Treatment of Hodgkins lymphoma in Germany
Hodgkin's Lymphoma is a malignant oncological disease when tumours develop from the lymphoid tissue. The substrate for its growth is Reed-Sternberg-Berezovsky cells or their predecessors - Hodgkin cells.
This disease counts for about 1% in the structure of malignancies, and for about 30% of all malignant lymphomas. Males are more prone to suffer from this disease than females.
Causes of Hodgkins lymphoma
Main risk factors of the disease:
- Infectious mononucleosis (the causative agent - the Epstein-Barr virus) in the medical history
- Hereditary background
- Exposure to chemicals
Hodgkin lymphoma disease peaks observed in 20-30 years and 60-75 years.
Hodgkins lymphoma - Symptoms
Hodgkin lymphoma can show various clinical scans, since it affects the organs and lymph nodes in different parts of the body.
All the symptoms are divided into local and general:
General symptoms are observed among the 30% of patients. It can be fatigue, itchy skin, high body temperature, weight loss, pain in the joints and bones. The temperature can rise up to 39-40 degrees.
Local symptoms depend on the location of the pathological process. In 90% of cases the lymph nodes above the diaphragm are affected.
These are the following statistics:
- In about 50% of patients the disease begins with enlarged neck lymph nodes.
- In 25% of the cases subclavian lymph nodes include first into the pathological process. They rarely reach large sizes.
- 15% of patients get swollen lymph nodes under the armpits.
- While 10% of patients experience swollen mediastinal nodes first. They can grow into nearby structures, causing the corresponding symptoms: a cough with a deep breath, pain in the chest. While increasing the mediastinal nodes can reach large sizes - 5-10 cm and more.
With the location of Hodgkin’s lymphoma below the diaphragm the retroperitoneal lymph nodes can be affected. In this case, the disease is asymptomatic for a long time. This is followed by the numbness in the lumbar region, flatulence, abdominal pain. The symptoms can increase with the intake of small doses of alcohol.
Hodgkin's lymphoma that occurs with a primary lesion of inguinal-femoral or iliac lymph nodes is characterised of a poor prognosis. The main symptom is the cramping pain in the lower abdomen. Lower limbs edema is observed due to the violation of lymphatic drainage.
Other symptoms, depending on the affected organs are:
- Enlargement of the spleen (sooner or later, this organ will be involved in the pathological process in 60-70% of patients)
- Cough, shortness of breath, coughing up blood (lungs are affected at some stage of the disease in 30% of patients)
- Pain in the bones (bone tissue is affected among 20% of patients, 50% of which affects the vertebrae)
- Bitter taste in the mouth, heaviness in the right upper quadrant, jaundice (liver is affected among 10-20% of patients)
Other organs and tissues can be affected rarely and this is what confirms the corresponding clinical scan: skin, thyroid, heart, mammary glands, the structure of the urogenital system.
Hodgkins lymphoma - Diagnostics
Hodgkin's lymphoma can be suspected in the early stages by the swollen lymph nodes and the intolerance to alcohol consumption. To confirm the diagnosis instrumental and laboratory tests are needed. The main of them are:
X-ray methods. Radiography and fluoroscopy are the methods that can detect enlarged lymph nodes.
Open biopsy of a lymph node is used to confirm the diagnosis. Unlike puncture biopsy (with a needle), it is more informative as it allows histological examination of biopsy and produces fewer false positive and false negative results. To take a biopsy of a lymph node the fragment from the first swollen lymph node is taken.
Ultrasound, CT, MRI is used to assess the prevalence of pathological process and determine the stage of Hodgkin's lymphoma. On the basis of this information, as well as the data of histological examination of lymph node biopsy the prognosis is made and therapeutic strategy selected.
Stages of Hodgkins lymphoma
Stage of the Hodgkin's lymphoma is determined on the basis of the manifestations of intoxication and locations affected of anatomical structures by the pathological process.
Stage 1. One lymphatic area or extra lymphatic organ (tissue) is damaged.
Stage 2. Several lymph zones on one side of the diaphragm or localized lesions of any organ and its regional lymph nodes on one side of the diaphragm are damaged.
Stage 3. Lymph nodes are damaged on the both sides of the diaphragm. The combination with the organs and tissues damage is possible.
Stage 4. Multi centre damage of the organs, their lymph nodes, or the defeat of a single organ, as well as distant lymph nodes is possible.
Each stage is divided into A and B, depending on the symptoms. “A” is determined if there is no expressed intoxication. “B” is determined if pyrexia (fever above 38 degrees for three consecutive days or more) is observed or a reduction in body weight is no less than 10% in six months.
Treatment of Hodgkins lymphoma abroad
Main methods of treatment are radiation therapy and chemotherapy. Best results are achieved with the combination of both radiation and chemotherapy. The treatment regimen is selected based on the stage of the disease and the patient's age. Radiation therapy involves the focused irradiation of swollen lymph nodes, as well as prophylactic irradiation of neighbouring structures. Chemotherapy is carried out using a combination of several drugs.
Some patients can have the transplantation of stem cells. Surgery is required for patients with refractory (remission is not achieved, in spite of the treatment given) or recurrent form of the Hodgkin's lymphoma. Stem cells for transplantation are taken from peripheral blood or bone marrow. Patient’s own and donor stem cells can be used.
Hodgkins lymphoma - Prognosis
The survival rate of patients with Hodgkin's lymphoma depends on the course of the disease. The basic risk factors affecting prognosis are determined. Without these factors, the five-year survival rate is 84%.
Each risk factor reduces it by an additional 7%. Among them are the following factors:
- The level of hemoglobin in the blood is less than 105 g / l
- Leukocytosis is 15 thousand / ml or above
- Blood albumin is less than 40 g / l
- Patient age is older than 45 years
- Male sex patient
- Level of lymphocytes in the blood is less than 600 l
- Stage 4 of Hodgkin's lymphoma
Among other adverse prognostic factors are: loss of 3 or more groups of lymph nodes, ESR greater than 50 mm / h, the presence of lymph nodes larger than 10 cm, the massive damage of the mediastinum or spleen.
The five-year survival rate of patients, depending on the stage is:
- Stages 1-2 with no risk factors (favourable prognosis) - 90-100%;
- Stages 1-2 with risk factors (intermediate prognosis) - 80%;
- Stages 3-4 (unfavourable prognosis) - 50-70%.
New treatment regimens for patients with Hodgkin's lymphoma are constantly developing, so a five-year survival rate is on the increase.
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc