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.
Main risk factors of the disease:
Hodgkin lymphoma disease peaks observed in 20-30 years and 60-75 years.
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:
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:
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.
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.
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.
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.
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:
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:
New treatment regimens for patients with Hodgkin's lymphoma are constantly developing, so a five-year survival rate is on the increase.
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