Hodgkin’s lymphoma

Illness description

This is a malignant lymphoma, also known as Hodgkin’s disease or Hodgkin-Sternberg-Paltauf disease. The histological hallmark of this disease (observable under a microscope) is Reed-Sternberg cells. These cells are a necessary but not sufficient condition for diagnosing Hodgkin’s lymphoma.

Initially, the disease is local – affecting lymph nodes. In later stages, it becomes systemic, meaning it involves not only the lymphatic system but also other systems such as bone marrow, liver, etc. The incidence is 2-4 cases per 100,000 people per year. Men are more commonly affected than women. The cause of the disease is unclear, but it is believed that oncogenic viruses, such as Epstein-Barr, may play a significant role.

Symptoms

General symptoms include fever, night sweats, weight loss, reduced performance, itching, occasional lymph node pain (especially after consuming alcohol).

Painless enlargement of lymph nodes occurs in 80-90% of cases. They are most commonly found in the neck area, less frequently in the groin or armpits. They can also occur in the mediastinum, abdominal area (with frequent fever in these cases).

Possible enlargement of the liver and spleen, signs of neurological, endocrine, urogenital, and other system involvement.

Diagnosis

A blood test may show an increased erythrocyte sedimentation rate (ESR), sometimes elevated LDH. There may be signs of anemia. The lymphocyte count decreases, and in a third of cases, there may be an increase in eosinophils. It is necessary to perform a histological examination under a microscope, taking a sample of the tissue (biopsy), chest X-ray, or computed tomography. Abdominal ultrasound/computed tomography, bone scintigraphy, and biopsy if bone involvement is suspected.

Treatment

Treatment and prognosis depend on the histological classification and stage of Hodgkin’s lymphoma. With a favorable prognosis, radiation therapy is used. For the intermediate prognosis group, a combination of radiation therapy and chemotherapy (medication) is applied. The unfavorable prognosis group is treated with polychemotherapy.

Treatment for disease recurrence is based on the effectiveness of the initial treatment. It may require repeat chemotherapy, bone marrow transplantation, or peripheral stem cell transplantation.

Patients are monitored after treatment because the disease often recurs within the first 5 years after the initial course of treatment.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology