Hodgkin lymphomacancers of the lymphatic system, or classic Hodgkin lymphoma, is a slow-growing and aggressive type of cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs that develops from B-lymphatic cellsthe basic structural and functional unit of all living things (or white bloodthe red bodily fluid that transports oxygen and other nutrients around the body cells). These cells develop abnormally to form Reed-Sternberg cells, which are larger than other lymphatic cells and are indicative of this disease.
The lymphatic systema network of tissues and organs that help our bodies fight infection and disease is a network of tissues and organs that help our bodies fight infectiona condition where harmful pathogens, such as bacteria, viruses or parasites, have entered the body and disease. It is composed of lymph vesselsa network/chain of thin tubes that moves lymph fluid around the body, lymph fluida clear watery fluid that carries nutrients around the body and removes unwanted bacteria/viruses, and lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid/glands. Some of the most well-known lymph tissues include the bone marrowsoft, spongy tissue found in bones that makes blood cells, the spleen, and the tonsils.
Classic Hodgkin lymphoma affects males and females equally, and is often diagnosed between the ages 15-29 or over 65. However, anyone can develop this disease.
Types of classic Hodgkin lymphoma
There are four different subtypes of classic Hodgkin lymphoma, which are differentiated histologically (cellular appearance under the microscope).
Nodular sclerosis classical Hodgkin lymphoma (NSCHL)
NSCHL is the most common subtype of Hodgkin lymphoma (classic or otherwise). It is characterised by nodular growth (abnormal cellular growth) separated by fibrous bands in the lymph nodes. This type is most commonly found in young adults, and usually involves the lymph glands in the neck and chest.
Mixed cellularity classical Hodgkin lymphoma (MCCHL)
MCCHL is characterised by either diffuse (widespread, not localisedaffecting only one area of body to a singular area) or slight nodular growth without fibrous band formation. This type is most commonly found in older patients with Hodgkin lymphoma, and tends to affect males more than females. It is often found in the abdominal lymph nodes and the spleen.
Lymphocyte rich classical Hodgkin lymphoma (LRCHL)
LRCHL is characterised by lots of lymphocytes in a sample, and can be diffuse or have nodular growth. It generally has the most favourable prognosisto predict how a disease/condition may progress and what the outcome might be of all Hodgkin lymphomas, and often presents in the earlier stages of the disease. However, is difficult to diagnose as it usually presents with few Reed-Sternberg cells, and is often confused with nodular lymphocyte predominant Hodgkin lymphoma (NLPHL).
Lymphocyte depleted classical Hodgkin lymphoma (LDCHL)
LDHCL is the least common form of Hodgkin lymphoma (classic or otherwise). It is characterised by a diffuse growth pattern and lack of lymphocytes in a sample. It is commonly found in patients infected with HIV (human immunodeficiency virus) or EBV (Epstein-Barr virus), and usually occurs in bone marrow. This subtype is often confused with non-Hodgkin anaplastica term used to describe abnormal cancer cells that grow uncontrollably in the body and have little or no resemblence to regular cells large-cell lymphoma.
Treatment
If Hodgkin lymphoma is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including age, stage of disease and overall health. The types of treatments generally don’t vary between adults and children.
Treatment options for patients with classic Hodgkin lymphoma may include:
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Immunotherapya treatment that uses a person's immune system to fight cancer.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the exact cause of Hodgkin lymphoma remains unknown, the following factors might increase the riskthe possibility that something bad will happen of a person developing this type of cancer.
- Having been infected with HIV or EBV.
- Being immunocompromised.
- Family history of Hodgkin lymphoma.
- Exposure to chemical solvents, such as certain pesticides and fertilisers.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Hodgkin lymphoma can appear asymptomatic, or with a vague set of symptoms. Some of these symptoms include:
- Painless but firm lump in neck, armpits and/or groinarea between the abdomen and thighs.
- B symptoms, which are:
- Extreme night sweats.
- Persistent fevers.
- Unexplainable weight loss.
- Swollen lymph nodes in the chest, which can cause:
- Chesty cough.
- Dyspneadifficulty breathing, shortness of breath.
- Loss of appetite.
- Generalised itchy skin.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Pain in lymph nodes after small quantities of alcohol.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have Hodgkin lymphoma, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Imagingtests that create detailed images of areas inside the body tests (if the cancer is thought to have spread beyond blood and bone marrow), potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- X-raya type of medical imaging that uses x-ray beams to create detailed images of the body .
- Bone marrow aspirationa procedure that involves inserting a needle into the hipbone (or the breastbone in some cases) to remove samples of solid and liquid bone marrow..
- Lumbar puncturea procedure that involves inserting a needle between two vertebrae in the lower spine and extracting a sample of cerebrospinal fluid (CSF) for analysis (if the cancer is thought to have spread to the brain or spinal cord).
- Biopsyremoval of a section of tissue to analyse for cancer cells.
