Hodgkin’s lymphoma and non-Hodgkin’s lymphoma: differences
Although both conditions are lymphomas – a type of cancer that begins in lymphocytes – there is a difference between non-Hodgkin’s lymphomas and those that receive this name.
It is the presence of a specific type of cell, called the Reed-Sternberg cell. These cells have more than one nucleus and originate from the excessive multiplication of leukocytes.
Although this may seem little, this difference is crucial for indicating the correct treatment and for a better understanding of the perspective of curing the problem.
Causes
The cause of Hodgkin’s lymphoma is not known. However, it is understood how it happens:
Most Hodgkin’s lymphomas occur when a cell that fights infections, called a B lymphocyte (or B cell), develops a mutation in its DNA.
Such a mutation causes these cells to multiply, while healthy cells continue to function, instead of dying and making room for new cells.
Thus, a large number of B lymphocytes of increased size and abnormal functioning appear, which accumulate in the lymphatic system and can spread to the rest of the body from there.
Types
There are two main types of Hodgkin’s lymphoma, classified according to the types and behavior of the cells involved in the disease. Such cells can be:
- Lymphocytes: Main defenses against infections, these cells stimulate the production of antibodies against microorganisms such as bacteria, viruses, etc .;
- Reed-Sternberg cells : These are cells with more than one nucleus, often looking like owl eyes on a spot, or pennies on a plate. They are an exclusive feature of Hodgkin’s lymphoma;
- Plasmocytes: These are large B cells that have been exposed to an antigen (microorganism or foreign body) and secrete large amounts of antibodies;
- Granulocytes: These are cells of the white blood cell type, which act against allergens and microorganisms, with the objective of destroying these foreign bodies through their absorption.
Classical Hodgkin’s lymphoma
This type of lymphoma represents 95% of the cases of the disease, and it can still be divided into 4 subtypes:
Nodular sclerosis
Characterized by the presence of lymphocyte nodules separated by collagen-rich connective tissue, in addition to little Reed-Sternberg cells. However, there are several similar abnormal cells. There may be increased necrosis and fibrosis.
It is the most common type, responsible for about 60 to 80% of cases. Its occurrence occurs, mainly, in young people, having the same incidence in both sexes.
Mixed cellularity
It is the second most common type (in 15 to 30% of cases), generally seen in older adults.
There is no type of cell more common in this type, being very “balanced”. The presence of Reed-Sternberg cells is abundant, with a small or moderate fibrosis, in addition to being able to find necrosis.
In this subtype, however, plasma cells are found more frequently than in others.
Lymphocyte predominance
This type is characterized by the abundance of lymphocytes, and there are few granulocytes and plasmocytes. Reed-Sternberg cells are rare and the possibility of necrosis is scarce. It occurs in 5% of cases and is more common in the upper body, rarely affecting more than some lymph nodes.
Lymphocyte depletion
Mostly seen in the elderly, only 1% of cases of Hodgkin’s lymphoma are lymphocyte depletion. In these cases, leukopenia (lack of leukocytes) is accentuated with the possibility of a large number of Reed-Sternberg cells with multiple nuclei.
Hodgkin’s lymphoma predominantly Nodular Lymphocyte
It corresponds to about 5% of cases of Hodgkin’s lymphoma, and can appear at any age. It is more common in men.
It usually involves the lymph nodes of the neck and armpits, being characterized by the formation of large cells with a similar appearance to popcorn. These cells are variations of the Reed-Sternberg cells.
Risk factors
Risk factors are conditions that increase a person’s chances of developing a particular disease. In the case of Hodgkin’s lymphoma, some of these factors are:
Age
Hodgkin’s lymphoma is more common in people between 15 and 30 years old. In addition, some types of the disease are also more common in people over 55.
Family history of lymphoma
Although it is not a genetic condition, having a family history of lymphoma (both Hodgkin’s and non-Hodgkin’s) increases the chances of developing the disease.
Sex
Men are more often affected than women.
History of Epstein-Barr virus infection
It is not known why, but people who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis , are more susceptible to the development of Hodgkin’s lymphoma.
Symptoms
Symptoms of Hodgkin’s lymphoma can be a problem, because they closely resemble symptoms of other diseases. The enlargement of the lymph nodes, for example, is a very common symptom of infections, which can lead the carrier of the disease to think that it is a bacterial infection, for example.
However, the absence of other symptoms of infection may be the clue for the patient to realize that something is wrong. Some of the most common symptoms in Hodgkin’s lymphoma are:
- Non-painful enlargement of the lymph nodes in the neck, armpits and groin;
- Persistent fatigue;
- Fever and chills;
- Excessive sweating during the night – the individual may need to change pajamas or bedding;
- Rapid and unexplained weight loss;
- Itch;
- Greater sensitivity to the effects of alcohol or pain in the lymph nodes after consuming alcohol.
