What Is Hodgkin's Lymphoma? 

Lymphoma refers to cancer originating from any part of the lymphatic system. Lymphatic system does contribute to the immune system; it protects the body from harmful pathogens. There are two types of lymphoma:

• Hodgkin's lymphoma 
• Non- Hodgkin's lymphoma ( NHL)

Hodgkin's lymphoma is a cancer affecting the B- lymphocytes of the lymphatic system. Hodgkin’s lymphoma is a rare type of cancer. In the UK, around 2,100 people are diagnosed with this cancer annually. 

Non- Hodgkin's lymphoma ( NHL) is a lymphatic system cancer  where the lymphocytes grow abnormally around the body. There are numerous variants of this cancer.  The treatment depends accordingly. It is detected more compared to Hodgkin's lymphoma. In the UK, around 13,000 people are diagnosed with this cancer annually 

Overview of the cancer 

Let's dive deep to discuss the immune system] along with the lymphatic system.

Immune system consists of several body parts working together to protect the body from harmful germs. When a bacteria or a virus attacks the body, the immune system keeps a memory of the pathogen and protects it if the same strain of bacteria or virus attacks in the future. Various parts of the immune system are:

• White blood cells (WBC)
• Lymph nodes 
• Spleen 
• Tonsils 
• Bone marrow 
• Skin 
• Thymus 
• Stomach 

The  lymphatic system is a part of the immune system which has a colourless fluid called lymph circulating in the body. The  lymphatic system maintains fluid levels in the body  that  transports and removes waste materials from the body.

• Lymphatic fluid or lymph: It is the fluid that drains from the cells and tissues after the plasma circulates throughout the body. It also transports white blood cells (lymphocytes) that play a primary role in providing immunity
• Lymph nodes:  The lymph nodes cleanse the lymph by filtering out the damaged cells. They are also a storehouse of lymphocytes and immune cells
• Lymphatic vessels: The lymphatic vessels are a network of capillaries throughout the body that transport the lymph. These vessels filter   to collect the lymph and move them to the collecting ducts
• Collecting ducts: Lymphatic vessels carry the lymph into the thoracic duct. These are divided into the right lymphatic duct and left lymphatic duct
• The spleen: It helps in producing lymphocytes that help in immunity building
• Tonsils and adenoid: Tonsil and adenoids trap and filter the germs from the food we digest  to the air we breathe

What are the  types of Hodgkin's  lymphoma?

Hodgkin's lymphoma is a rare type of cancer  with different variants.¹,²

Classical type: Almost 95% of the cases fall under this category. They are sub-divided into nodular sclerosing, mixed cellularity, lymphocyte-depleted and lymphocyte-rich.

All of these sub-types  of treatment are similar . The subtypes are common as Reed-Sternberg cells are seen.

• Nodular sclerosis Hodgkin lymphoma (NHL): The cancer occurs in lymphoma in a young adults and people assigned female at birth (AFAB). It develops in the lymph nodes of the chest. It accounts for 70% of the cases
• Mixed cellularity Hodgkin lymphoma: The type of cancer usually develops   in people around the age of 60 years in the abdomen.  It accounts for 25% of the cases
• Lymphocyte-depleted Hodgkin lymphoma: Mostly found in people around 60 years old and in patients   suffering from viruses like HIV/AIDS. In this, normal cells of the lymph nodes get replaced by abnormal cells. It accounts for less than 1% of the cases
• Lymphocyte-rich Hodgkin lymphoma: More common in people assigned male at birth (AMAB) than AFAB. ] Lymph nodes carry normal lymphocytes along with Reed-Sternberg cells. It accounts for 5% of the cases
• Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) :  NLPHL is a rare type of cancer that grows slower than classical cancer. The treatment also differs from the classical ones. It accounts for around 5% of the cases

What are the stages and description of Hodgkin's  lymphoma ?

Here is Hodgkin’s lymphoma classification and the different stages.³ 

• Stage I: The presence of lymphoma in one lymph node
• Stage II: The presence of lymphoma in two lymph nodes around the diaphragm area
• Stage II bulky: The presence of a single node  is about 10 cm  or more than one-third of transthoracic (the chest wall) diameter
• Stage III: The presence of lymphoma in lymph nodes around the diaphragm or in the spleen
• Stage IV: The presence of one or more lymphoma in organs such as liver, bone marrow or lung

Stage II bulky, stage III and stage IV are advanced stages of the disorder.

What causes hodgkin's lymphoma tumour? 

