortness of breath and coughing because the hard and swollen cell masses around the lung tissue exert strong pressure.
As a result, the lungs cannot develop normally and the breathing process is disturbed.

Predisposition to infections
The tumor hits the immune system, the efficiency of the body’s protective mechanism for fighting infections is increasingly decreasing. As a result, the immune system needs more time to clear the infection.

Diagnosis of Hodgkin’s lymphoma

Some tests and examinations can diagnose lymphoma.
The doctor physically examines the patient and looks for lymph node swelling on the neck, armpits and groin.
A blood analysis with a large blood count is carried out to obtain a hematological picture to determine the values of the white blood cells.
In advanced lymphoma, the erythrocyte sedimentation reaction (BKS) may be increased.
A chest X-ray is helpful for detecting signs of this condition.
An effective examination for the diagnosis of lymphoma is the biopsy.
This consists of taking part or all of the lymph node and sending the sample to the pathologist, who can microscopically detect the presence of tumor cells.

Determination of stages of Hodgkin’s lymphoma

There are 4 stages of lymphoma, depending on the severity and progress of the tumor. At the first stage, neoplasia is localized in part of the lymph nodes. It can also develop in organs other than the lymphatic system.

In the second stage, lymphoma slowly progresses to other groups of lymph nodes on the same side of the diaphragm under the lungs.
In the third phase, the tumor cells multiply and spread to other organs on both sides of the diaphragm.
The disease can also spread to the spleen.
In the fourth and final stage, the aggressive cancer affects the bone marrow and liver, altering their normal functioning. In this phase, lymphoma also spreads to all other organs of the body and forms metastases, especially to bones, liver and lungs.

Treatment options for Hodgkin’s lymphoma

There are several treatment options for Hodgkin’s lymphoma.
The disease can be treated depending on the type, stage and histology.
There are four treatment options: radiation therapy, chemotherapy and targeted cancer therapy.

Radiation therapy (radiotherapy) consists of using high-energy X-rays to kill the tumor cells. Usually, this treatment is postponed in pregnant women because radiation therapy can harm the unborn child.

Chemotherapy is another treatment option that uses drugs to prevent the cancer cells from growing.

Targeted cancer therapy consists in the use of drugs to identify, attack and destroy only the cancer cells without harming other body cells.

Lymphoma survival rate and prognosis

There are 5 factors that influence the prognosis of lymphoma.
These include:

  1. age of the patient (over or under 60 years);
  2. stage of lymphoma (for the third and fourth stages, the prognosis is poor);
  3. location of the lymphoma (whether organs or lymph nodes are affected);
  4. the person’s ability to perform normal everyday activities;
  5. Lactate dehydrogenase (LDH) in the blood (this level increases depending on the spread of lymphoma in the body).

For each negative prognostic point (such as age over 60 years) one point is awarded. The risk factors are determined by the prognostic points.
With 1 negative prognostic factor, the risk is low, while 4 or 5 of these factors increase the risk of lymphoma.
The availability of the latest drug rituximab (Rituxan/MabThera) allows for a revision of the IPI (International Prognostic Index), which uses the same factors but divides patients into only three groups:

  • low risk (no prognostic negative factor);
  • medium risk (there are 1 or 2 prognostically negative factors);
  • high risk (there are more than 3 prognostically negative factors).

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