Hodgkin's lymphoma
Definition:
Hodgkin's lymphoma — formerly known as Hodgkin's disease — is a cancer of the lymphatic system, which is part of your immune system.
In Hodgkin's lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.
Hodgkin's lymphoma is one of two common types of cancers of the lymphatic system. The other type, non-Hodgkin's lymphoma, is far more common.
Advances in diagnosis and treatment of Hodgkin's lymphoma have helped give people with this diagnosis the chance for a full recovery. The prognosis continues to improve for people with Hodgkin's lymphoma.
[1]
Symptoms:
Hodgkin's lymphoma signs and symptoms may include:
⦁ Painless swelling of lymph nodes in your neck, armpits or groin
⦁ Persistent fatigue
⦁ Fever and chills
⦁ Night sweats
⦁ Unexplained weight loss — as much as 10 percent or more of your body weight
⦁ Loss of appetite
⦁ Itching
⦁ Increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol.
[2]
Causes:
It's not clear what causes Hodgkin's lymphoma.
Doctors know that most Hodgkin's lymphoma occurs when an infection-fighting cell called a B cell develops a mutation in its DNA. The mutation tells the cells to divide rapidly and to continue living when a healthy cell would die. The mutation causes a large number of oversized, abnormal B cells to accumulate in the lymphatic system, where they crowd out healthy cells and cause the signs and symptoms of Hodgkin's lymphoma.
Various types of Hodgkin's lymphoma exist. The type is based on the types of cells involved in your disease and their behavior. Your type determines your treatment options.
Classical Hodgkin's lymphoma:
Classical Hodgkin's lymphoma is the more common type of this disease. It can be broken down further into subtypes. People diagnosed with classical Hodgkin's lymphoma have large, abnormal cells called Reed-Sternberg cells in their lymph nodes.
Subtypes of classical Hodgkin's lymphoma include:
⦁ Nodular sclerosis Hodgkin's lymphoma
⦁ Mixed cellularity Hodgkin's lymphoma
⦁ Lymphocyte-depleted Hodgkin's lymphoma
⦁ Lymphocyte-rich classical Hodgkin's lymphoma
Lymphocyte-predominant Hodgkin's lymphoma:
This much rarer type of Hodgkin's lymphoma involves large, abnormal cells that are sometimes called popcorn cells because of their appearance. Treatment may be different from the classical type. People with this type of Hodgkin's lymphoma may have a better chance of a cure when the disease is diagnosed at an early stage.
[2]
Risk factors:
⦁ Your age. Hodgkin's lymphoma is most often diagnosed in people between the ages of 15 and 30, as well as those older than 55.
⦁ A family history of lymphoma. Having a close family member who has Hodgkin's lymphoma or non-Hodgkin's lymphoma increases your risk of developing Hodgkin's lymphoma.
⦁ Your sex. Males are slightly more likely to develop Hodgkin's lymphoma.
⦁ Past Epstein-Barr infection. People who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin's lymphoma than are people who haven't had Epstein-Barr infections.
⦁ A weakened immune system. Having a compromised immune system, such as from HIV/AIDS or from having an organ transplant requiring medications to suppress the immune response, increases the risk of Hodgkin's lymphoma. [3]
Tests and diagnosis:
Tests and procedures used to diagnose Hodgkin's lymphoma include:
⦁ Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
⦁ Blood tests. A sample of your blood is examined in a lab to see if anything in your blood indicates the possibility of cancer.
⦁ Imaging tests. Imaging tests used to diagnose Hodgkin's lymphoma include X-ray, computerized tomography (CT) scan and positron emission tomography (PET).
⦁ Surgery to remove a swollen lymph node. Minor surgery may be done to remove all or part of an enlarged lymph node for testing. The lymph node is sent to a laboratory for testing. A diagnosis of Hodgkin's lymphoma is made if the abnormal Reed-Sternberg cells are found within the lymph node.
