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  • Lewis

Hodgkin's Lymphoma: A Background

Updated: Oct 12, 2020

Before I start writing, I suppose the only fair thing to do would be to give you a background to Hodgkin's disease. What is it? Who does it affect? Why does it affect them? Is it a death sentence? Can it be cured? The list of questions someone that is diagnosed is endless, I suppose.

Hodgkin's lymphoma (also often referred to as Hodgkin's disease - named after Dr. Thomas Hodgkin who first discovered the condition in 1832.) is a form of blood cancer that starts in the lymphatic system. Lymphocytes - a white blood cell, multiply out of control or do not die when they should. These mass of cells cause tumours to form in lymph nodes (small pea-sized glands that typically swell in response to infection.) It is a moderately aggressive cancer that spreads from lymph node to lymph node and most often spreads to the bone marrow, lungs or liver. The cause of the disease can be linked to the EB Virus in 50% of cases (the same virus that causes Glandular Fever.) However, the cause of the other 50% of the cases is unknown.

There are two types of Hodgkin's disease. Classical disease or nodular lymphocyte-predominant Hodgkin Lymphoma. Classical HL has four subtypes - nodular sclerosis cHL, mixed cellularity cHL, lymphocyte-rich cHL and lymphocyte-depleted cHL. I had Nodular Sclerosis cHL.

Around 1,800 people in the UK are diagnosed with a form of HL each year, with it causing about 330 deaths. It is accountable for less than 1% of cancers. Most people diagnosed are between 20-30 or over the age of 65. It has a 5-year overall survival rate for those diagnosed with stage 1 or 2 of 90%. Those unfortunate enough to be diagnosed with stage 3 or 4 of the disease have a 75% chance of being alive five years after diagnosis.

Stage 1 disease is where only a single lymph node region is involved, i.e. cervical lymph nodes on one side of the neck. Stage 2 disease is where two or more lymph node regions on the same side of the diaphragm (a muscle that separates the abdomen and the chest) are involved. Stage 3 is the involvement of lymph node regions on both sides of the diaphragm or involvement of the spleen or tonsils. Stage 4 means it has spread to organs outside the lymph system such as the liver or lungs. A or B is added to the stage - A to indicate no systematic symptoms, B to indicate the opposite.

HL presents typically as a swollen, hard, pain-free lymph node - most commonly in the neck, although it can begin anywhere. Systematic symptoms are; a severe itch, that does not get better; Drenching night sweats; unexplained weight loss and a persistent fever. A minority of people will experience pain in the swollen nodes with minimal alcohol consumption.

Treatments for HL include Radiotherapy, Chemotherapy, Immunotherapy and Stem Cell Transplants. Treatments usually are very successful, especially chemotherapy in more advanced stages of the disease. Surgery is ineffective since the human eye can only see large accumulations of lymphocytes and not smaller ones travelling around the body.

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