Hodgkins Lymphoma

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Overview

Hodgkin’s lymphoma, commonly known as Hodgkin’s disease, is a kind of lymphoma that develops from white blood cells known as lymphocytes. Hodgkin’s lymphoma is an uncommon malignancy that primarily affects two age groups: those aged 15 to 40 and those aged 55 and up. Males are more likely than females to develop Hodgkin’s lymphoma.

Thomas Hodgkin was the first to describe this condition in the lymphatic system in 1832, and it was named after him.

Hodgkin’s lymphoma is characterised by the presence of RS cells. The RS cells, also known as Reed-Sternberg cells, are unusual, enormous cells found in the blood samples of patients with Hodgkin’s lymphoma. These cells exhibit a moth-eaten appearance. Multiple RS cells can be seen when cancer cells are examined under a microscope.

HCG has the finest Hodgkin’s lymphoma Specialists in India who are trained and experienced in managing various subtypes of Hodgkin’s lymphoma with appropriate and personalised treatment plans in order to achieve positive health outcomes.

Types

There are several forms and subtypes of Hodgkin’s lymphoma. Each variety forms and spreads in a unique way, requiring different treatment methods.

a. Classic Hodgkin’s Lymphoma: This is the most prevalent type of Hodgkin’s lymphoma, and it’s divided into four subtypes:

1. Nodular Sclerosis Hodgkin’s Lymphoma: It originates in the neck or chest lymph nodes. It is most common among teenagers and young adults, but it can strike anyone at any age.
2. Mixed Cellularity Hodgkin’s Lymphoma: This subtype is generally seen in people who are immunocompromised (HIV). It most commonly affects the lymph nodes in the upper portion of the body.
3. Lymphocyte-rich Hodgkin’s Lymphoma: This subtype affects the upper half of the body and is of rare occurrence.
4. Lymphocyte-depleted Hodgkin’s lymphoma: This is an uncommon kind that affects mostly the elderly and those who have HIV. It is one of the aggressive subtypes of Hodgkin’s lymphoma, and it’s more likely to be advanced at the time of diagnosis. The lymph nodes in the abdomen (belly), as well as the spleen, liver, and bone marrow, are the most common sites for Lymphocyte-depleted Hodgkin’s lymphoma.

b. Nodular Lymphocyte-predominant Hodgkin’s Lymphoma: In this subtype, cancer cells have a popcorn-like appearance, and it usually arises from the lymph nodes in the neck and armpits.

Symptoms

Swollen lymph nodes, which appear as lumps under the skin, are the most prevalent symptom of Hodgkin’s lymphoma. The neck, armpit, and groin are common areas from where these tumours arise. Following are other main symptoms associated with Hodgkin’s lymphoma:

Lymph node pain after alcohol consumption
Coughing
Breathing difficulties or chest pain caused by swollen lymph nodes in the chest
Extreme tiredness
Unintentional weight loss
Consistent fever
Sweating at night

The last three symptoms are designated as ‘B symptoms,’ which necessitate immediate medical attention.

It’s crucial to remember that patients with Hodgkin’s disease may not have any symptoms at all, or symptoms may not show until the disease has progressed.

Courses

Hodgkin’s lymphoma is a rare malignant disorder and the exact causes for it are not known. The abnormal lymphocytes start proliferating or multiplying in the lymph nodes present in the regions of the neck, armpits and groin. Over time, the disease spreads to other parts of the body, namely the spleen, lungs, liver, bone marrow and skin. Here are some of the risk factors that are associated with Hodgkin’s lymphoma:

Gender: Hodgkin’s lymphoma is found to be more common in men than women.
Age: People between the ages of 15 and 40, as well as those over 55, are prone to developing Hodgkin’s lymphoma.
Family History: Individuals with a family history of Hodgkin’s lymphoma are more likely to develop the disease.
EBV Virus Infection: The EBV virus causes glandular fever, often known as infectious mononucleosis, which is linked to Hodgkin’s lymphoma development.
Weakened Immune System: Compromised immunity caused due to diseases like HIV or AIDS increases the risk of Hodgkin’s lymphoma.
Prolonged Usage of Human Growth Hormone: Those who use human growth hormone therapy for a long time have a higher risk of developing Hodgkin’s lymphoma.