How is Hodgkin’s lymphoma diagnosed?
The diagnosis of Hodgkin’s lymphoma can be complicated, since the initial symptoms are common to several diseases, such as infections. However, there is no reason to worry: the diagnostic methods used today are quite accurate and it is possible to identify the disease in the early stages, improving the chances of a good prognosis.
Some tests that the doctor may order are:
Physical exam
On physical examination, the doctor will look for signs such as swollen lymph nodes in the neck, armpits and groin. However, this does not say much, as this is a common symptom of several problems, such as severe infections.
Bloodtests
A blood count is able to find signs of lymphoma, although not specifically. This is because the cells do not appear directly in the blood. However, some signs that may indicate the presence of a tumor are anemia and a high white blood cell count.
Biopsy
A mandatory exam for the diagnosis of Hodgkin’s lymphoma is a biopsy. This is because it is the only one capable of showing the Reed-Sternberg cells, characteristic of the tumor.
This type of examination removes a portion of the tissue to be examined, which is sent for analysis. In the case of lymphomas, the sample must be taken from the affected lymph nodes.
At another time, the doctor may order a bone marrow biopsy. This time, it is not a diagnostic test, but a test to verify the extent of the tumor throughout the body.
Imaging exams
They are also needed to determine the extent of the tumor. X-rays of the chest indicate whether there is involvement of the ganglia and organs found there, while computed tomography produces detailed images from various angles and part of the body, allowing a more complete analysis.
Magnetic resonance imaging can be used to create images of organs and soft tissues using magnetic waves and radio. A final imaging exam is gallium scintigraphy, a radioactive substance that, when injected into the patient’s body, is attracted precisely by the sites affected by cancer.
An erythrocyte sedimentation speed test, on the other hand, can reveal whether there is inflammation somewhere, even if it is non-specific.
Other exams
In order to understand the nature of cancer cells, the doctor may order some more specific tests, such as:
Cytogenetics studies: This test can identify chromosomal changes in cells;
Immunohistochemistry: Uses antibodies to separate and distinguish different types of cancer cells;
Molecular genetics studies: It consists of DNA and RNA tests to determine if there are specific genetic traits of cancer cells.
Stages of Hodgkin’s lymphoma
The stage of the disease depends on how much the lymphoma has spread, being extremely important for the choice of treatment. Diagnostic techniques help to find the stage in which the cancer is, which can be:
Check below the chances of cure (that is, patients without relapse within 5 years) of each stage of the disease:
- Stage I (limited to just one region of lymph nodes): more than 80%;
- Stage II (two or more regions on the same side of the diaphragm, above or below – may affect any organ in the region: more than 80%;
- Stage III (involves lymph nodes above and below the diaphragm, with the possibility of extension to the spleen): between 70 to 80%;
- Stage IV (the tumor reached other organs): more than 50%.
In this context, the doctor can also use the letters A and B to indicate whether the patient has significant symptoms of the disease:
- A: There are no significant symptoms;
- B: There are symptoms like high fever, chills, excessive sweating at night and sudden weight loss.
Thus, a patient whose cancer extends from the neck to the groin lymph nodes, with symptoms will have its lymphoma classified as IIIB . Already an asymptomatic patient with only the armpit lymph nodes affected and neck will be classified as II .
Is Hodgkin’s lymphoma curable?
As seen above, Hodgkin’s lymphoma has great possibilities for cure , depending on its extent. However, it is not uncommon for cases in which the patient does not respond to treatment or where the disease returns after a few years.
Hodgkin’s lymphoma kills?
Like any type of cancer, Hodgkin’s lymphoma kills . This can happen both because of the involvement of other vital organs – which start to produce excess cells too – and by the compromise of the immune system, formed mainly by the lymphatic system.
Treatment
Once the diagnosis is confirmed, there are several treatment options for lymphoma. In general, doctors’ first attempt is a combination of chemo and radiation therapy, the most commonly used in any type of cancer. Better understand the treatment options currently available:
Chemotherapy
One of the best known treatments for any type of cancer is chemotherapy. This method consists of using chemical substances to eliminate the mutated cells.
This treatment can be done both orally and intravenously, and sometimes both routes are used. It all depends a lot on the drugs indicated. Currently, there are several protocols to be followed. These protocols are combinations of drugs that have been shown to be effective in the treatment of Hodgkin’s lymphoma.
Not infrequently, chemotherapy treatment is done in conjunction with radiotherapy. Its main adverse effects are hair loss and nausea. In the long run, these drugs can result in damage to the heart, lungs, fertility problems and even other cancers, such as leukemia .
