Lymphoma (Hodgkin’s Disease)

Lymphoma (Hodgkin’s lymphoma or formerly Hodgkin’s disease) is a malignant disease of the lymphatic system in which lymph cells degenerate. A typical symptom is swollen lymph nodes, but these do not cause any pain. Other signs may include general discomfort such as fatigue, fever and significant weight loss. Lymph node cancer can usually be treated well with chemotherapy and/or radiation therapy. The stage at which the lymph node cancer is diagnosed is the most decisive factor for the chances of cure. Cancer: these symptoms can be warning signs

Hodgkin lymphoma and non-Hodgkin lymphoma.

A swelling or enlargement of a lymph node is called a lymphoma. Such a tumor can be benign or malignant. For malignant tumors, medical science distinguishes between Hodgkin’s lymphoma (Hodgkin’s disease, lymphogranulomatosis) and non-Hodgkin’s lymphoma. The term non-Hodgkin’s lymphoma is used to refer to all malignant lymphomas that are not Hodgkin’s disease. Here you can find detailed information about non-Hodgkin’s lymphoma.

What is lymphoma?

The term lymphoid cancer is not uniformly defined. Sometimes it is used to refer to all forms of malignant lymphoma, but often the term means only Hodgkin lymphoma. When lymphoid cancer is referred to in this article, it usually means Hodgkin’s disease. Hodgkin’s disease is relatively rare compared to other cancers in Germany. Approximately 2 to 3 people per 100,000 inhabitants are diagnosed with this form of lymph node cancer each year. Children, adolescents and young adults are particularly affected, and Hodgkin’s lymphoma is one of the most common cancers among them. However, the tumor disease can also occur in older age. Hodgkin’s disease is diagnosed particularly frequently in people between 20 and 30 years of age and between 60 and 70 years of age. Men are more frequently affected than women, the ratio being 3:2. A characteristic feature of Hodgkin’s disease is that certain cell types are detected in the lymph nodes. The so-called Sternberg-Reed cells arise from degenerated B lymphocytes, which multiply uncontrollably and do not die. The B lymphocytes belong to the white blood cells, which in turn play an important role in immune defense and are part of the so-called lymphatic system (lymphatic system). Due to the large number of degenerated white blood cells, the immune system of those affected by lymphatic cancer is often weakened. Therefore, they are particularly susceptible to infections.

Causes of lymphoma

As with many other cancers, the causes of lymph node cancer are not yet known for certain. However, it is suspected that certain viral diseases increase the risk of developing Hodgkin’s lymphoma. This is thought to be the case for people infected with hepatitis B or C and the Epstein-Barr virus, among others. Infection with HIV is also thought to increase the risk of lymphoma. In addition, scientists suspect that genetic factors may also play a role. So far, however, no consistent genetic changes have been identified in people with lymphoma, so it is not clear whether the disease is hereditary. Smoking may also be among the risk factors.

Symptoms of lymphoma

How does lymph node cancer make itself known? Typical symptoms of lymph node cancer are swollen, enlarged lymph nodes, but they do not cause any pain. In contrast, swollen lymph nodes that occur in the context of infectious diseases, such as a cold, hurt when pressure is applied. In the case of lymph node cancer, the swellings usually become noticeable over a period of several weeks. They occur particularly on the neck, but often also behind the breastbone. Consequences of this can be problems with breathing, a feeling of pressure or a dry cough. In addition, swelling of the lymph nodes may be seen in the armpits, abdomen or groin. In addition to swollen lymph nodes and possibly an associated feeling of pressure, there are other signs that may indicate lymph node cancer – however, these symptoms are usually relatively non-specific. For example, the following symptoms may occur:

  • Significant weight loss
  • Loss of appetite
  • Itching
  • Drop in performance
  • Feeling of weakness
  • Fatigue
  • heavy night sweating (night sweats)
  • Recurrent fever
  • Diarrhea

After drinking alcoholic beverages, pain in the diseased lymph nodes may occur in rare cases. Also, an increased susceptibility to infections is one of the possible signs. In the course of the disease, or at a late stage, the cancer can also spread and affect other organs such as the bone marrow, lungs, liver or spleen. If so, other symptoms such as enlargement of the spleen or anemia may occur.

Diagnosis of lymphoma

If the lymph nodes are swollen for a prolonged period of time, a doctor should definitely be consulted. If lymph node cancer is suspected, a tissue sample is taken (biopsy). As a rule, the entire lymph node is removed. In most cases, this procedure can be performed under local anesthesia. The removed lymph node is then examined microscopically for signs of lymph node cancer. If Sternberg-Reed cells are found, this is considered evidence of Hodgkin’s disease. In addition, examination under the microscope can determine the exact subtype of Hodgkin’s lymphoma. A distinction is made between classic Hodgkin lymphoma, which accounts for about 95 percent of cases and is further subdivided into four subtypes, and nodular lymphocyte-predominant Hodgkin lymphoma, which is considered a disease in its own right.

