Hodgkin’s Disease (Hodgkin’s Lymphoma) - Types, Symptoms, Causes, Stages, and Treatment

Introduction:

Hodgkin’s disease (HD), now known as Hodgkin’s lymphoma or Hodgkin lymphoma, is a type of blood cancer that originates in the lymphatic system. The lymphatic system removes waste and fights off infection in the body. This cancer originates in the white blood cells (lymphocytes), which are the cells that protect the body against infections. In HD, lymphocytes grow abnormally in the lymphatic system and spread beyond it. In advanced cases, the body is not able to fight off infections effectively.

HD can affect people of any age, but it is commonly seen in people between 20 and 40 years and those older than 55 years. Hodgkin’s lymphoma is one of the two types of lymphomas, the other being non-Hodgkin’s lymphoma, which is more common.

What Are the Types of Hodgkin’s Disease?

There are two types of Hodgkin’s disease based on the cells involved. They are:

1. Classical Hodgkin’s lymphoma - this is the more common type. In this type, large cancer cells called Reed-Sternberg cells can be seen in the lymph nodes. The subtypes include:

   1. Nodular sclerosing Hodgkin lymphoma (NSHL).

   2. Mixed-cellularity Hodgkin lymphoma (MCHL).

   3. Lymphocyte-rich classical Hodgkin lymphoma (LRHL).

   4. Lymphocyte-depleted Hodgkin lymphoma (LDHL

2. Nodular lymphocytic-predominant Hodgkin’s lymphoma (NLPHL) - this is the rarer type. Here, large cells, called popcorn cells, are seen in the lymph nodes. The prognosis is better if it is diagnosed early.

HD is believed to be caused by DNA mutations and infection with EBV (Epstein-Bar virus), but the exact cause is still not known. With the recent advances in the treatment of Hodgkin's disease, more patients suffering from this cancer are making a full recovery.

What Are the Signs and Symptoms of Hodgkin’s Disease?

Swollen or enlarged lymph nodes are the most common sign of Hodgkin’s disease. This swelling results in a lump under the skin, which is usually painless. The lymph nodes in the neck, armpit, and groin can get enlarged. The other symptoms of this cancer are:

• Night sweats.

• Fever.

• Tiredness or fatigue.

• Itchy skin.

• Losing weight without trying.

• Chest pain.

• The lymph nodes might pain after drinking alcohol.

• Chronic cough.

• Breathing problems.

• Splenomegaly (enlarged spleen).

If you have any of these symptoms, consult a doctor immediately.

What Causes Hodgkin’s Disease?

As doctors do not the exact cause of this disease, the following are believed to play a role:

1. Epstein-Barr virus (EBV) infection - EBV is said to cause Hodgkin’s disease, which is the same virus responsible for infectious mononucleosis (mono).

2. Genetics - you are at a high risk of getting this cancer if one of your parents or your identical twin or same-sex sibling has it.

3. Age - it is commonly diagnosed in people between 20 and 40 years of age and older adults above 55 years.

4. Sex - males are more susceptible than females.

How Does a Doctor Diagnose Hodgkin’s Disease?

The doctor will take a complete personal, family, and medical history. Then the doctor will check for swollen lymph nodes in your neck, groin, and armpit, and see if your spleen or liver is enlarged. Then based on your symptoms and history, if the doctor suspects Hodgkin’s disease, he or she will suggest you get the following tests done:

1. Blood tests - CBC (complete blood count) is done to see the levels of white and red blood cells and platelets.

2. Imaging tests - X-ray, CT, and positron emission tomography are used to look for signs of Hodgkin's lymphoma.

3. Immunophenotyping - to detect the type of lymphoma cells.

4. Lymph node biopsy - an enlarged lymph node is removed for testing. The lymph node is then tested for the presence of abnormal cells called Reed-Sternberg cells or popcorn cells.

5. Bone marrow biopsy - a sample of the bone marrow is taken for testing. Here, a needle is inserted into the hipbone and a sample of the bone marrow is aspirated.

What Are the Stages of Hodgkin’s Disease?

After the diagnosis of HD is made, the doctor will then stage cancer. The following are the stages of HD:

1. Stage 1 - Early stage - cancer cells are present in one lymph node or a single area of an organ.

2. Stage 2 - Locally advanced disease - cancer cells are present in two lymph nodes on a single side of the diaphragm (the muscle under your lungs) or cancer cells found in one lymph node and a nearby organ.

3. Stage 3 - Advanced disease - cancer cells are found in lymph nodes present both above and below the diaphragm or cancer cells seen in one lymph node and an organ on opposite sides of the diaphragm.

4. Stage 4 - Widespread disease - cancer cells found outside the lymph nodes and has spread to other parts, such as liver, bone marrow, etc.

What Are the Treatment Options for Hodgkin’s Disease?

Your treatment plan will depend on the type and stage of Hodgkin’s lymphoma, and overall health. The treatment options include:

1) Chemotherapy - here, drugs are used to kill abnormal cancer cells. These drugs travel through the bloodstream and reach all areas of the body. It is often combined with radiation therapy to treat people with early-stage lymphoma. Chemotherapy drugs are either administered orally or can be injected into the vein. The side effects include hair loss, nausea, and fertility problems.

2) Radiation therapy - this treatment uses high-energy X-rays and protons to destroy cancer cells. This is often used after chemotherapy. During therapy, the patient lies flat on the table and a large arm of a machine moves around the affected body part. The rays are projected towards the affected lymph nodes. The common side effects are skin redness, hair loss, heart disease, stroke, infertility, etc.

3) Bone marrow transplant - otherwise called stem cell transplant. Here, cancer affected bone marrow is replaced with healthy bone marrow. Once the bone marrow is removed and stem cells are frozen to use later, high-dose chemotherapy and radiotherapy are used to destroy cancerous cells. Then the stem cells are injected back in the body through the veins.

4) Immunotherapy - these drugs focus on specific vulnerabilities in the cancer cells. They activate your immune system to kill abnormal lymphocytes. This treatment option is used if other treatments have not been effective or if cancer recurs.

The average five-year survival rate for people diagnosed with HD is 86 % and the 10-year survival rate is 80 %. The survival rates may vary depending on the stage of cancer and the patient’s age. For more information on Hodgkin’s disease, consult an oncologist online!