What is Hodgkin lymphoma?

Lymphocytes come out of the bone marrow and they go through the lymph to the immune system structures distributed throughout the body that is where they come into contact with antigens, create antibodies and, from there, go into the blood to fight infection.

When for whatever reason the lymphocytes found in the lymph nodes become malignant, that is, they begin to proliferate uncontrollably, its structure is altered and are not sensitive to signals of programmed cell deathi.e. the natural death of cells that are defective or old, create a tumor in these lymph nodes, which is what is known as lymphoma.

Hodgkin lymphoma represents 1% of all cancers that exist. It is more frequent in men (except in one of its varieties) and presents two ages with the highest incidence, between the 2nd and 3rd decade of life and around 60 years of age.

How does Hodgkin lymphoma occur?

The cause is unknown which causes the lymphocytes of the lymph nodes (especially type B) to become malignant and lead to Hodgkin's disease, but it can be said that in about half of the cases, material from the Epstein-Barr virus, one of the viruses that can lead to infectious mononucleosis.

Hodgkin's disease is defined by a lymphoma in which, when performing the node biopsy lymphatic affected, a cell called Reed-Sternberg characterized by presenting two nuclei and having specific cellular markers. This cell, however, is not exclusive to this disease. There is a variant of it that has only one nucleus and is called the Hodgkin cell. Likewise, the biopsy shows other cells of the immune system as a consequence of the inflammatory response generated by the tumor.

The main factors that determine a poor prognosis are stage, extralymphatic involvement, B symptoms, advanced age, the presence of a tumor mass larger than 10 cm, the type of cells that make up the tumor, and the existence of more than 5 nodules in the spleen.

Types of Hodgkin lymphoma

Depending on the cells that make up the tumor, four types of Hodgkin lymphomas are distinguished with different incidences and prognoses:

• Lymphocytic predominant lymphoma represents 5-15% of all cases and is the best prognosis form.
• Nodular sclerosis, the most frequent form (40-75%); it is the form with the second best prognosis and is the most frequent variant in women.
• Mixed cellularity, 20-40% of cases, it usually spreads easily.
• Lymphocytic depletion constitutes 5-15% of Hodgkin's lymphomas and is the form with the worst prognosis.

Hodgkin lymphoma usually spreads through the lymphatic pathway to neighboring lymph node areas, but it can also spread through the blood or simply by contiguity to adjacent tissues.

Lymphoma Symptoms

The main symptom is the appearance of enlarged lymph nodes, with no apparent infectious cause that justifies them. They are adenopathies that they are not painful and that can sometimes increase and decrease in size cyclically. The nodes that are most frequently affected are:

• Cervical ganglia
• Those located in the mediastinum
• The ganglia of the abdomen
• Axillaries

The spleen is usually affected in approximately one third of cases and the liver in 5% of Hodgkin lymphomas, always with previous splenic involvement.

There are a number of secondary symptoms which are called symptoms B and which are: tumor fever, night sweats, weight loss of more than 10% in 6 months with no apparent cause and skin itching associated with B symptoms. At the same time, due to the immunodeficiency that these patients present, they may suffer infections of repetition, especially certain viruses, fungi or parasites.

Diagnosis

Lymphoma of any type should be suspected in a patient with palpable lymphadenopathy without an infectious cause that justifies it and in the case of Hodgkin lymphomas if you have any of the symptoms B already mentioned.

• blood test: An increase in leukocytes will be appreciated, with a predominance of a specific type, eosinophils, and later a decrease in the number of lymphocytes. Anemia secondary to chronic disease is also common. The erythrocyte sedimentation rate (ESR), a parameter that marks the existence of an inflammatory response, will be elevated.
• Computerized axial tomography (CT): It will be the imaging test to be used to assess whether there is lymph node involvement, especially in areas such as the mediastinum or the abdomen that are not accessible by physical examination.
• Bone marrow biopsy: Reed-Sternberg cells can be found, as well as fibrosis and a decrease in the proportion of fatty tissue in the marrow. If the biopsy is positive, an exploratory laparotomy will not be performed to take biopsies of the lymph nodes, liver, iliac crest, ovaries and remove the spleen, as it will indicate that there is dissemination. This laparotomy will only be done if Hodgkin's disease is localized and can be treated with radiation therapy.
• Ann-Arbor Classification: which is based on the number of lymph node areas affected, their location (varying the stage if they are on the same side of the diaphragm or on both sides), the presence or absence of contiguous involvement and the involvement of the spleen and other organs , as well as the existence or not of the so-called B symptoms.

Treatment for Hodgkin lymphoma

Treatment for Hodgkin lymphoma will be based on radiation therapy and chemotherapy. One, the other, or both will be used depending on the stage of the Ann-Arbor classification.

• Stages I and II (involvement of one or more ganglion areas or territories affected by contiguity) the treatment of choice will be radiotherapy.
• In stages III and IV chemotherapy will be chosen as treatment, with a minimum of 6 cycles.
• In those cases in which the lymphoma is larger than 10 cm, occupies more than a third of the chest or abdominal X-ray, or in stages I and II that present B symptoms, the choice is made for combining radiation therapy with chemotherapy.
• In case of recurrence, if it is local, it will be done radiation therapy or chemotherapy depending on whether the first has been applied or not previously. If it is a diffuse recurrence, chemotherapy will be administered again, changing the regimen if the relapse is less than a year, a fact that indicates that there is resistance to the treatment.

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