⦁ A procedure to collect bone marrow for testing. A bone marrow biopsy may be used to look for signs of cancer in the bone marrow. During this procedure, a small amount of bone marrow, blood and bone are removed through a needle. [3]
Staging Hodgkin's lymphoma:
After your doctor has determined the extent of your Hodgkin's lymphoma, your cancer will be assigned a stage. Your cancer's stage helps determine your prognosis and your treatment options.
Stages of Hodgkin's lymphoma include:
⦁ Stage I. The cancer is limited to one lymph node region or a single organ.
⦁ Stage II. In this stage, the cancer is in two lymph node regions or the cancer has invaded one organ and the nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
⦁ Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
⦁ Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.
Additionally, your doctor uses the letters A and B to indicate whether you're experiencing symptoms of Hodgkin's lymphoma:
⦁ A means that you don't have any significant symptoms as a result of the cancer.
⦁ B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats .[3]
Treatments and drugs:
Which treatment options are appropriate for your Hodgkin's lymphoma depends on your type and stage of disease, your overall health, and your preferences. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission.
Chemotherapy:
Chemotherapy is a drug treatment that uses chemicals to kill lymphoma cells. Chemotherapy drugs travel through your bloodstream and can reach nearly all areas of your body.
Chemotherapy is often combined with radiation therapy in people with early-stage classical type Hodgkin's lymphoma. Radiation therapy is typically done after chemotherapy. In advanced Hodgkin's lymphoma, chemotherapy may be used alone or combined with radiation therapy.
Chemotherapy drugs can be taken in pill form, through a vein in your arm or sometimes both methods of administration are used. Several combinations of chemotherapy drugs are used to treat Hodgkin's lymphoma.
Side effects of chemotherapy depend on the specific drugs you're given. Common side effects include nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers,such as leukemia.
Radiation:
Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. For classical Hodgkin's lymphoma, radiation therapy can be used alone, but it is often used after chemotherapy. People with early-stage lymphocyte-predominant Hodgkin's lymphoma typically 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.
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 forms of cancer, such as breast or lung cancer.[4]
Stem cell transplant:
A stem cell transplant is a treatment to replace your diseased bone marrow with healthy stem cells that help you grow new bone marrow. A stem cell transplant may be an option if Hodgkin's lymphoma returns despite treatment.
During a stem cell 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. [4]
Alternative medicine:
No alternative medicines have been found to treat Hodgkin's lymphoma. But alternative medicine may help you cope with the stress of a cancer diagnosis and the side effects of cancer treatment. Talk to your doctor about your options, such as:
⦁ Acupuncture
⦁ Aromatherapy
⦁ Massage
⦁ Meditation
⦁ Relaxation techniques [3]
Drug Combinations Used in Hodgkin Lymphoma:
ABVD
ABVE
ABVE-PC
BEACOPP
COPDAC
COPP
COPP-ABV
ICE
MOPP
OEPA
OPPA
STANFORD V
VAMP [3]
Coping and support:
A diagnosis of Hodgkin's lymphoma can be extremely challenging. The following strategies and resources may make dealing with cancer easier:
⦁ Learn about Hodgkin's lymphoma. Learn enough about your cancer to feel comfortable making decisions about your treatment and care. In addition to talking with your doctor, look for information in your local library and on the Internet. Start your information search with the National Cancer Institute and the American Cancer Society.
⦁ Maintain a strong support system. Having a support system and a positive attitude can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful.
⦁ Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But avoid setting goals you can't possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work at least part time. In fact, many people find that continuing to work can be helpful.
⦁ Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan for the downtimes when you may need to rest more or limit what you do.
