Lymphomas are cancers that develop in the lymph system, part of the body's immune system. They are divided into two general types, Hodgkin's and non-Hodgkin's. Hodgkin’s lymphoma (previously called Hodgkin’s disease) is distinguished by the presence of abnormal cells called Reed-Sternberg cells, visible under the microscope.

Adult Hodgkin's disease most commonly affects young adults and people older than 55. It may also be found in patients with HIV/Aids; these patients require special treatment. Hodgkin's disease can also occur in children, where it is treated differently from the disease in adults.

Symptoms


Symptoms may include:

    • Painless swelling of the lymph nodes in the neck, underarm or groin

    • Fever

    • Night sweats

    • Tiredness

    • Weight loss without dieting

    • Itchy skin



Diagnosis


A doctor should be seen if any of these symptoms persist for longer than two weeks.

Your doctor will carefully check for swelling or lumps in the neck, underarms and groin. If abnormal lymph nodes are present, a node must be surgically removed for analysis. The lymph node is sent to a laboratory, where it is evaluated by a specialist pathologist; the diagnosis will be confirmed and the subtype of lymphoma determined.

Several other tests are then required to ‘stage’ the disease (determine how far advanced it is). These may include CT (computerised tomography) scans of chest, abdomen and pelvis; analysis of bone marrow samples; and blood tests.

There are four stages of Hodgkin’s lymphoma:

Stage I


The disease involves only one group of nodes.

Stage II


More than one group of lymph nodes are involved, on one side of the diaphragm (either upper or lower part of the body, but not both).

Stage III


The disease involves lymph nodes on both sides of the diaphragm (upper and lower body), but not the bone marrow.

Stage IV


This is widespread disease, frequently involving the bone marrow.

Treatment


Treatment can be offered to all patients with adult Hodgkin's disease, with generally good survival rates. The chance of recovery and choice of treatment depend on the stage of the lymphoma; the size of the lymph node masses; test results; symptoms; and the patient's age, sex and general health.

Two types of treatment are used to kill cancer cells and shrink tumours: radiation therapy (high-dose X-rays) and chemotherapy (drugs).

    • Chemotherapy drugs may be taken by pill, or may be injected into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and kill cancer cells throughout the body.

    • For Hodgkin's lymphoma, radiation is usually delivered by a machine outside the body (external-beam radiation therapy). Radiation therapy may be limited to the ‘mantle field’ – the neck, chest and lymph nodes under the arms. If it is also given to the spleen and the lymph nodes in the upper abdomen and pelvis, it is called total nodal irradiation.



Depending on the stage of the disease, or if the disease recurs, different combinations of therapy may be used. Chemotherapy is the mainstay of treatment, but combination therapy (chemo- together with radiation therapy) is common. Radiation therapy alone is restricted to patients with very early-stage disease.

A bone-marrow transplant is needed in some cases. If the lymphoma is resistant or responds slowly to treatment, high-dose chemotherapy is used, destroying bone marrow. For this reason, some of the patient’s own blood stem cells are gathered beforehand. (Cells may also come from someone else, eg. a compatible sibling.) After chemotherapy, the cells are given back to the patient intravenously. They return to the bone marrow, where they replicate, replacing destroyed tissue.

Not all patients are cured with standard therapy and some standard treatments may have undesirable side effects. Five to 15 years after treatment, some patients develop another form of cancer as a result of their treatment; for this reason, patients should have regular check-ups.

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