Malignant lymphoma (aka Hodgkin's lymphoma, Hodgkin's disease, Hodgkin's lymphoma (HL), Hodgkin's disease (HD), lymphogranulomatosis) is one of the neoplasms of the haematopoietic system. It is mainly afflicted by young people between 15 and 35 years of age and patients over 50. Malignant Hodgkin is curable as long as it is detected early enough - what symptoms should worry you and prompt you to urgently consult a doctor?
Malignant lymphomais a term that is now slowly fading into oblivion - nowadays this entity is referred to asHodgkin's lymphoma(or also Hodgkin's disease, Hodgkin's lymphoma (HL), Hodgkin's disease (HD), lymphogranulomatosis).
The name of Malignant Hodgkin, used today, comes from the name of the author of its first description. It was the British physician Thomas Hodgkin, and it was he who in 1832 described the first malignant granulomatosis. He made his observations on a group of several patients who developed similar symptoms - one of them was painless enlargement of the lymph nodes.
Hodgkin's lymphoma incidence peaks are observed in two age groups: the individual is found primarily in young patients (15-35 years old) and in people over 50 years of age. The disease is slightly more common in men.
Statistics on the incidence of Hodgkin's disease fluctuate over time - it is generally noticeable that there are fewer and fewer cases of Hodgkin's disease every year. It is estimated that about 3 out of 100,000 people develop Hodgkin's disease a year. Of all cancers, Hodgkin's lymphoma accounts for about 1% of them.
Malignant lymphoma (Hodgkin's lymphoma): symptoms
The main symptom of Hodgkin's disease is enlargement of the lymph nodes. Characteristic of the disease is that the affected lymph nodes are painless.
Typically nodal lesions are located above the diaphragm - the cervical lymph nodes, mediastinal lymph nodes and axillary nodes are most often affected. Patients may experience various ailments depending on how much the nodes are enlarged.
For example, when serious changes concernnodes in the mediastinum, patients may complain of shortness of breath and cough. Then, when the lymph nodes in the abdominal cavity are enlarged, the patient may develop, among others, discomfort, flatulence and constipation.
Sometimes lymphadenopathy is the only symptom of Hodgkin's disease, however, many other ailments may appear in the course of the disease. Examples of them include:
- general symptoms (such as weight loss of more than 10% in 6 months, night sweats and a fever over 38 degrees Celsius)
- intermittent fever (i.e. where episodes of increased body temperature alternate with episodes of normal temperature)
- itchy skin
- constant fatigue
- liver enlargement and / or spleen enlargement
An interesting and quite characteristic symptom of Hodgkin's disease is also the occurrence of pain in the lymph nodes after consuming alcohol by the patient.
Malignant lymphoma (Hodgkin's lymphoma): causes
In fact, the causes of Hodgkin's disease remain unclear to this day - it is not fully known what causes this disease.
Genetic factors may contribute to its occurrence - this was based on the fact that about 1 in 100 patients with this condition have a relative or relatives who also have or have had the same disease in the past.
It is also noticeable that if one of the siblings becomes ill with Hodgkin's disease, then the risk that the other will develop the disease is 3- to 7-fold.
However, taking into account that the vast majority of people with Hodgkin's disease do not have close relatives who would also suffer from this unit, scientists were looking for other possible causes of Hodgkin's disease.
The Epstein-Barra virus (EBV - this virus causes, among others, mononucleosis) may be associated with the disease. Such a relationship is presumed due to the fact that proteins of this virus are found in the body in up to 3 to 5 out of 10 patients with Hodgkin's disease. However, it is still unclear how EBV would lead to Hodgkin's disease.
There are, however, other theories about the pathogenesis of Hodgkin's disease. One of them is that the disease would appear as a result of an abnormal response of the immune system to various viruses or other factors that stimulate its activity.
The relationship between Hodgkin's disease and HIV is also interesting - it turns outit is apparent that people infected with this pathogen suffer from Hodgkin's disease more often than he althy people. Here, however, it is also not clear why this is so, it is also worth mentioning that Hodgkin's disease is not classified as an indicator disease that occurs in the course of AIDS.
Malignant lymphoma (Hodgkin's lymphoma): types
Malignant lymphoma is a neoplasm originating from one of the populations of blood cell proteins - lymphocytes. However, there are different types of this disease due to the dominant cell types.
The basic classification includes two types of malignant Hodgkin:
- classical Hodgkin's lymphoma
- non-classical Hodgkin's lymphoma
The latter is definitely less frequent - it accounts for only a few percent of all cases of Hodgkin's disease - and is very slow.
Classical Hodgkin's lymphoma is definitely more common - in this case four types are distinguished:
- nodular sclerosis (NS, the most common form of Hodgkin's disease)
- mixed character (MCCHL)
- Lymphocyte Depletion (LDCHL) character
- lymphocyte-rich character (LRCHL)
Malignant lymphoma (Hodgkin's lymphoma): diagnosis
The most important factor in the diagnosis of Hodgkin's lymphoma is the histopathological examination of the tissue collected from the patient. Usually, a lymph node is used for research, which is obtained by a biopsy into the patient. The finding of histopathological features characteristic for the disease enables the diagnosis of Hodgkin's disease.
