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NON HODGKIN LYMPHOMA

Lymphomas is a form of carcinoma that start in white blood cells called lymphocytes. There are 2 main types of lymphoma. Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). They behave, spread, and respond to treatment differently, so it’s important for you to know which one you have.

Types of Hodgkin lymphoma

Classic Hodgkin lymphoma

Classic Hodgkin lymphoma (cHL) accounts for about 95% of all cases of Hodgkin lymphomas in developed countries.

The carcinoma cells in cHL are called Reed-Sternberg cells. These cells are usually an abnormal type of B lymphocyte. Enlarged lymph nodes in people with cHL usually have a small number of Reed-Sternberg cells and a large number of surrounding normal immune cells. These other immune cells make up most of the enlarged lymph nodes.

Classic HL has 4 subtypes:

• Nodular sclerosis Hodgkin lymphoma: This is the most common type of Hodgkin disease in developed countries. It is most common in teens and young adults, but it can occur in people of any age. It tends to start in lymph nodes in the neck or chest.

• Mixed cellularity Hodgkin lymphoma: This is the second most common type and is seen mostly in older adults (although it can occur at any age). It can start in any lymph node but most often occurs in the upper half of the body.

• Lymphocyte-rich Hodgkin lymphoma: This subtype usually occurs in the upper half of the body and is rarely found in more than a few lymph nodes.

• Lymphocyte-depleted Hodgkin lymphoma: This is the least common form of Hodgkin disease. It is seen mainly in older people. It is more likely to be advanced when first found, in lymph nodes in the abdomen as well as in the spleen, liver, and bone marrow.

Nodular lymphocyte predominant Hodgkin lymphoma

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) accounts for about 5% of cases. The carcinoma cells in NLPHL are large cells called popcorn cells (because they look like popcorn), which are variants of Reed-Sternberg cells.

NLPHL usually starts in lymph nodes in the neck and under the arm. It can occur in people of any age, and is more common in men than in women. This type of HL is treated differently from the classic types.

Causes

Scientists aren’t sure what causes Hodgkin’s lymphoma. But it begins when an infection-fighting cell called a lymphocyte develops a genetic mutation. The mutation tells the cell to multiply rapidly, causing many diseased cells that continue multiplying.

The mutation causes a large number of oversized, abnormal lymphocytes to accumulate in the lymphatic system, where they crowd out healthy cells and cause the signs and symptoms of Hodgkin’s lymphoma.

Various types of Hodgkin’s lymphoma exist. Your diagnosis is based on the types of cells involved in your disease and their behavior. The type of lymphoma you are diagnosed with determines your treatment options.

Symptoms

Signs and symptoms of Hodgkin’s lymphoma may include:

• Painless swelling of lymph nodes in your neck, armpits or groin
• Persistent fatigue
• Fever
• Night sweats
• Unexplained weight reduction
• Severe itching

Diagnosis

To diagnose HD, your health care provider will perform a physical exam and ask you about your health history. Your health care provider will also order certain tests so they can make a proper diagnosis. The following tests may be done:

• imaging tests, such as X-rays or CT scans
• lymph node biopsy, which involves removing a piece of lymph node tissue to test for the presence of abnormal cells
• blood tests, such as a complete blood count (CBC), to measure levels of red blood cells, white blood cells, and platelets
• immunophenotyping to determine the type of lymphoma cells that are present
• lung function tests to determine how well your lungs are working
• an echocardiogram to determine how well your heart is working
• bone marrow biopsy, which involves the removal and examination of marrow inside your bones to see if the carcinoma has spread

Treatment

Treatment for HD typically depends on the stage of the disease. The main treatment options are chemotherapy and radiation.

Radiation therapy uses high-energy beams of radiation to destroy carcinoma cells. Chemotherapy involves the use of treatments that can kill carcinoma cells. Chemotherapy may be given orally or injected through a vein, depending on the specific treatment.

Radiation therapy alone may be sufficient for treating early stage NLPHL. If you have NLPHL, you may only need radiation since the condition tends to spread more slowly than classic HD. In advanced stages, targeted therapeutic treatment may be added to your chemotherapy regimen.

Immunotherapy or a stem cell transplant may also be used if you don’t respond to chemotherapy or radiation. A stem cell transplant infuses healthy cells called stem cells into your body to replace the infected cells in your bone marrow.

After treatment, your health care provider will want to follow up with you on a regular basis. Be sure to keep all your appointments and follow your health care providers instructions.

Risks of treatment for Hodgkin’s disease

Treatments for HD can have long-term side effects and can increase your risk of developing other seriou health conditions. HD treatments may increase your risk of:

• second relapses
• infertility
• infections
• thyroid problems
• lung damage

You should get regular mammograms and heart disease screenings, keep up with vaccinations, and avoid smoking.

It’s also important to attend regular follow-up appointments with your health care provider. Make sure to tell them about any concerns you may have about long-term side effects and what you can do to help reduce your risk.