Hodgkin’s Lymphoma

 Hodgkin lymphoma or Hodgkin disease

Reed-Sternberg cell.

Hodgkin lymphoma is a disease characterized by the presence of a specific type of abnormal cells called Reed-Sternberg cell.

Lymphoma refers to a variety of cancer that originates in lymphocytes- a type of white blood cells. Lymphoma cells grow and form masses, usually in the lymph nodes, located throughout our bodies in the lymphatic system.

Collectively, these cell types circulate in the vessels of the lymphatic system. Lymph is a clear and transparent fluid where the cells that help fight infections and cancer flow through all your body, always vigilant and ready to mount an immune response when tissue is irritated, damage in the presence of foreign invaders, and when abnormal cells are detected.  Lymph nodes are small being shape structures linking lymph vessels and serve as immune response stations were cells are trained to fight and mature into the protective professionals cells known as T and B lymphocytes.  B lymphocytes developed into memory cells or antibody-producing cells known as plasma cells.

Just as there are many types of lymphocytes, so there are many types of lymphoma.

Lymphomas are part of the broad group of diseases called hematological neoplasms.

Because the lymphatic system is part of the body’s immune system, patients with a weakened immune system, such as from HIV infection or from certain drugs or medication, also have a higher incidence of lymphoma.

Lymphoma is a broad category which is normally divided into 2 types of cancer: Hodgkin lymphoma and non-Hodgkin’s lymphoma.  Knowing which type lymphoma you have is important because it affects your treatment options and your prognosis.

A tissue sample can be examined by a pathologist who can tell the difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma by examining the cancer cells under a microscope. If in examining the cells, the doctor detects the presence of a specific type of abnormal cell called a Reed-Sternberg cell, the lymphoma is classified as Hodgkin’s. If the Reed-Sternberg cell is not present, the lymphoma is classified as non-Hodgkin’s.

 

Only within the past 10 years has the B-cell( a type of lymphocyte) nature of the pathognomonic Hodgkin and Reed- Sternberg (HRS) cells been revealed, along with several recurrent genetic lesions. The pathogenetic role for Epstein- Barr virus infection has also been substantiated. HRS cells in classical Hodgkin’s lymphoma have several characteristics that are unusual for lymphoid tumor cells, and the Hodgkin’s lymphoma microenvironment is dominated by an extensive mixed, potentially inflammatory cellular infiltrate.

 

HL decision aking

How frequent is Hodgkin’s lymphoma?

This year, 2018, an estimated 8500 people in the United States will be diagnosed with Hodgkin’s lymphoma, HL. It is estimated that 1,050 will die from this disease this year. The overall 5-year survival rate for people with HL is 86%

HL Epidemiology

What the risk factors for Hodgkin’s Lymphoma?

The following risk factors may increase a person’s likelihood of developing Hodgkin lymphoma:

  • The Epstein-Bar virus, known for causing mononucleosis, is associated with the development of Hodgkin lymphoma.
  • People infected with human immunodeficiency virus (HIV) have increased the probability of developing Hodgkin lymphoma.
  • There are occasional cases of Hodgkin lymphoma in families-having a parent or a sibling with Hodgkin lymphoma may increase the risk of developing the disease. These cases are uncommon, but some experts are studying whether some people have a genetic predisposition to Hodgkin lymphoma.
  • the disease is not transmitted from person to person

HL risk factors

 

What are the symptoms of Hodgkin’s lymphoma?

The most common early presentation of Hodgkin lymphoma is painless swelling (enlargement) of one or more lymph nodes in the neck. Sometimes the affected lymph nodes are in the armpit, stomach area or groin.

In addition to swollen lymph nodes, other signs and symptoms of Hodgkin lymphoma may include:

  • Unexplained fever
  • Persistent fatigue
  • Persistent cough
  • Shortness of breath during normal activity
  • Drenching sweats, especially at night
  • Unexplained weight loss
  • Decreased appetite
  • Itchy skin
  • Abdominal pain or swelling and feeling of fullness (due to an enlarged spleen)
  • Lymph node pain after drinking alcohol

B symptoms. is a term used when the tumor is associated with complaints of fever, drenching night sweats and loss of more than 10 percent of body weight over six months are sometimes termed “B symptoms.” These symptoms are significant to the prognosis and staging of the disease.

Some Hodgkin lymphoma symptoms are associated with other, less serious illnesses.

 

How is Hodgkin’s lymphoma diagnosed?

