I hope you all had a merry Christmas and wonderful holiday! It may not be the a very festive post today but since I heard some sad news that a very dear friend of mine was diagnosed with Hodgkin's Lymphoma, and never hearing of it before, I thought that it would be a good idea to spend some time writing on the disease to shed some light on for those who may want to learn more about it.
To understand Hodgin's, it is helpful to have a basic understanding of the lymphatic system. It is a system that is one of the body's defenses against infections and diseases made up of lymphatic organs such as bone marrow, tonsils, thymus, spleen and lymph nodes. Lymph nodes are throughout the body, although are mainly found in the neck, armpit and groin, and are connected by a network of tiny lymphatic tubes. Circulating in the lymphatic vessels are a fluid called lymph that contains something called lymphocytes which are also known as white blood cells. They are a significant part of our immune system, essential at fighting viruses, bacteria and other foreign bodies that threaten our health. They are produced inside the bone marrow and stored in our blood and lymphatic tissues.
As lymph circulates the body, the fluid passes through the lymph nodes which filter out bacteria that cause infection. Sometimes, if you have a cold, the lymph nodes in your neck may get larger which is a sign that your body is fighting the infection. There are two main types of white blood cells (lymphocyte) - T-cells and B-cells. While both types develop in the bone marrow from immature cells to stem cells, T-cells mature in the thymus gland and B-cells mature in the bone marrow or lymphatic organs.
Here is a diagram showing the lymphatic system is green all over the body.
In summary, the lymphatic system is composed of a series of vessels that are all over the body which drain fluid from tissues. Bacteria and other microbes are picked up in the lymphatic fluid and trapped inside lymph nodes where they are attacked and destroyed by white blood cells.
Hodgkin's Lymphoma
It is a cancer of the lymphatic system and can be divided into two main types:
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Its cause is unknown, however, there are some risk factors that may contribute to its development including poor immunity and previous exposure to the Epstein Barr virus which causes glandular fever. It is most common in younger people aged 20-34 and older people aged 70-79. Having a member of the family with Hodgkin lymphoma may slightly increase someone's risk of getting it, but it is not known whether this is caused by an inherited faulty genes or because families may have similar lifestyle factors that affect their risk.
Symptoms
The first is usually a swelling in the neck, armpit or groin which are usually painless but some find that they ache. Other symptoms may include frequent sweats, especially at night, unexplained high temperatures, weight loss, tiredness, a cough or breathlessness or a persistent itch all over the body. A few people with Hodgkin lymphoma have abnormal cells in their bone marrow when diagnosed which can lower the number of healthy blood cells in the blood which in turn, can cause breathlessness and tiredness, increased risk of infection and/or excessive bleeding. When diagnosing a patient, the doctor may take blood tests and a chest x-ray and a definite diagnosis is made by a biopsy where the removal of an enlarged lymph node or part of it is examined under a microscope.
Staging
- Stage 1: one group of lymph nodes is affected
- Stage 2: two or more groups of lymph nodes are affected on the same side of the diaphragm
- Stage 3: lymph nodes above and below the diaphragm are affected
- Stage 4: the lymphoma has spread outside the lymph nodes to organs such as the liver, bones or lungs
If the Hodgkin lymphoma comes back after initial treatment, this is known as recurrent lymphoma. As well as a stage, doctors use a letter: A or B, to show whether or not you have certain symptoms (unexplained high temperatures, drenching night sweats, for example). If the patient doesn't have these symptoms, the doctor will prescribe the letter A next to the stage. If the patient has one or more of these symptoms, the letter B is prescribed next to the stage.
Treatment
Luckily, with current treatment the majority of people with Hodgkin's lymphoma can be cured. The main types of treatment are chemotherapy and radiotherapy and a treatment plan would be decided based on the results of the staging tests and other factors such as age, general health, what parts of the body is affected and specific type of Hodgkin lymphoma.
Chemotherapy involves the use of anti-cancer, also known as cytotoxic, drugs to destroy the lymphoma cells by disrupting their growth and can reach lymphoma cells anywhere in the body through the bloodstream. The drugs can be administered as tablets or capsules or by injection into a vein in your arm which is called intravenously. A combination of several drugs is normally given over a few days followed by a break and would continue from 2 to 6 months depending on the stage of lymphoma.
Radiotherapy treats cancer by the use of high-energy rays that destroy the cancer cells while doing as little harm as possible to normal cells because it only treats the area of the body it is aimed at. This is usually provided after a course of chemotherapy for early-stage disease as part of the overall treatment. In more advanced stage disease, it may be used after after chemotherapy to treat areas where there may still be cancer.
Another treatment is called high-dose treatment with stem cell support for Hodgkin lymphoma. This is a high-dose chemotherapy treatment if the standard chemotherapy had not completely gotten rid of the disease and may also be used if the lymphoma reoccurs. High doses of chemotherapy destroy the bone marrow where blood cells are usually made which means stem cells must be collected from your body at a time when you are well - this is called stem cell harvest. The stem cells are collected by a process where blood is removed through a needle in your arm and it is then passed through a machine called a cell separator where stem cells are separated from the rest of your blood. Alternatively, stem cells can be collected from your bone marrow. Stem cells are then frozen and kept in storage until the patient receives high-dose treatment and once it is administered, stem cells are thawed and given back through a drip to support their immune system.
Steroid therapy involves steroids, such as prednisolone or dexamethasone, which are drugs that are often given with chemotherapy to help treat Hodgkin lymphoma which may help the patient feel better and reduce nausea.
Possible long-term effects from the treatment may be permanent infertility from some chemotherapy drugs. Both chemotherapy and radiotherapy can also lead to a slightly increased risk of developing another cancer later in life.
Hope this has been informative and, as always, thanks for reading
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