Hodgkin lymphoma
(Hodgkin's lymphoma; Hodgkin's disease)
by Carol S. Portlock, MD, Professor of clinical Medicine, Weill Cornell University Medical College; Attending Physician, Lymphoma Service, Memorial Sloan-Kettering Cancer Center
Hodgkin's lymphoma is a type of lymphoma characterized by the presence of a specific type of cancer cells called Reed-Sternberg cells.
His cause is unknown.
Lymph nodes are hypertrophy but not painful.
Other symptoms, such as fever and shortness of breath, appear depending on where the cancer cells develop.
A lymph node biopsy is necessary to make the diagnosis.
The treatment is done by chemotherapy and radiation therapy.
Most people heal.
In the United States, there are about 9 000 new cases of Hodgkin's lymphoma per year. The disease affects men more frequently than women; The report is about three men for two women. Hodgkin's lymphoma rarely occurs before the age of 10 years. It is common between 15 and 40 years and in persons over 50 years of age.
The cause of Hodgkin's lymphoma is unknown. Although in some families several people are infected with Hodgkin's lymphoma, it is not contagious.
Symptoms
A person with Hodgkin's lymphoma usually has one or more hypertrophied lymph nodes located most often at the neck level, but sometimes also at the armpit or groin level. Although generally not painful, these hypertrophied lymph nodes can sometimes become a few hours after consuming alcoholic beverages.
People with Hodgkin's lymphoma sometimes have fever, night sweats and weight loss. They can also be itchy and tired. Some present a Pel-Ebstein fever, an unusual type of high temperature for several days alternating with a few days to a few weeks of normal or below normal temperature. Other symptoms may appear, depending on the location of the cancer cells. For example, hypertrophy of the thorax may cause partial obstruction and irritation of the airways, which induces cough, chest discomfort or shortness of breath. An increase in the volume of the spleen or the lymph nodes in the abdomen may cause abdominal discomfort.
Diagnosis
Hodgkin's lymphoma is suspected when a person with no obvious cause of infection has a persistent, non-painful increase in the volume of his lymph nodes for several weeks. This hypothesis is particularly well-founded when lymph gland hypertrophy is associated with fever, night sweats and weight loss. Ganglion Hypertrophys of rapid and painful onset, such as in cases of cold or infection, are not typical of Hodgkin's lymphoma. Sometimes, hypertrophied lymph nodes at the thorax and abdomen are accidentally discovered during an X-ray or CT scan (CT) of the thorax, performed for another reason.
Abnormalities in blood count and other blood tests provide important diagnostic help. However, to make the diagnosis, physicians must perform a biopsy on a affected lymph node to verify that it is abnormal and that it contains Reed-Sternberg cells. Reed-Sternberg cells are large cancerous cells that contain several nuclei (a structure within a cell that contains the genetic material of the latter). Their characteristic appearance can be demonstrated after microscopic examination of a biopsy ganglionic tissue sample.
The type of biopsy depends on the ganglion concerned and the amount of tissue needed. A sufficient amount of tissue must be taken to distinguish Hodgkin's lymphoma from other disorders, such as enlarged lymph nodes, including non-Hodgkin lymphomas, infections or other cancers.
The best way to obtain a sufficient tissue sample is to perform a ganglionic biopsy with resection (a small incision is made to remove a portion of the ganglion). Sometimes, when the hypertrophied ganglion is superficial, a sufficient tissue sample can be taken by puncturing the ganglion using a needle through the skin (biopsy or needle biopsy). In the case of hypertrophied lymph nodes at the abdominal or thoracic level, surgery may be required to collect a tissue sample.
Staging
Before any treatment, doctors must determine the degree of spread of lymphoma, i.e. its stage. The choice of treatment and the prognosis depend on it. The initial assessment may show only one hypertrophied ganglion, but the tests performed to assess the extent of the disease (staging) may reveal a much more advanced disease.
The disease is classified in four stages, defined according to the extent of its extension (I, II, III, IV). The higher the stage, the more disseminated the lymphoma. The four stages are subdivided according to the absence (a) or presence (B) of one or more of the following symptoms:
Unexplained fever (over 37.5 °c for 3 consecutive days)
Sweats
Unexplained loss of more than 10% of body weight over the previous 6 months
For example, a person who has stage II Hodgkin's lymphoma and who has nocturnal sweats will by definition have stage IIB Hodgkin's lymphoma.
Different tests are performed to classify or define the stage of Hodgkin's lymphoma. Standard tests include routine blood balances, liver and renal function tests, human immunodeficiency virus (HIV) screening and hepatitis B and C infection, chest x-rays and CT (CT) of the thorax, abdomen and pelvis. The TDM can be used to pinpoint the hypertrophied lymph nodes or the spread of lymphoma at the liver and other organs.
Positron emission tomography (PET) is the most sensitive technique for determining the stage of Hodgkin's lymphoma and evaluating the person's response to treatment. As living tissues can be identified by PET, the doctor may use this imaging technique to distinguish a scar tissue from a tissue still reached by Hodgkin's lymphoma despite treatment (although pet is not always Precise because it also identifies the areas of ignition). For most people with Hodgkin's lymphoma, surgery is not necessary to determine if the disease has spread in the abdomen, as all patients receive chemotherapy that treats lymphoma, what Its location.
Prognosis and treatment
With chemotherapy, with or without radiation therapy, the majority of people with Hodgkin's lymphoma can be cured.
Chemotherapy is used at all stages of the disease. Several chemotherapeutic agents are generally used. Several associations can be used. Radiotherapy of the field reached (radiotherapy located only to affected areas of the body, which avoids exposing the healthy regions to radiation) can be added after chemotherapy. Radiation therapy is usually carried out in ambulatory, about 3 to 4 weeks.
More than 80% of people with stage I or II lymphoma are cured by chemotherapy alone, or associated with localized radiation therapy. The stage III healing rate is between 70 and 80%. The recovery rate at stage IV, although not as high, is greater than 50%.
Although chemotherapy significantly increases the likelihood of healing, its side effects can be severe. Anticancer patients may cause temporary or permanent sterility, increased risk of infection, possible lesions in other organs, such as the heart or lungs, and reversible loss of hair. After radiotherapy, the risk of cancers, such as lung, breast or stomach cancer, is increased and occurs 10 or more years after treatment in irradiated organs. Non-Hodgkin's lymphoma may develop in some people many years after successful treatment for Hodgkin's lymphoma, regardless of the treatment used.
A person in remission (whose disease is under control) after an initial treatment but then relapse (lymphoma cells reappear) can still be cured using a second-line treatment. The recovery rate for relapsing persons is at least 50%. The recovery rate is quite low when relapse occurs in the first 12 months after the initial treatment, whereas this rate tends to be higher when the relapse is delayed. People who relapse after initial treatment usually receive "rescue" chemotherapy, followed by high-dose chemotherapy and autologous stem cell grafting. Autologous stem cell transplantation, which uses the person's own stem cells (stem cell transplant), can be done after high doses of chemotherapy. High-dose chemotherapy associated with a stem cell transplant is usually a safe procedure, with less than 1-2% risk of death from treatment.
Following treatment, medical consultations and examinations are regularly conducted to exclude recurrence of lymphoma (post-treatment surveillance). The tests generally performed are X-rays and CT of the thorax and pelvis. If the person has already received radiation therapy, a mammogram or magnetic resonance imaging (MRI) of the breasts and thyroid tests is also practised to verify that a new cancer has not developed in these organs.
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