⦁ Stay active. Receiving a diagnosis of cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It's important to stay active and involved as much as you can. [5]
Other prognostic factors:
Along with the stage of the Hodgkin disease, other factors can affect a person’s prognosis (outlook). For example, some factors mean the disease is likely to be more serious and might prompt the doctor to give more intensive treatment:
⦁ Having ⦁ B symptoms or bulky disease
⦁ Being older than 45
⦁ Being male
⦁ Having a high white blood cell count (above 15,000)
⦁ Having a low red blood cell count (hemoglobin level below 10.5)
⦁ Having a low blood lymphocyte count (below 600)
⦁ Having a low blood albumin level (below 4)
⦁ Having a high erythrocyte sedimentation rate, or ESR (over 30 in someone with B symptoms, or over 50 for someone without B symptoms). [6]
Non-Hodgkin's lymphoma
Definition:
Non-Hodgkin's lymphoma, also called non-Hodgkin lymphoma, is cancer that originates in your lymphatic system, the disease-fighting network spread throughout your body. In non-Hodgkin's lymphoma, tumors develop from lymphocytes — a type of white blood cell.
Non-Hodgkin's lymphoma is more common than the other general type of lymphoma — Hodgkin lymphoma.
Many different subtypes of non-Hodgkin's lymphoma exist. The most common non-Hodgkin's lymphoma subtypes include diffuse large B-cell lymphoma and follicular lymphoma.[7]
Symptoms:
Non-Hodgkin's lymphoma symptoms may include:
⦁ Painless, swollen lymph nodes in your neck, armpits or groin
⦁ Abdominal pain or swelling
⦁ Chest pain, coughing or trouble breathing
⦁ Fatigue
⦁ Fever
⦁ Night sweats
⦁ Weight loss[7]
Causes:
Doctors aren't sure what causes non-Hodgkin's lymphoma.
Non-Hodgkin's lymphoma occurs when your body produces too many abnormal lymphocytes — a type of white blood cell.
Normally, lymphocytes go through a predictable life cycle. Old lymphocytes die, and your body creates new ones to replace them. In non-Hodgkin's lymphoma, your lymphocytes don't die, but continue to grow and divide. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell. [8]
B cells and T cells:
Non-Hodgkin's lymphoma can begin in the:
⦁ B cells. B cells fight infection by producing antibodies that neutralize foreign invaders. Most non-Hodgkin's lymphoma arises from B cells.
Subtypes of non-Hodgkin's lymphoma that involve B cells include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt lymphoma.
⦁ T cells. T cells are involved in killing foreign invaders directly. Non-Hodgkin's lymphoma occurs less often in T cells.
Subtypes of non-Hodgkin's lymphoma that involve T cells include peripheral T-cell lymphoma and cutaneous T-cell lymphoma.
Whether your non-Hodgkin's lymphoma arises from your B cells or T cells helps to determine your treatment options. [8]
Where non-Hodgkin's lymphoma occurs:
Non-Hodgkin's lymphoma generally involves the presence of cancerous lymphocytes in your lymph nodes, but the disease can also spread to other parts of your lymphatic system. These include the lymphatic vessels, tonsils, adenoids, spleen, thymus and bone marrow. Occasionally, non-Hodgkin's lymphoma involves organs outside of your lymphatic system.[9]
Risk factors:
In most cases, people diagnosed with non-Hodgkin's lymphoma don't have any obvious risk factors, and many people who have risk factors for the disease never develop it. Some factors that may increase the risk of non-Hodgkin's lymphoma include:
⦁ Medications that suppress your immune system. If you've had an organ transplant, you're more susceptible because immunosuppressive therapy has reduced your body's ability to fight off new illnesses.
⦁ Infection with certain viruses and bacteria. Certain viral and bacterial infections appear to increase the risk of non-Hodgkin's lymphoma. Viruses linked to increased non-Hodgkin's lymphoma risk include HIV and Epstein-Barr virus. Bacteria linked to an increased risk of non-Hodgkin's lymphoma include the ulcer-causing Helicobacter pylori.
⦁ Chemicals. Certain chemicals, such as those used to kill insects and weeds, may increase your risk of developing non-Hodgkin's lymphoma. More research is needed to understand the possible link between pesticides and the development of non-Hodgkin's lymphoma.