Patients may be diagnosed on the basis of their symptoms or sometimes in patients with no symptoms as a result of imaging and laboratory tests. A diagnosis of Hodgkin’s lymphoma becomes suspected based on symptoms and the white blood cell count, a lymph node biopsy is performed. The exact diagnosis of Hodgkin’s lymphoma can only be based on a lymph node biopsy. It involves the removal of a lymph node when the patient may be under anesthesia (excisional biopsy). The removed lymph node tissue will be examined in the laboratory. This examination is called histopathology and mainly consists of visually assessing the tissue under a microscope to look for lymphoma cells. In contrast, the removal of only a part of a lymph node using a wide needle (core biopsy) should only be performed in patients without easily accessible lymph nodes due to their position in the body. Of note, the results of the biopsy examination may not be clear since the lymphoma cells could be different from one part of the lymph node to another (known as heterogeneity). The removal of tissue or fluid using a thin needle (fine needle biopsy) even though is commonly performed  is not recommended for a reliable lymphoma diagnosis

 

  • Imaging tests. Your doctor may recommend imaging tests to look for signs of Hodgkin’s lymphoma in other areas of your body. Tests may include X-ray, CT and positron emission tomography.
  • Removing a sample of bone marrow for testing. A bone marrow biopsy and aspiration procedure involves inserting a needle into your hipbone to remove a sample of bone marrow. The sample is analyzed to look for Hodgkin’s lymphoma cells.

How is Hodgkin’s lymphoma classified?

there are various types of Hodgkin’s lymphoma, each with a different prognosis and survival; the types include:

 

How is Hodgkin’s lymphoma Stage?

After the diagnosis of Hodgkin’s lymphoma, tests must be done to find out if lymphoma cells have spread within the lymph system or to other parts of the body. Staging is the process of determining whether the tumor has spread, and if so, how far. It is extremely important to know the stage of the disease in order to plan the treatment. The staging system used to describe the spread of Hodgkin’s lymphoma is called the Ann Arbor Staging System. It uses Roman numerals (I-IV) for different stages

 

 

WHAT ARE THE TREATMENT OPTION FOR HODGKIN’S LYMPHOMA?

 

The treatment is a multidisciplinary approach.  Treatment of Hodgkin’s lymphoma is tailored to each individual based on the stage and patient characteristics, including age and other diseases that the patient may have such as diabetes, coronary heart disease or chronic obstructive pulmonary disease. Although this usually occurs in the management of solid tumors, surgery does not play a major role in the treatment of Hodgkin’s lymphoma since the nature of the lymphatic system lymphoma is not often confined to only one area of the body. Treatment may control or cure the lymphoma. It can also improve your quality of life by controlling symptoms of the disease. The goal of Hodgkins lymphoma treatment is to apply one or more of these strategies, including killing the lymphoma cells as quickly as possible, stopping the growth of new lymphoma cells, treating side effects caused by lymphoma such as pain, fevers, chills and night sweats, and/or maintaining a sense of control over your treatment choices and life. In general, several approaches are considered when treatment decisions are made for the management of Hodgkin’s lymphoma. These include watchful waiting, radiotherapy, chemotherapy and targeted therapy with a monoclonal antibody.

External radiotherapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells and keep them from growing. External radiotherapy uses a machine that focuses the radiation from outside the body and targets it towards the cancer. For classical Hodgkin’s lymphoma, radiation therapy is often used after chemotherapy. People with early-stage nodular lymphocyte-predominant Hodgkin’s lymphoma may undergo radiation therapy alone.

During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease. A typical treatment plan might have you going to the hospital or clinic five days a week for several weeks. At each visit, you undergo a 30-minute radiation treatment.

Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More-serious risks include heart disease, stroke, thyroid problems, infertility and other cancers, such as breast or lung cancer.

Chemotherapy is an anticancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way chemotherapy is given depends on the stage of the disease. Combination chemotherapy provides treatment using two or more anticancer drugs. Steroid drugs may be added to kill the lymphoma cells as well. Side effects of chemotherapy depend on the drugs you’re given. Common side effects are nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.

Immunotherapy is a type of treatment that either boosts the patients own immune system or uses man-made drugs called monoclonal antibodies that attack a specific target on the surface of lymphocytes (cells in which lymphoma starts). The monoclonal antibody rituximab is a drug used to treat Hodgkin’s lymphoma and administered by infusion into veins.

Radioimmunotherapy refers to a type of treatment where a radioactive substance is attached to the monoclonal antibody. When the monoclonal antibody is delivered to the cells’ targets, the radioactive source acts on the lymphoma cells and potentially some nearby cells. This treatment is known as yttrium 90-ibritumomab tiuxetan.

Bone marrow transplantation either with patients’ own bone marrow cells or donors may be a part of lymphoma treatment. Before performing the bone marrow transplantation, the radiation and chemotherapy are applied with the aim to reduce the cells in bone marrow affected by the disease. The treatment mainly depends on the stage of the disease. A bone marrow transplant may be an option if Hodgkin’s lymphoma returns despite treatment.

During a bone marrow transplant, your own blood stem cells are removed, frozen and stored for later use. Next, you receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally, your stem cells are thawed and injected into your body through your veins. The stem cells help build healthy bone marrow. People who undergo bone marrow transplant may be at increased risk of infection.

For more advanced stages (stage III and IV), the goal of the treatment involves two major strategies. Firstly, induce a regression of the tumor (induction phase). Secondly, consolidate or maintain this regression (consolidation/maintenance phase).

 

Coping with the Hodgkin disease is very stressing. some alternative therapies to help you cope with it are:

  • Art therapy
  • Exercise
  • Meditation
  • Music therapy
  • Relaxation exercises
  • Spirituality

 

 

 

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • American Academy of Hematology

 

 

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