The term “lymphoma” describes a variety of cancer diseases originating in lymph nodes or their elements, and also from extranodal lymphoid tissue. Two main groups had been defined, on order to classify lymphomas: non-Hodgkin’s lymphoma (genetic modification in one lymphocyte, a DNA mutation) and Hodgkin’s lymphoma (Hodgkin’s disease).
What is Hodgkin's lymphoma?
Hodgkin’s lymphoma (synonyms – Hodgkin’s disease, lymphogranulomatosis) – a malignant disease, affecting the lymphatic system. The disease is named after the physician who described it for the first time – Thomas Hodgkin. It is, in fact, malignant transformation of B-lymphocytes. Wherever there is lymph tissue the disease can manifest itself. Most often it occures in the lymph nodes, but the secondary lesions can also affect the liver, lungs, bone marrow or spleen.
Types of Hodgkin's Lymphoma
Depending on the type of tumor cells, five forms of the disease can be identified:
- Lymphocytes rich form;
- Lymphocytes depleted;
- Nodular type (nodular sclerosis);
- Mixed-cell type;
Causes of Hodgkin’s disease are not known. Studies have shown some connection to the Epstein-Barr virus. The latter causes atypical growth of lymphoid tissue cells. But in most cases of Hodgkin’s disease this virus is not present, so the certain cause of lymphoma growth remains uncertain.
Symptoms of the disease
The manifestation of symptoms depends on where in the lymphatic system the disease develops. Early stage of the disease is characterized by mild and non-specific manifestations, but with the progression of severity of the symptoms:
- Body temperature above 38 °C (100.4°F);
- Excessive sweating at night;
- Weight loss for no apparent reason;
- Itching all over the body;
- Noticable swollen lymph nodes on the skin surface;
- Cough, turning into a chronic condition, shortness of breath (thoracic lesion, and/or lesions in lungs and pleura);
- Pale skin (bone marrow lesion);
- Pain in the joints, bones (loss of bone tissue).
Typical symptoms of Hodgkin’s lymphoma: a slow increase in size of lymph nodes (one or more) with absence of pain, usually localized to the neck, back of the head, armpits, groin, near the collarbone or in parallel in several locations in the body. Most often the disease manifestation begins with the increase of mediastinal lymph nodes. Enlarged lymph nodes in the chest are start to apply pressure on the lungs and trachea, thus cause shortness of breath and dry cough incidents (compression of the superior vena cava syndrome). If it affects peritoneal lymph nodes – then patients experience a feeling of heaviness, pain, stool problems. With the penetration of lymphoma cells into the bone marrow marked a decrease in erythrocytes and plateletscan be noticed.
Diagnosis of the disease
If lymphoma is suspected, doctors order a series of tests – both laboratory and instrumental (imaging etc.) examinations:
- Complete blood count with leukocyte formula;
- X-rays of the chest cavity;
- Ultrasonography of the abdomen;
- Computed tomography (PET-CT, MRI);
- The gold standard for Hodgkin’s disease diagnosis is a histological study of lymph node, obtained during a biopsy. If Berezovsky-Stemberg cells are found in the extracted tissue, then the diagnosis is confirmed.
- Diagnostic laparotomy, biopsy or trepanobiopsy are performed to investigate lesions in the liver, spleen and bone marrow.
After carefully studying the results of the diagnostics, the doctor determines the stage of disease and risk factors, and afterwards assigns the most suitable treatment of Hodgkin’s lymphoma.
Stages of the disease
Stage 1: Characterized by lesions confined to one of area of the lymphatic system, or one extralymphatic organ.
Stage 2. Malignant process affects multiple areas of the lymphatic system, but only on one side of the diaphragm. Involvement of one extralymphatic organ in the pathological proccess is acceptable in this stage.
Stage 3. Lymph nodes on both sides of the diaphragm are affected. There might be malignant lesions in one extralymphatic organ and/or in the spleen.
Stage 4. Disseminated lesions of the lymphatic system.
Taking the stage into consideration, risk group classification is carried out: low, medium and high risk, – the duration and intensity of lymphoma’s treatment determines the level of escalation in the risk degree.
Factors that worsen the prognosis
In case of Hodgkin lymphoma those factors have no direct correlation to the stage of the disease, but may lead to use of more aggressive therapy, or a poorer prognosis. These include:
- Greatly increased erythrocyte sedimentation rate;
- Lesions in more than three areas of the lymphatic system;
- Large mediastinal tumor;
- Extranodal lesions.
Treatment of Hodgkin’s lymphoma
Out of all malignant diseases in adults, Hodgkin’s lymphoma is the most treatable and has the best prognosis. The course of treatment is determined by the risk groups. The main method of treatment of Hodgkin’s disease – chemotherapy. Treatment is carried out by the use of medications, sometimes combining different drugs for better effect, which can act on the deadly cancer cells and block their division. After the chemotherapy treatment, nearly half of the patients are treated also with low-dose radiation therapy to the affected areas of the body. Typically, radiation therapy is carried out in a couple of weeks after completion of chemotherapy.
In cases of relapse or if the standard chemotherapy or radiation therapy are not effective, high-dose chemotherapy is prescribed. This treatment kills even the most persistent and resistant lymphoma cells and leads to the destruction of hematopoiesis process in the bone marrow. Therefore, before high dose chemotherapy, hematopoietic stem cells are extracted from patient’s blood or bone marrow, and after the therapy is complete, bone marrow transplantation is performed.
After completing therapy course, regular check-ups are required in order to monitor the results of the treatment and patient’s condition. This way, a possible recurrence of the disease can be identified at a later stage. It also allows to monitor and treat the negative effects of the treatment on the patient.
Statistics show that using high-precision modern diagnostic methods and standard protocols of intensive combination therapy, leads to high rates of complete recovery in Hodgkin’s lymphoma patients – more than 95%. The final results depends on some factors, for example the intensity of the treatment, stage of the disease and the age of the patient.