Lymphomas are cancers that develop in the lymph system, part of the body's immune system.
Lymphomas are divided into two general types: Hodgkin's disease and non-Hodgkin's lymphomas.
Adult Hodgkin's disease most commonly affects young adults and people older than 55.
It may also be found in patients with acquired immunodeficiency syndrome (Aids).
Typical symptoms are: painless swelling of the lymph nodes in the neck, underarm, or groin, fever, tiredness and itchy skin.
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Lymphomas are cancers that develop in the lymph system, part of the body's immune system. Lymphomas are divided into two general types: Hodgkin's disease and non-Hodgkin's lymphomas. The diagnoses of different lymphomas are made based on their appearance under a microscope.
Adult Hodgkin's disease most commonly affects young adults and people older than 55. It may also be found in patients with acquired immunodeficiency syndrome (Aids); these patients require special treatment. Hodgkin's disease can also occur in children and is treated differently from that in adults.
Symptoms
A doctor should be seen if any of the following symptoms persist for longer
than two weeks: painless swelling of the lymph nodes in the neck, underarm, or
groin, fever, night sweats, tiredness, weight loss without dieting, itchy skin.
If there are symptoms, a doctor will carefully check for swelling or lumps in
the neck, underarms, and groin.
Diagnosis and staging
If abnormal lymph nodes are present a lymph node has to be removed surgically to confirm the diagnosis. The lymph node is sent to a laboratory where it is evaluated by a specialist pathologist and the diagnosis and subtype of lymphoma is determined. Several other tests are then indicated to stage the disease. They include chest X-ray, CT scan and several blood tests.
The chance of recovery (prognosis) and choice of treatment depend on the
stage of the cancer (whether it is just in one area or has spread throughout the
body), the size of the swollen areas, the results of blood tests, the type of
symptoms and the patient's age, sex and overall condition.
Treatment
There are treatments for all patients with adult Hodgkin's disease. Two types of treatments are used:
radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells and shrink tumours)
chemotherapy (using drugs to kill cancer cells and shrink tumours)
Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumours. Radiation for Hodgkin's disease usually comes from a machine outside the body (external-beam radiation therapy). Radiation therapy given to the neck, chest, and lymph nodes under the arms is called radiation therapy to a mantle field.
Radiation therapy given to the mantle field as well as to the lymph nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis is called total nodal irradiation. Radiation therapy may be used alone or in addition to chemotherapy.
Chemotherapy is the use of drugs to kill cancer cells and shrink tumours. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.
Bone marrow transplantation is used in clinical trials for appropriate patients. Sometimes Hodgkin's disease becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, peripheral blood stem cells or bone marrow is taken from the patient before treatment. The stem cells or bone marrow is then frozen, and the patient is given high-dose chemotherapy with or without radiation therapy to treat the cancer. The stem cells or bone marrow is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.
This type of transplant is called an autologous transplant.
If the stem cells or bone marrow is taken from another person (almost always a compatible brother or sister), the transplant is called an allogenic transplant.
Treatment by stage
Patients may be immunized with influenza, pneumonia and meningitis vaccines before treatment and every few years after treatment, in order to guard against infection. Treatment of adult Hodgkin's disease depends on the type and stage of the disease, the patient's age, pregnancy status, past surgery to determine the stage of the disease, clinical symptoms and general health.
Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. Within five to 15 years after treatment, some patients develop another form of cancer as a result of their treatment; therefore they should visit a doctor regularly to be checked.
Stage I Adult Hodgkin's Disease
The disease involves only one group of nodes. Treatment depends on whether the patient has stage IA or stage IB disease and where the cancer is found.
Stage IA disease: If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:
Combination chemotherapy and radiation therapy.
Radiation therapy to a mantle field and to the lymph nodes in the upper abdomen.
Radiation therapy to a mantle field only, after surgery to determine the stage of the tumour.
Clinical trials of combination chemotherapy alone.
If the cancer is above the diaphragm but involves a large part of the chest, treatment may be one of the following:
Radiation therapy to a mantle field plus chemotherapy.
Radiation therapy to a mantle field and to the lymph nodes in the upper abdomen.
If the cancer is below the diaphragm, treatment may be one of the following:
Radiation therapy.
Combination chemotherapy with radiation therapy.
Clinical trials of chemotherapy alone.
Stage IB disease: Treatment may be one of the following for patients with "B" symptoms:
Combination chemotherapy with radiation therapy.
Clinical trials of chemotherapy alone.
B-symptoms are: The presence of fever above 38°C or night sweats in the last month and/or unexplained loss of 10% or more body weight in the preceding six months.
Stage II Adult Hodgkin's Disease
More than one group of lymph nodes is involved, on one side of the diaphragm (either upper or lower part of the body, but not both). Treatment depends on whether the patient has stage IIA or stage IIB disease and where the cancer is found.
Stage IIA disease: If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:
Combination chemotherapy and radiation therapy.
Radiation therapy to a mantle field and to the lymph nodes in the upper abdomen.
Radiation therapy to a mantle field only, after surgery to determine the stage of the tumour. This treatment option is rarely used these days.
Clinical trials of combination chemotherapy alone.
If the cancer is above the diaphragm but involves a large part of the chest, treatment may be the following:
Chemotherapy plus radiation therapy to a mantle field.
Chemotherapy alone.
Stage IIB: Treatment may be one of the following for patients with "B" symptoms:
Combination chemotherapy with or without radiation therapy to places of bulky tumour.
Clinical trials of chemotherapy alone.
Stage III Adult Hodgkin's Disease
Disease involving lymph nodes on both sides of the diaphragm (upper and lower body), but not the bone marrow. Treatment depends on whether the patient has stage IIIA or stage IIIB disease and where the cancer is found.
Stage IIIA: If the cancer does not involve a large part of the chest, treatment may be one of the following:
Combination chemotherapy alone.
Combination chemotherapy plus radiation therapy.
Total or subtotal nodal irradiation.
A clinical trial of chemotherapy.
If the cancer involves a large part of the chest, treatment may be combination chemotherapy with radiation therapy.
Stage IIIB: Treatment may be one of the following:
Combination chemotherapy with radiation therapy.
A clinical trial of chemotherapy.
Stage IV Adult Hodgkin's Disease
This is widespread disease frequently involving the bone marrow. Treatment may be one of the following:
Combination chemotherapy.
Combination chemotherapy and radiation therapy.
Clinical trials of chemotherapy with bone marrow transplantation.
Recurrent Adult Hodgkin's Disease
The treatment depends on:
Place of recurrence
Treatment received before.
If the treatment received before was radiation therapy without chemotherapy, chemotherapy may be given. If the treatment received before was chemotherapy without radiation therapy and the cancer comes back only in the lymph nodes, radiation therapy to the lymph nodes with or without more chemotherapy may be given. If the disease comes back in more than one area, more chemotherapy may be given or a clinical trial of high doses of chemotherapy with bone marrow or peripheral stem cell transplantation may be presented as an option.
Reviewed by Dr Betsie Lombard, MBChB (Pret), Mmed (Haem Path) (Stell).
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