⦁ Older age. Non-Hodgkin's lymphoma can occur at any age, but the risk increases with age. It's most common in people in their 60s or older.[9]
Tests and diagnosis:
Tests and procedures used to diagnose non-Hodgkin's lymphoma include:
⦁ Physical examination. Your doctor may conduct a physical exam to determine the size and condition of your lymph nodes and to find out whether your liver and spleen are enlarged.
⦁ Blood and urine tests. Blood and urine tests may help rule out an infection or other disease.
⦁ Imaging tests. Your doctor may recommend imaging tests to look for tumors in your body. Imaging tests may include X-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI) or positron emission tomography (PET).
⦁ Removing a sample of lymph node tissue for testing. Your doctor may recommend a biopsy procedure to sample or remove a lymph node for testing. Analyzing lymph node tissue in a lab may reveal whether you have non-Hodgkin's lymphoma and, if so, which type.
⦁ Looking for cancer cells in your bone marrow. To find out whether the disease affects your bone marrow, your doctor may request a bone marrow biopsy. This involves inserting a needle into your pelvic bone to obtain a sample of bone marrow.[10]
Treatments and drugs:
Your treatment options are determined based on the type and stage of your lymphoma, your age, and your overall health.[11]
Treatment isn't always necessary:
If your lymphoma appears to be slow growing (indolent), a wait-and-see approach may be an option. Indolent lymphomas that don't cause signs and symptoms may not require treatment for years.
Delaying treatment doesn't mean you'll be on your own. Your doctor will likely schedule regular checkups every few months to monitor your condition and ensure that your cancer isn't advancing.[11] .
Treatment for lymphoma that causes signs and symptoms:
If your non-Hodgkin's lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment. Options may include:
⦁ Chemotherapy. Chemotherapy is drug treatment — given orally or by injection — that kills cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or combined with other treatments.
⦁ Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancerous cells and shrink tumors. During radiation therapy, you're positioned on a table and a large machine directs radiation at precise points on your body. Radiation therapy can be used alone or in combination with other cancer treatments.
⦁ Stem cell transplant. A stem cell transplant is a procedure that involves very high doses of chemotherapy or radiation with the goal of killing the lymphoma cells that may not be killed with standard doses. Later, healthy stem cells — your own or from a donor — are injected into your body, where they can form new healthy blood cells.
⦁ Medications that enhance your immune system's ability to fight cancer. Biological therapy drugs help your body's immune system fight cancerFor example, one biological therapy called rituximab (Rituxan) is a type of monoclonal antibody that attaches to B cells and makes them more visible to the immune system, which can then attack. Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.
⦁ Medications that deliver radiation directly to cancer cells. Radioimmunotherapy drugs are made of monoclonal antibodies that carry radioactive isotopes. This allows the antibody to attach to cancer cells and deliver radiation directly to the cells. One radioimmunotherapy drug — ibritumomabtiuxetan (Zevalin) — is used to treat lymphoma.[11]
Coping and support:
A diagnosis of cancer can be overwhelming. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:
⦁ Learn enough about lymphoma to make decisions about your care. Ask your doctor about your non-Hodgkin's lymphoma, including your treatment options and, if you like, your prognosis. As you learn more about non-Hodgkin's lymphoma, you may become more confident in making treatment decisions.
⦁ Keep friends and family close. Keeping your close relationships strong will help you deal with your non-Hodgkin's lymphoma. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
⦁ Find someone to talk with. Find a good listener with whom you can talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. [11]
Drug Combinations Used in Non-Hodgkin Lymphoma
CHOP
COPP
CVP
EPOCH
Hyper-CVAD
ICE
R-CHOP
R-CVP
R-EPOCH
R-ICE [12]
What Is the Difference Between Hodgkin Lymphoma and Non-Hodgkin Lymphoma?
