Lymphoma is a cancer of the lymphatic system, which is composed of the lymph nodes and other immunological and blood-forming organs. Hodgkin’s lymphoma (HL) is a subtype of lymphoma with unique characteristics. Dr. Thomas Hodgkins, an English physician and pathologist first described this disease in 1832.
The National Cancer Institute estimates that there are 78,00 new cases of Hodgkin’s lymphoma per year in the United States and 62,329 new cases in the world each year. It is more common in men than women and more common in whites than in Asians. New cases occur most frequently in young people and individuals older than 50.
Patients with Hodgkin’s lymphoma may have a number of signs and symptoms, including enlarged lymph nodes, unexplained weight loss, fever, night sweats, itching, and intermittent fever. On examination, they may have an enlarged spleen or enlarged liver. Less common but also seen are chest pain, cough, shortness of breath, coughing of blood, and nervous system problems.
While the cause of this cancer is unknown, the Epstein-Barr virus is thought to have some relationship with the lymphoma. Patients with HIV infection also have a higher incidence of Hodgkin’s lymphoma than the general population. A thorough history, physical examination, and laboratory studies of the blood and imaging techniques may direct a physician toward the diagnosis of Hodgkin’s lymphoma, but the definitive diagnosis must be made with examination of the cancer tissue. This may be obtained from a biopsy of a lymph node. All Hodgkin’s lymphoma tissue reveals characteristic Reed-Sternberg cells when the cancer tissue is examined under the microscope.
The World Health Organization (WHO) classifies HL into five types based on tissue findings. Sixty to 80 percent of all cases are nodular sclerosing type, 15–30 percent are the mixed-cellularity type, less than one percent are lymphocyte depleted, five percent are lymphocyte rich, and five percent are nodular lymphocyte-predominant type. The nodular sclerosing type is frequently observed in adolescents and young adults.
Staging of Hodgkins lymphoma is most commonly done clinically with the Ann Arbor classification. Stage 1 denotes cancer involving a single lymph node area or single extranodal site. Stage 2 is cancer involving two or more lymph node areas on the same side of the diaphragm. Stage 3 denotes lymph node areas on both sides of the diaphragm involved. Stage IV indicates disseminated or multiple involvement of extranodal organs. “A” or “B” designations indicate the absence or presence of B symptoms. B designation signifies the presence of either fever or unexplained loss of more than 10 percent of body weight in the last six months. A designation is the absence of any B symptoms. The stage of HL correlates indirectly with prognosis; in other words, the farther the spread of the disease, the poorer the prognosis.
Treatment options for HL include radiation therapy, chemotherapy, and high-dose chemotherapy with transplantation. There are several possible combinations of chemotherapy, but the standard regimen now in use is ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine).
Prognosis of patients with HL is dependent on the staging of the cancer. The statistic “five-year survival” indicates the percentage of people who are alive five years after their diagnosis. The five-year survival rate for patients with stage I and II Hodgkins lymphoma is 90 percent, for stage III is 84 percent, and for stage IV is 65 percent.
Cancer (General); Lymphoma; Non-Hodgkin’s Lymphoma.
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