Hodgkin’s Lymphoma

Hodgkin’s lymphoma is a malignant condition of the lymphocytes that particularly occurs in the lymph nodes it is characterized by the presence of Reed Sternberg cells on Histology and it spreads in a fashion to affect the lymph nodes. The condition has bimodal age distribution that is one peak is present during the 20s of age and another peak during the 60s of age. Meals are more commonly affected than females.

The Pathogenesis of HD is still largely unknown. The condition nearly always arises and disseminates in lymph nodes. Hodgkin's lymphoma with distinct histology, biological behavior, and clinical characteristics. Hodgkin’s lymphoma is divided into various types depending on the histological findings and the condition is stages based on the severity of the condition.

The disease is life-threatening in 90% of untreated patients dying within 2 to 3 years, with chemotherapy, more than 80% of patients are cured. The diagnosis of the condition is based on the history of symptoms, a physical examination to look for involved lymph nodes and a biopsy is required to confirm the diagnosis. Histology shows the presence of typical Reed Sternberg cells in these patients. Imaging tests are required to look for the involvement of other organs. Treatment is mainly done by chemotherapy and radiotherapy depending on the severity of the condition.

Hodgkin’s Lymphoma: Causes

The exact cause of the condition is unknown. Several factors play an important role in the development of the condition that includes −

• Infectious agents, especially the Epstein-Barr virus (EBV), may be involved in the pathogenesis of HD.

• Patients with HIV infection have a higher incidence of HD compared to the population without HIV infection.

• Genetic predisposition may play a role in the pathogenesis of the disease.

• Approximately 1% of patients with the condition have a family history of the disease.

• Siblings of an affected individual have a 3- to 7-fold increased risk of developing the condition.

• This risk is higher in monozygotic twins due to genetic association with specific HLA antigens.

Hodgkin’s Lymphoma: Symptoms

The symptoms of Hodgkin’s lymphoma vary from person to person depending on the severity of the condition.

• The presence of enlarged, painless, rubbery, non-erythematous, non-tender lymph nodes is the hallmark of the disease.

• Cervical, supraclavicular, and axillary lymphadenopathy is the most common initial signs of the disease.

• The enlarged lymph nodes may become painful after drinking alcohol

• Increase in the size of the liver and spleen

• Cough, difficulty in breathing, hypoxia

• Pleural or pericardial effusion

• Hepatocellular dysfunction when present the patients present with pain in the abdomen and yellowish discoloration of the body.

• Bone marrow infiltration present with decreased hemoglobin, platelets, and white blood cells. Hence, the patient appears weak and pale and has fatigue

• Itching is another important symptom in these patients.

• Systemic Symptoms such as Unexplained fever of more than 39 degrees, weight loss of more than 10% in 3months, drenching night sweats, and immune system abnormalities

Hodgkin’s Lymphoma: Risk Factors

Several factors play an important role in increasing the risk of developing Hodgkin’s lymphoma which include −

• Most common among teens and adults aged 15 to 35 years and adults aged 55 years and older.

• Males are more commonly affected than the females

• An individual with a family history of the same condition.

• Certain viruses such as Epstein-Barr virus (EBV), Human immunodeficiency virus (HIV) are more commonly associated with this condition

• People with Weakened immune systems are at increased risk

• Exposure to radiation and certain chemicals can also predispose the condition

Hodgkin’s Lymphoma: Diagnosis

The diagnosis of Hodgkin’s lymphoma is done based on the history, and physical examination and some investigations are required to confirm the diagnosis.

• History of symptoms and family history should be asked for

• Physical examination to look for enlarged lymph nodes

• Erythrocyte sedimentation rate (ESR) may be elevated.

• Complete blood count (CBC) should be performed. Anaemia is usually due to chronic disease, but it may be due to bone marrow involvement or the presence of an autoantibody. Cytopenia is common in advanced diseases. Platelet counts can be increased or decreased

• Lactate dehydrogenase (LDH) may be increased. LDH may correlate with the bulk of disease.

• Rarely, HD is associated with nephrotic syndrome hence RFT is advised

• Alkaline phosphatase may be increased due to the presence of liver or bone involvement.

• CT scans of the chest, abdomen, and pelvis that show enlarged lymph nodes, hepatomegaly, and splenomegaly with or without focal parenchymal abnormalities, lung nodules or infiltrates, and pleural effusions.

• Chest X-ray shows a mediastinal mass, representing mediastinal lymphadenopathy, which is a very common finding.

• Gallium-67 scan or positron emission tomography (PET) scan may be used as a baseline test to assess response to therapy.

• Lymphangiography may demonstrate abnormalities, even in normal-sized lymph nodes.

• Biopsy is the confirmatory test to diagnose the condition, Which on Histology typically shows the presence of Reed Sternberg cells.

Hodgkin’s Lymphoma: Treatment

The treatment is based on the severity of the condition. Therapy is entirely based on the stage of Hodgkin’s lymphoma.

• Localized disease is managed predominantly with radiation therapy

• In patients where the condition has spread and is severe are managed with chemotherapy.

• The most effective combination chemotherapeutic regimen for Hodgkin lymphoma is ABVD ( adriamycin, bleomycin, vinblastine, and dacarbazine).

Hodgkin’s Lymphoma: Prevention

Some of the measures that can help to prevent the development of Hodgkin’s lymphoma include −

• Genetic counseling can help the patient to know the risk of their child getting the disease

• Avoid exposure to any radiation that can increase the risk

• Save sexual practices screening for HIV before blood transfusion or any organ transplantation can help to prevent HIV which is a known risk factor for the condition

• Following a healthy diet and regular exercises can improve the overall immune health of the patient

• Avoiding exposure to certain chemicals can prevent the occurrence of the condition

• Regular health check-ups to identify the condition at the earliest

Conclusion

Hodgkin’s lymphoma is a malignant tumor of the lymphocytes which mainly involves the lymph nodes. The exact cause of the condition is unknown but certain factors such as HIV and EBV viral infection and genetics have been known to influence its occurrence. Initially the patients mainly present with painless enlarged lymph nodes in some patients the lymph nodes are painful on drinking alcohol. Other symptoms such as unexplained weight loss, unexplained fever for a longer duration, and night sweats at present.

The condition is mainly diagnosed based on the history of the symptom’s family history, physical Examination, and certain investigations such as blood tests LFT, RFT, and imaging tests are required to look for the involvement of other organs, and biopsy is used for confirming the condition. The condition is mainly treated by radiation therapy in the initial stage and later when the disease has spread it requires chemotherapy. The condition can be cured in more than 80% of the patients with proper treatment if neglected it becomes life-threatening.