Although the diseases may sound similar, there are a variety of differences between Hodgkin and non-Hodgkin lymphoma.
Both Hodgkin and non-Hodgkin lymphoma are malignancies of a family of white blood cells known as lymphocytes, which help the body fight off infections and other diseases. Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, which are mature B cells that have become malignant, are unusually large, and carry more than one nucleus. The first sign of the disease is often the appearance of enlarged lymph nodes. Non-Hodgkin lymphoma, by contrast, can be derived from B cells or T cells and can arise in the lymph nodes as well as other organs. (B cells and T cells play different roles in the body’s immune response to disease.)
Both diseases are relatively rare, but non-Hodgkin lymphoma is more common in the United States, with more than 70,000 new cases diagnosed each year, compared to about 8,000 for Hodgkin lymphoma. The median age of patients with non-Hodgkin lymphoma is 60, but it occurs in all age groups. Hodgkin lymphoma most often occurs in people ages 15 to 24 and in people over 60. There are more than 60 distinct types of non-Hodgkin lymphoma, whereas Hodgkin lymphoma is a more homogeneous disease.
The two forms of lymphoma are marked by a painless swelling of the lymph nodes. Hodgkin lymphomas are more likely to arise in the upper portion of the body (the neck, underarms, or chest). Non-Hodgkin lymphoma can arise in lymph nodes throughout the body, but can also arise in normal organs. Patients with either type can have symptoms such as weight loss, fevers, and night sweats.
The diseases often follow different courses of progression. Hodgkin lymphoma tends to progress in an orderly fashion, moving from one group of lymph nodes to the next, and is often diagnosed before it reaches an advanced stage. Most patients with non-Hodgkin lymphoma are diagnosed at a more advanced stage.
Treatments for lymphoma vary depending on the type of disease, its aggressiveness, and location, along with the age and general health of the patient. As a general rule, however, Hodgkin lymphoma is considered one of the most treatable cancers, with more than 90 percent of patients surviving more than five years. Survival rates for patients with non-Hodgkin lymphoma tend to be lower, but for certain types of the disease, the survival rates are similar to those of patients with Hodgkin lymphoma. New treatment approaches, including the use oftherapies that spur the immune system to attack cancerous lymphocytes, are showing considerable promise. [13]
References:
Hoffman R, et al. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed June 6, 2014.
⦁ Hodgkin lymphoma. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed June 6, 2014.
⦁ What you need to know about Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/hodgkin. Accessed June 6, 2014.
⦁ Integrative medicine & complementary and alternative therapies as part of blood cancer care. The Leukemia & Lymphoma Society. http://www.lls.org/resourcecenter/freeeducationmaterials/treatment/integrativemedandcam. Accessed June 6, 2014.
⦁ Lymphoma SPOREs. National Cancer Institute. http://trp.cancer.gov/spores/lymphoma.htm. Accessed June 6, 2014.
⦁ Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. March 5, 2014.
⦁ Non-Hodgkin's lymphomas. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Dec. 10, 2014.
⦁ Hoffman R, et al. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Dec. 10, 2014.
⦁ Non-Hodgkin lymphoma. Leukemia & Lymphoma Society. http://www.lls.org/resourcecenter/freeeducationmaterials/lymphoma/nonhodgkin. Accessed Dec. 10, 2014.
⦁ What you need to know about non-Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/publications/patient-education/wyntk-non-hodgkin-lymphoma. Accessed Dec. 10, 2014.
⦁ Taking time: Support for people with cancer. National Cancer Institute. http://www.cancer.gov/publications/patient-education/taking-time. Accessed Dec. 10, 2014.
⦁ Lymphoma SPOREs. National Cancer Institute. http://trp.cancer.gov/spores/lymphoma.htm. Accessed Dec. 10, 2014.
⦁ http://blog.dana-farber.org/insight/wp-content/uploads/2015/07/Hodgkin_Non-Hodgkins-2017-edited.jp