Radiotherapy
Radiotherapy uses radiation beams (X-rays or protons) to eliminate defective cells. It can be done either with chemotherapy or alone, depending on the type and stage of the lymphoma.
During radiation therapy, the patient is lying on a stretcher while a large machine moves around him. This machine is programmed to direct the radioactive beams at specific points. In the case of Hodgkin’s lymphoma, the targets are the lymph nodes affected by the tumor.
The main side effects of radiotherapy are hair loss and redness of the skin affected by the rays. Fatigue can also be common in some patients. Finally, in the long run, this type of treatment can bring problems such as cardiovascular disease, stroke, thyroid problems, infertility and other types of cancer, such as lung cancer and breast cancer , 10 years or more after treatment.
Bone marrow transplant
This option is considered when the patient does not respond to any of the treatments mentioned above. In bone marrow transplantation, the patient’s own stem cells are removed and frozen for later use.
Then, the patient receives high doses of chemo and radiation to exterminate all cancer cells in the body. Then, the stem cells are recovered and injected back into the patient.
These stem cells help to rebuild bone marrow healthily.
Target therapies
The target therapies are the use of new drugs that are able to directly attack cancer cells. These drugs were developed by extracting the mutated cell’s genetic code. In this way, it is possible to create a substance capable of attacking this particular mutation, preserving healthy cells and reducing side effects.
Complications
Tumor spread
The biggest complication of Hodgkin’s lymphoma is the involvement of other organs, especially through the lymphatic vessels. Because they are spread throughout the body, the tumor can reach anywhere, without necessarily affecting the organs and tissues along the way.
This can be dangerous because it can affect vital organs, such as the lungs, liver, among others.
Immune system impairment
While the tumor itself attacks the immune system, most of the available therapies also promote this effect, causing the destruction of white blood cells and leaving the body more defenseless against infections.
Living together
Being diagnosed with cancer is not pleasant, but there is no reason to lose hope: with the right treatment, Hodgkin’s lymphoma can be cured! In the meantime, here are some tips for getting along better with the new routine:
Learn about the tumor
Knowledge is the key to everything! Understanding your illness in depth and being aware of the news about new treatments and discoveries can help a lot in your treatment process. In addition, knowing what you are dealing with will make you feel more relaxed about the choices you have to make regarding treatment.
Seek support
Having people who support you by your side, fighting together with you, is certainly an important factor for the recovery to take place more smoothly. Always have people at your side who can help you with feelings of pain and anxiety about your future.
Often, friends and family are not enough to deal with all of these problems. In such cases, it is necessary to seek professional help. Consult a psychologist or psychiatrist and keep your mind healthy in order to cope better with adversity.
Deal with stress
Adapting to the new routine can be quite stressful. Therefore, some alternatives to better deal with your feelings at this time are:
- Art therapy;
- Music therapy;
- Physical exercises;
- Relaxation exercises;
- Meditation;
- Yoga;
- Taking care of spirituality, if the patient has faith.
Have goals
As much as things seem to be over, you are still able to do a lot for the world and for you! Therefore, continue to have goals: to graduate from university, to work in that area that you like so much, among others.
However, be realistic: with the new routine, you may not be able to work full time, for example. Therefore, look for alternatives such as working part time.
Take time for yourself
Time alone, taking care of your own things, is extremely necessary and healthy for anyone. The lack of such moments can easily culminate in a mood disorder, such as depression . So, when you need to, stop charging yourself and take the time to do what you want, even if only to watch that funny series that you like so much.
Stay active
Be sure to do the things you like because of a diagnosis. Especially because, as long as you are fit, this is the best thing you can do for yourself. If you like to play football, keep going! There is no reason to stop if you feel good enough to play.
This measure helps both in recovery by helping to take care of the body and also in mental health , preventing you from losing interest in the things you love because of a disease that is being fought.
Prognosis
After the first month of treatment, the patient can already notice some improvements: he has greater facility to gain weight, has more energy and his lymph nodes are reduced in size.
The chances of a cure for Hodgkin’s lymphoma are high, as has already been explained. However, the recurrence can happen in the next 5 years after the remission of the tumor. In these cases, the chance of a permanent cure drops to 50%. It is considered cured when the patient no longer presents the tumor for 5 years after treatment.
Prevention
Nowadays, there are still no known ways to prevent Hodgkin’s lymphoma. However, it is believed that having healthy habits, such as maintaining a balanced diet and exercising, decrease the chances of developing any type of cancer and other chronic diseases that can affect the individual.
Although we hear a lot about lymphomas, not everyone understands what they are and what their main symptoms are. So, share this text with your family and friends. Who knows, you will be helping someone to better understand the condition and seek help in identifying the symptoms!
