Hodgkin Lymphoma
Hodgkin lymphoma is a rare form of lymphoma characterised by a particular abnormal tumour cell - Reed Sternberg - not present in other forms of lymphoma. Over 62,000 people worldwide are diagnosed with Hodgkin lymphoma each year, of those 38,000 (60%) are male and 24,000 (40%) are female. Approximately 25,000 people worldwide die each year from the disease (1).
Non-Hodgkin Lymphoma (NHL)
Any lymphoma that is not Hodgkin lymphoma is classified as non-Hodgkin lymphoma. There are more than 30 different subtypes of non-Hodgkin lymphoma, which are generally classified into two equal groups, depending on the rate at which the tumour is growing.
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Indolent (low-grade): Tumour cells divide and multiply slowly making initial diagnosis difficult. Patients may live many years with the disease, yet standard treatment cannot cure the disease in its advanced stages.
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Aggressive (intermediate/high grade): Tumour cells divide and multiply rapidly in the body and, if left untreated, can be fatal within six months to two years. Unlike indolent NHL, treatment of aggressive NHL can lead to patients being cured.
Common Symptoms of Hodgkin Lymphoma
The effects that Hodgkin lymphoma has on the body - and hence the symptoms that are experienced - will depend on where the cancer cells are located and what parts of the body are involved.
Enlarged lymph node 'lumps': the lymph nodes become enlarged because of the growth of lymphoma cells - abnormal lymphocytes (a type of white blood cell) - which divide and form more lymphoma cells. Hodgkin lymphoma often starts in the neck or chest area but may also occur in other parts of the body. As these lumps of lymphoma cells grow they affect the surrounding area causing pain and/or irritation – for example, a lump in the neck/throat area may cause a cough. While this may not seem a serious symptom, the lumps will continue to grow if not treated and can spread to other parts of the body.Immune system problems: the body uses healthy lymphocytes to fight infection. In Hodgkin lymphoma cancer cells are produced instead of normal lymphocytes, leaving the body with less healthy cells to protect it from infection, even a simple cold. Cancer cells in the immune system can also cause it to react as if it is fighting infection - symptoms such as night sweats, fevers and unexplained weight loss (called “B symptoms”) are commonly experienced in someone with Hodgkin lymphoma.Other symptoms: Hodgkin lymphoma can grow in other parts of the body and so can interfere with the normal function of that particular part of the body. For example, Hodgkin lymphoma can grow in the bone marrow which can cause problems with the production of new blood cells. A growing tumour will also compete with the healthy cells and organs of the body for energy and blood supply
Diagnosis
How is Hodgkin lymphoma diagnosed?
As the symptoms of Hodgkin lymphoma are not specific, a person may initially see their doctor because of lymph node swelling or general symptoms such as fatigue or lacking energy. More serious B symptoms such as severe weight loss, fever and night sweats may also be reported prior to diagnosis. The doctor will detect swollen lymph nodes during a physical examination but the confirmation of Hodgkin lymphoma requires a tissue biopsy. The presence of Reed-Sternberg cells found under microscopic examination of the tissue biopsy confirms the diagnosis of Hodgkin lymphoma.
What is a biopsy?
A lymph node biopsy is a crucial step in diagnosing Hodgkin lymphoma. It involves the removal of a sample of tissue (cells) from an affected lymph node; this is usually performed by a surgeon. The cells are then examined under a microscope to look for the presence of Reed-Sternberg cells.
A bone marrow biopsy may also be performed to see if the lymphoma has spread to the bone marrow. Using local anaesthetic, a needle is inserted through the skin into the hip bone (pelvis) and marrow is drawn up in the needle. These cells are also examined under a microscope to see if any Reed-Sternberg cells are present in the bone marrow.