Diagnosis

There are various testing methods available for the detection and diagnosis of Hodgkin’s lymphoma:

a. Physical Examination: During diagnosis, the doctor goes through the patient’s medical history and performs a physical examination. The doctor looks for the swollen lymph nodes in the region of the neck, armpit and groin, and if they are found, additional tests may be recommended to confirm the diagnosis of cancer and study whether or not the other organs have been affected.

b. Blood Tests: Blood tests are not used to diagnose Hodgkin’s lymphoma. Instead, they are used to determine the extent of the disease and assess the patient’s response to the treatment. In a few cases, patients with Hodgkin’s lymphoma may have abnormal blood counts, which could probably be due to the lymphoma spreading to the bone marrow. Therefore, blood tests may also help in assessing disease progression.

c. Imaging Tests: Imaging methods such as X-ray, PET CT, etc., play a significant role in Hodgkin’s lymphoma diagnosis. These tests are used to find any abnormalities such as swollen lymph nodes and tumour growth. Disease staging, treatment planning and therapy monitoring are the key applications of these imaging tests.

d. Biopsy: The most definitive technique to diagnose Hodgkin’s disease is to take a biopsy of the suspicious lymph node. A pathologist looks for Reed-Sternberg cells and other abnormalities in the lymph node sample. In individuals with Hodgkin’s disease, bone marrow biopsies may be taken to see if the malignancy has spread to the bone marrow.

Treatment

The main treatment options for Hodgkin’s disease include chemotherapy, stem cell transplantation, radiation therapy. Patients who have relapsed or who are at a high risk of recurrence may benefit from stem cell transplantation.

a. Chemotherapy: Chemotherapy is the primary treatment for Hodgkin’s lymphoma in most cases. Chemotherapy is a systemic treatment that kills lymphoma cells with chemicals. Chemotherapy chemicals move through the body’s bloodstream, killing cancer cells all over the place. Chemotherapy medications are given orally or intravenously, and in rare cases, both.

b. Stem Cell Transplant or Bone Marrow Transplant: Transplantation of stem cells or bone marrow is not used as the first-line treatment for Hodgkin’s lymphoma, but it may be advised for people who have lymphoma that has not responded to chemotherapy or for those who have cancer that has returned after treatment. A round of high-dose chemotherapy is administered first to destroy the lymphoma cells. This treatment may also damage the healthy bone marrow cells and therefore, it is followed by a stem cell transplant to replace the damaged bone marrow cells with the healthy ones. The stem cells could be extracted from the patient’s blood and then put back into his or her body (autologous), or they could be taken from another person/donor (allogeneic).

c. Radiation Therapy: Many people with Hodgkin’s lymphoma receive radiation therapy as part of their treatment regimen. It’s especially helpful when the problem only affects one region of the body. The latest imaging tests can pinpoint the exact location of Hodgkin’s lymphoma tumours, allowing for precision radiation delivery to cancer cells while sparing healthy tissues nearby.

d. Immunotherapy: If the disease does not respond to chemotherapy or radiotherapy, immunotherapy may be recommended. When immunotherapy is administered, the immune system of the patient is activated, allowing it to recognise and eliminate lymphoma cells. This method targets lymphoma cells directly while leaving healthy tissues unharmed.

Frequently Asked Questions

1. Is Hodgkin’s lymphoma curable?

If found early, Hodgkin’s lymphomas are one of the most easily treatable conditions. With a wide range of treatment options that are available today, Hodgkin’s lymphomas can be successfully treated with higher survival rates.

Thanks to the recent advancements in the field of cancer care, even advanced-stage Hodgkin’s lymphomas can be treated with positive clinical outcomes today.

2. Can Hodgkin lymphoma form solid tumours?

Yes. In Hodgkin’s lymphoma patients, cancerous lymphocytes can build up in the lymph system’s organs and glands, particularly in lymph nodes. Tonsils, thymus, spleen and bones are common areas where these cancer cells usually get accumulated. Over time, these tumours can cause lumps, cause pain, and obstruct breathing, circulation and other bodily functions. In most cases, they have to be surgically removed.

3. What are the common side effects of Hodgkin lymphoma treatment?

As Hodgkin’s lymphoma affects the lymphatic system, treatment may result in lymphedema, a swollen condition caused by the accumulation of lymphatic fluid.

Other side effects include infections, thyroid issues, fertility problems, lung damage, stroke and heart diseases and secondary malignancies. Regular follow-ups help in reducing the relapse risk and managing these side effects effectively.

4. Will Hodgkin’s lymphoma come back?

In most cases, Hodgkin’s lymphoma survivors lead a normal and disease-free life throughout. Nevertheless, in rare cases, Hodgkin’s lymphoma may relapse. Therefore, it is important for Hodgkin’s lymphoma patients to keep up their follow-up appointment after the treatment. Follow-ups play a significant role in detecting relapses in their early stages when they can be treated the best