However, before the decision to perform a biopsy is made, other tests are ordered beforehand. It is important, for example, to perform a blood count with a smear - the deviations that can be found in it may be, among others:
- anemia
- lymphopenia
- neutrophilia
- eosinophilia
Research is also important, among others :
- lactate dehydrogenase activity (may be increased)
- albumin (their concentration can be lowered)
- OB (sometimes increased)
These and other tests are important not only for diagnostic purposes, but they are also important in the subsequent prognosis of a patient with Hodgkin's disease.
Apart from that, these tests are also important when conducting differential diagnosis. In a patient with suspected Hodgkin's disease, it is necessary to take into account other potential causes of lymphadenopathy, including:
- various infections (such as tuberculosis, syphilis, mononucleosisand HIV)
- autoimmune diseases (e.g. lupus and sarcoidosis)
- other neoplasms (e.g. types of lymphomas and leukemias other than Hodgkin's disease)
Speaking of estimating the patient's prognosis, it is impossible not to mention the imaging tests, which are also of great importance in determining the stage of Hodgkin's disease.
They can be performed, inter alia, by such tests as:
- Chest X-ray
- computed tomography
- PET
they make it possible to detect exactly which groups of lymph nodes in a patient have enlarged, and they also allow to identify possible extra-nodal changes (e.g. in the liver, spleen, kidneys or uterus).
Tests not mentioned so far, and sometimes also used in the diagnosis of Hodgkin's disease, are bone marrow biopsy and lumbar puncture (the latter is performed when there is a suspicion that the central nervous system may have been involved in the course of the disease).
Malignant lymphoma (Hodgkin's lymphoma): treatment
Chemotherapy is of fundamental importance in the treatment of Hodgkin's disease (especially in its classic form).
Multiple medications are used, such as the ABVD regimen where the patient is given doxorubicin, bleomycin, vinblastine and dacarbazine.
Usually chemotherapy is supplemented with radiotherapy.
In the case of recurrence in classic forms, second-line chemotherapy is used, possibly supplemented with radiotherapy and bone marrow autograft.
In the case of non-classical Hodgkin's disease, in its low stages of advancement, surgical resection of altered lymph nodes in combination with radiation therapy may be used in treatment.
In patients with more advanced disease - especially with the coexistence of unfavorable prognosis factors - chemotherapy is sometimes used in conjunction with radiotherapy.
Malignant lymphoma (Hodgkin's lymphoma): prognosis
Fortunately, the prognosis of patients with Hodgkin's disease is good - even in 9 out of 10 patients, thanks to modern methods of treatment, it is possible to obtain a permanent cure.
The exact prognosis depends primarily on the degree of the disease at the time of its diagnosis and treatment.
Hodgkin's severity is now determined according to a modified Ann Arbor classification. According to her, there are four degrees of disease:
- Grade 1: One or one node is occupiedgroup of adjacent nodes or one extra-nodal organ occupied
- step 2: involvement of more than two groups of nodes on the same side of the diaphragm or nodal changes with the involvement of one extra-nodal organ by continuity
- grade 3: lymph nodes on both sides of the diaphragm are affected or the lymph nodes above the diaphragm are affected with spleen involvement
- step 4: lymph node involvement and extra-lymphatic organ involvement
In addition to the grade, the letters "A" and "B" are also used in determining the advancement of Hodgkin's disease.
The symbol "A" is used when the patient does not develop general symptoms.
And when a patient has a fever above 38 degrees C, the abovementioned weight loss or night sweats, then we can already speak of general symptoms and the diagnosis is made using the symbol "B".
However, survival is influenced not only by the stage of the disease, but also by the so-called unfavorable prognostic factors - this is used to define various abnormalities, the detection of which suggests that the patient's prognosis may be worse.
In the case of Hodgkin's disease, the following factors are considered unfavorable prognostic factors:
- serum albumin less than 4 g / dL
- hemoglobin level below 10.5 g / dl
- male gender
- over 45
- WBCs greater than 15,000 / mm3
- total blood lymphocyte count less than 600 / mm3
As you can easily guess, the prognosis in Hodgkin's disease is the better, the earlier treatment is started.
In stages 1 and 2, five-year survival is noted in more than 90% of patients.
In the case of stage 3, 5-year survival is more than 80%, and in stage 4 - more than 70%.
Looking at these numbers, one conclusion can be drawn: overall the prognosis in the course of the disease is good, but in order to maximize the chances of recovery, it is necessary to start therapy as early as possible.
For this reason, with disturbing symptoms, such as persistent enlargement of the lymph nodes, there is simply nothing to wait for - you just have to see a doctor.
Also read:
- Lymphomas: types, symptoms, treatment
- Non-Hodgkin's lymphomas: causes, symptoms, treatment, prognosis
- Leukemia: causes, symptoms, types, treatment, prognosis