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Hodgkin's Lymphoma (Hodgkin's Disease)

Definition


Disease: Hodgkin's Lymphoma (Hodgkin's Disease) Hodgkin's Lymphoma (Hodgkin's Disease)
Category: Blood diseases & tumors
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Disease Definition:

Cancer of the lymphatic system, which is part of the immune system, is called Hodgkin's lymphoma and was formerly known as Hodgkin's disease.

The cells in the lymphatic system grow abnormally in Hodgkin's lymphoma and may spread beyond the lymphatic system. As this disease progresses, it will compromise the body's ability to fight infection.

One of the two common types of cancers of the lymphatic system is Hodgkin's lymphoma. Non-Hodgkin's lymphoma is the other type, which is far more common.

Thanks to advances in diagnosis and treatment, this once uniformly fatal disease is now highly treatable, with the potential for full recovery. For people with Hodgkin's lymphoma, the prognosis continues to improve.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms of Hodgkin's lymphoma may be:

 

  • Fever and chills
  • Painless swelling of lymph nodes in the neck, armpits or groin
  • Unexplained weight loss, which could be as much as 10% or more of the body weight
  • Persistent fatigue
  • Itching
  • Chest pain, coughing or trouble breathing
  • Increased sensitivity to the effects of alcohol or pain in the lymph nodes after drinking alcohol
  • Night sweats
  • Loss of appetite


Numerous other conditions could cause these symptoms. However, a person should see a doctor for diagnosis in case:

 

  • Their symptoms linger for more than two weeks
  • Their symptoms repeatedly go away and then return

Causes:

What exactly causes Hodgkin's lymphoma is still not known. This disease has two main types, classical and nodular lymphocyte-predominant Hodgkin's lymphoma. Classical Hodgkin's lymphoma is the most common one, and its subtypes are:

 

  • Nodular sclerosing Hodgkin's lymphoma
  • Mixed cellularity Hodgkin's lymphoma
  • Lymphocyte depleted Hodgkin's lymphoma
  • Lymphocyte-rich classical Hodgkin's lymphoma


All of the five types are among a group of cancers called lymphomas, which are cancers of the lymphatic system. The lymphatic system is made up of the spleen, thymus gland, bone marrow and the lymph nodes, also known as the lymph glands that are located throughout the body and connected by small vessels called lymphatics.

In the lymph nodes that are located in the upper part of the body is where Hodgkin's lympoma usually begins. Some of the lymph nodes are in areas that are easily noticed, such as in the neck, above the collarbone, under the arms or in the groin area. The lymph nodes in the chest could also become enlarged. Ultimately, Hodgkin's lymphoma could spread outside of the lymph nodes to virtually any part of the body.

ABNORMAL B CELLS:
The development of abnormal B cells is a key step in Hodgkin's lymphoma. B cells are a type of lymph cells that is an important part of the immune system's response to foreign invaders. To fight infection, B cells usually work with T cells that mature in the thymus.

Reed-Sternberg cells are the B cells that develop into large, abnormal, cancerous cells. Rather than undergoing the normal cell cycle of life and death, these cells don't die and continue to produce abnormal B cells in a malignant process. The lymph nodes become enlarged because these cells also attract other normal immune cells.

Complications

Complications:

Mainly because of the effects of treatment of Hodgkin's lymphoma, people suffering from this disease may be at an increased risk of developing these conditions:

 

  • Thyroid dysfunction
  • Second malignancy, such as non-Hodgkin's lymphoma, tumors in the lungs, breasts or gastrointestinal system and leukemia
  • Sterility
  • Cardiovascular disease
  • Vascular disease, such as a stroke.

Treatments:

The stage of the disease is the most important factor in Hodgkin's lymphoma treatment. Other important considerations include the number and regions of lymph nodes affected and whether only one or both sides of the diaphragm are involved. Some of the other factors that affect decisions about treating this disease may include the patient's age, symptoms, whether they're pregnant or not and their overall health status.

Destroying as many malignant cells as possible and bringing the disease into remission is the goal of treatment. With proper treatment, about 95% of people with stage I or stage II Hodgkin's lymphoma survive for five years or more, and about 60% to 70% of people with widespread Hodgkin's lymphoma also survive five years.

Some of the treatment options may include:

RADIATION:
Radiation therapy could be the preferred treatment in case the disease is confined to a limited area. High-energy X-rays are used to kill cancer cells in radiation therapy. Typically, the affected lymph nodes are radiated along with the next area of nodes where the disease might progress. Based on the stage of the disease, the length of radiation treatment varies. Although radiation therapy is usually used with chemotherapy, it could also be used alone. Chemotherapy will become necessary in case the patient experience a relapse after radiation therapy.

The risk of heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as lung or breast cancer may be increased due to some forms of radiation therapy. Nearby healthy tissue may also be damaged by radiation. Most children with Hodgkin's lymphoma are treated with chemotherapy; however, they may also be treated with low-dose radiation therapy.

CHEMOTHERAPY:
Chemotherapy is the preferred treatment in case the disease progresses and involves more lymph nodes or other organs. To kill tumor cells, chemotherapy uses specific drugs in combination. These drugs could reach nearly all the areas of the body by travelling through the bloodstream.

The possibility of long-term side effects and complications such as lung damage; liver damage; heart damage; secondary cancers, such as leukemia; and fertility problems are a major concern with chemotherapy.

Despite the fact that severe effects are not common, however, researchers are trying to find equally effective regimens with less toxicity. In people who have received multiple courses of chemotherapy and radiation therapy, drug regimens have been developed for Hodgkin's lymphoma, which basically diminish the likelihood of long-range, life-threatening complications, such as acute leukemia.

Usually, chemotherapy regimens are referred to by their initials, such as:

 

  • BEACOPP: It consists of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincrisitine, procarbazine and prednisone.
  • ABVD: It consists of doxorubicin, bleomycin, vinblastine and dacarbazine.
  • Stanford V: It consists of doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin and prednisone. People who take this regimen are also treated with radiation therapy.
  • COPP/ABVD: It consists of cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine and dacarbazine.
  • MOPP: It consists of mechlorethamine, vincristine, procarbazine and prednisone.


Currently, the preferred treatment is ABVD. However, people may receive a more intensive treatment such as BEACOPP in case they're at high risk.

BONE MARROW OR STEM CELL TRANSPLANT:
Someone may need a bone marrow or stem cell transplant in case the disease returns. In this procedure, the patient's own bone marrow or stem cells (autologous) will be removed and treated in order to kill cancerous cells. After that, the marrow or stem cells will be frozen and stored for safekeeping. Later, the patient will receive high-dose chemotherapy in order to destroy cancerous cells in their body. Finally, the frozen marrow or stem cells will be thawed and injected into the body intravenously.

Prognosis:

Not Available

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