There are several causes for developing this lymphoma.⁴

• Genetics: This disease seems to run in families as the chances of getting this lymphoma increases when inherited
• Age: The chances of getting diagnosed with this lymphoma are in the range of  the age group 20 to 30, including and 55+ years of age
• Gender: People AMAB are more susceptible than people AFAB
• Epstein-Barr infection: Any history of Epstein-Barr infection increases the chances of getting diagnosed with this disease
• HIV: People who have HIV are susceptible to developing this disorder
• Medications: Consuming any immunosuppressant or having a weakened immune system can increase the chances of this disease

What are the signs and symptoms to look for in hodgkin's lymphoma?

Hodgkin's lymphomas  are often associated   with swelling in the lymph nodes, which are mostly painless. The benign tumour prefers  in the neck area, armpit or groin area. Some of the symptoms reactions occur after  alcohol consumption. Other signs and symptoms of this disorder are:⁵

• Swelling of the lymph node 
• Sweating, mostly at night 
• Fever 
• Sudden weight loss 
• Itching 
• Shortness of breath 
• Abdominal pain 
• Tiredness

Here is how management and treatment are required for hodgkin's lymphoma? 

This cancer is quick to spread and the treatment depends on the type and severity of the cancer cells.⁶ 

• Chemotherapy: Some chemical-forming medications are ingested kill the cancer cells. The treatment comes in tablet form or via injection. The side effects include hair loss and nausea
• Radiotherapy: It is one of the main treatment options. Radiation can be used via machines to kill off cancer cells. The side-effects can include skin redness and fatigue
• Surgery: Depending on the tumour’s state, the surgery practises are performed to remove the tumour. Bone marrow transplant or stem cell transplanting the bone marrow to better regulate healthy cells distribution. In this case, the diseased cells are declining leaving healthy cells that aid in the growth of new bone marrow
• Immunotherapy: As the name suggests, the antibodies from our   immune system fuel to fight off the tumour. Cancer cells might produce some proteins that help them hide from the immune system. So, this therapy will activate the immune system to fight the cancer cells

In the early stages, combinations of chemotherapy and radiotherapy show 94% survival rates. Advanced stage patients are more likely to relapse to which they turn to chemotherapy alone. 

What tools are used to diagnose hodgkin's lymphoma? 

If you feel unwell or experience  the swelling that does appear  in the neck, groin or armpit area, then it is better to consult your GP. They will carry out a physical assessment or these diagnostic procedures to rule it out. 

• Physical exam: Healthcare professionals might ask for symptoms and check for swollen lymph nodes in the arm, groin or neck region
• Blood tests: Some blood tests are ordered for the purpose of ruling out this cancer. These may check the levels of red blood cells (RBC), white blood cells (WBC) and platelets
• X-ray: A chest X-ray is scheduled to check the spread of cancer cells in lungs or chest area
• CT scan: Computerised Tomography (CT) is a radiological procedure that uses radiation to provide the inside images of the body and information about the spread of cancer
• MRI scan: Magnetic resonance imaging (MRI) is a radiological procedure that uses magnetic fields to provide images and information about cancer cells in the body
• PET scan: Positron emission tomography (PET) is a radiological procedure which uses a radiopharmaceutical to assess the functional activity of the cancer cells
• Bone marrow sample: A sample from bone marrow is analysed  to confirm the presence of cancer cells
• Lymph node biopsy: A biopsy of a sample from the affected lymph node is obtained and tested to diagnose the presence and severity of cancer

FAQs

How can I prevent hodgkin's lymphoma ?

Experts are still unable to identify the trigger for Hodgkin's lymphoma. But overall, a healthy lifestyle and diet may reduce the chances of getting diagnosed.⁴

How common is hodgkin's lymphoma? 

According to the data from NHS and Cancer Research UK, around 2,100 people are diagnosed with Hodgkin's lymphoma  annually in the UK.

When should I see a doctor? 

Please contact your GP if you notice  swelling in your armpit, groin or neck areas. These swelling might or might not be painful.

Summary 

Hodgkin's lymphoma is a benign type of cancer affecting the lymphatic system. The 2,100 people in the UK are getting affected annually. 

Risk factors or causes include genetics, usually in people in their 20s and 30s and 55+ years or having HIV, consuming any immunosuppressant medications and people with AMAB are more prone than people with AFAB.

Symptoms include fever, swelling of lymph nodes in the neck, groin or armpit area, tiredness, sudden weight loss, itching, abdominal pain and sweating. Some symptoms often occur at night or after alcohol consumption. 

 X-rays, CT scans, MRI, PET scans, blood tests or biopsy samples are diagnosis tool for Hodgkin's lymphoma.

Treatment options include chemotherapy, radiation therapy, immunotherapy or surgery.