Methods of investigation in Hodgkin’s disease

To gain more precise findings, a number of other examinations may be necessary in addition to the biopsy, for example, to detect possible metastases. These include:

  • An ultrasound examination
  • A magnetic resonance imaging (MRI) scan
  • A computed tomography (CT)
  • A positron emission tomography (PET) (an examination with a marker substance, similar to a scintigraphy).
  • An X-ray examination
  • A blood examination (blood count and other blood values)
  • A biopsy of the liver and bone marrow

Which of these examinations actually need to be performed varies from individual to individual.

Lymph node cancer: determine stage.

As part of the diagnosis, the stage in which the malignant lymphoma is located is also determined. In Hodgkin’s lymphoma, the stage is critical in determining how good the lymphoma’s chances of cure are. It is determined using what is known as the Ann Arbor classification:

  1. Stage I: Only one lymph node region is affected.
  2. Stage II: Two or more lymph node regions on one side of the diaphragm are affected.
  3. Stage III: Two or more lymph node regions on both sides of the diaphragm are affected.
  4. Stage IV: There is diffuse organ involvement of one or more organs outside the lymphatic system.

If no general symptoms such as fever, night sweats or weight loss (so-called B symptoms) occur, the respective stage contains the addition A, for example, stage IA. If these signs are present, the suffix B is added. The suffix E means that an organ is affected that is not part of the lymphatic system.

Therapy: treating Hodgkin lymphoma

Without treatment, Hodgkin lymphoma is usually fatal. However, the earlier lymphoma is detected, the better the chances that treatment will be successful and the affected person can be cured. This is because malignant lymphoma is usually very sensitive to radiation or chemotherapy. Surgery, on the other hand, is not suitable for treating lymphoma. The type of therapy used depends in particular on the stage of the lymphoma, but also on the age of the patient. Therapy for lymph node cancer should be carried out by experienced physicians, preferably in clinics specializing in hemato-oncology. Both chemotherapy and radiation therapy can sometimes be performed on an outpatient basis.

Chemotherapy for lymph node cancer

A combination of chemotherapy and radiation therapy is often used for lymphoma. Chemotherapy is usually given in several cycles. The patient is given cytotoxins (cytostatics) that destroy rapidly dividing cells such as cancer cells. However, since healthy cells are also attacked, side effects such as nausea, vomiting, fatigue, susceptibility to infection and hair loss may occur.

Radiotherapy for Hodgkin’s disease

Radiation therapy uses ionizing radiation to target cancer cells. The goal of treatment is to inhibit cell division or stop it altogether. While healthy cells can often repair radiation damage, the repair system of tumor cells functions much more poorly. Radiation therapy is often used following chemotherapy.

Consequences of treatment

Because healthy tissue is usually affected as well, radiotherapy can cause problems with the heart, lungs, or thyroid gland after treatment, depending on the radiation site. Affected women also have an increased risk of breast cancer. Chemotherapy can also increase the risk of developing another type of cancer. Overall, however, the benefits of the two forms of treatment outweigh the risks in lymphoma. If there is a desire to have children, the potential effects of the therapy on fertility and appropriate countermeasures should be discussed with the treating physician before starting treatment.

Hodgkin lymphoma: follow-up is important

If lymphoma has been successfully treated, follow-up medical examinations must be performed at regular intervals after the end of therapy. This ensures that a relapse is detected early. In addition, possible long-term side effects of radiation or chemotherapy are also treated during follow-up care. This follow-up care should be lifelong. At the beginning, checks are usually carried out after three, six and twelve months, and every six months from the second year after therapy. From the fifth year on, check-ups are performed once a year. If a patient suffers a relapse (recurrence) after a completed lymph node cancer treatment, a particularly high-dose chemotherapy is usually performed or a bone marrow transplantation with the patient’s own stem cells (autologous stem cell transplantation) is performed. If only radiation therapy was used in the initial treatment, this is considered favorable in the event of a relapse: then standard chemotherapy may also be sufficient to cure the lymphoma.

Lymphatic gland cancer: life expectancy and chances of cure

For sufferers who receive a diagnosis, the question often immediately arises: is lymphoma curable? Hodgkin’s disease has a relatively good prognosis compared with other cancers, because lymphoma is one of the most treatable malignancies. However, the stage at which the cancer is diagnosed is always decisive for the chances of cure. If lymph node cancer is detected at an early stage, the chances of curing Hodgkin’s disease are particularly high. But even at a later stage, the cancer can often still be treated well, so that the overall chances of cure are 80 to 90 percent. The life expectancy of Hodgkin’s disease depends – just like the chances of cure – on the stage at which the lymph node cancer is discovered. The five-year survival rate is about 90 percent. Research is currently being conducted into alternative therapeutic approaches for the treatment of lymph node cancer. Immunotherapy with antibody preparations plays a particularly important role here. Nutrition in cancer: 13 golden rules