Hodgkin’s Lymphoma, Hodgkin’s and Non-Hodgkin’s Lymphoma
At Hospital Angeles Lomas we have successfully used bone marrow transplants and peripheral blood stem cell transplants to treat Lymphoma, the most common type of blood cancer in the US, with about 74,500 new cases being diagnosed each year. Learning about a disease that you may never have heard of before and deciding on which treatment is best for you can be tough, which is why we offer a free consultation, so that you can find out as much as possible about the different treatment options before making a decision.
Lymphoma is a cancer of lymphocytes, cells in the body’s lymphatic system, which is a part of the immune system. There are around 35 types of lymphoma, affecting different lymphocytes.
There are two main types of lymphocytes; T lymphocytes (or T cells) and B lymphocytes (or B cells). B cells produce antibodies which circulate and attach to infectious or abnormal cells, alerting other cells in the immune system to destroy them. T cells control the activity levels of the immune system and also kill threatening cells. Some types of B and T cells remember the virus it fought and maintain the ability to fight it again.
These lymphocytes are carried through the lymphatic system in fluid called lymph. The lymph system contains thousands of lymph nodes which filter out the pathogens; bacteria, viruses and other microbes. If a person has an infection these nodes can become swollen with the microbial organisms, resulting in ‘swollen glands’.
If a person has lymphoma, their normal B or T cells or subtypes of these cells, grow and multiply uncontrollably, collecting in lymph nodes or lymph tissues, such as the spleen or tonsils. This often results in a tumor forming at the site. Abnormal lymphocytes have the potential to travel around the whole body via the lymphatic system.
Symptoms of Lymphoma
Frequently, the first sign of lymphoma is a painless swelling in one of the lymph nodes or tissue, which can then cause other problems such as numbness, where the swelling presses on a nerve. Stomach pain from a swollen spleen is also a common symptom. For many, these will be the only symptoms they experience but for others symptoms may include:
- Unexplained weight loss
- Night sweats
- Reduced energy levels
It is easier to attribute these symptoms to a virus or ‘flu but in lymphoma cases the symptoms will last much longer and can’t be explained by an obvious illness.
Types of Lymphoma and Diagnosis
There are two main types of lymphoma; Hodgkin’s Lymphoma (HL) and non-Hodgkin’s Lymphoma (NHL), with 30 subtypes of non-Hodgkin’s disease and 5 subtypes of Hodgkin’s disease. Both occur in the lymphatic system and have similar symptoms but can be distinguished in a laboratory.
Whilst Hodgkin’s disease develops from one particular abnormal B cell, Non-Hodgkin’s Lymphoma starts in either B or T cells. Although the different types of lymphoma can seem confusing and quite similar, it is important that the right subtype is diagnosed as the function and treatment varies for each type.
If your doctor examines and interviews you and suspects that you may have lymphoma they will probably order a range of tests. A blood test will show how well your blood cells and organs, such as the kidneys and liver, are working and check for high levels of enzymes typical in Non-Hodgkin’s Lymphoma. A biopsy may be taken if you have a swelling, so that the mass can be analysed. X-rays, CT and MRA scans can help physicians to see any abnormalities within your body, such as enlarged nodes and a lymphangiogram can be used to track the function of your lymph system. Usually, a bone marrow sample will be taken and analysed. The presence of certain B and T lymphocytes confirms Lymphoma.
Stages and Classification of Lymphoma
Once diagnosed, Lymphoma will be staged, to see how far it has progressed. Often Hodgkins lymphoma is described as nonbulky, meaning the tumor is small and the prognosis is good, or bulky, meaning that the tumor is larger.
Because Non-Hodgkin’s Lymphoma is such a complicated set of diseases, the classification system is also complicated and ever-changing. Low grade NHL is used to describe slow growing tumors. They are often wide spread when detected but because they grow so slowly, medical treatment is not usually needed unless one of the lymphomas threatens to affect organ function. Intermediate grade NHL lymphomas grow rapidly and require immediate treatment but are often curable. High grade lymphomas are very aggressive and grow very rapidly. Immediate, intensive treatment is required and they are less curable than the two other grades of the disease.
The staging process for NHL and HL are similar:
- Stage 1 (early disease) where the lymphoma is located on one node or in one area or organ.
- Stage 2 (locally advanced), where the lymphoma is located in two or more lymph node regions on the same side of the diaphragm or one lymph node region and one nearby tissue and organ.
- Stage 3 (advanced): two or more lymph nodes, or one lymph region and one organ on opposite sides of the diaphragm.
- Stage 4 (widespread or disseminated): the lymphoma has spread outside of the lymph nodes and spleen to another area or organ, such as bone, central nervous system or bone marrow.
Lymphoma and BMT
Bone Marrow or Stem Cell Transplants can be used to treat and cure most of the types of HL and NHL. Intensive chemotherapy (or, in the case of a mini-transplant, less intensive chemotherapy) is administered to destroy the existing unhealthy cells and the bone-marrow that creates those cells. Depending on the type, grade and stage of the disease, the patient’s own (autologous) cells or donated (allogeneic) hematopoietic stem cells, bone marrow or cord blood cells are introduced back into the body so that they can create healthy, functioning bone marrow, free of cancerous cells.
Although there are a range of standard treatment options for HL and NHL, doctors and oncologists may vary on opinion. You may want to speak to a more than one specialist to see what treatment they would recommend so that you can make an informed decision, taking into account the risks and potential outcomes for each treatment option.
Depending on the stage and grade of your disease, it may be important that you start treatment as soon as possible. If you are considering a Bone Marrow Transplant, let your doctor know so that your treatment prior to your transplant can be altered slightly to maximise the success of the transplant.
Dr Ovilla with Jorge, 7 years post autologous Bone Marrow Transplant for Hodgkin’s Disease.
If, like Jorge’s parents, you would like a free consultation with a medical professional then please don’t hesitate to contact us by filling out an inquiry form.