stage 4 lymphoma | Hodgkin's disease (lymphoma, Hodgkin's disease)

Hodgkin's disease
(lymphoma, Hodgkin's disease)



Description
Hodgkin's disease is a group of cancers that appear in the lymph nodes and then spread to neighbouring regions. The lymph nodes are small organs that are found in various parts of the body, such as the armpits, the groin, the back of the abdomen and the neck.

These lymph nodes help the organism fight infection by filtering bacteria and other harmful substances. In some people, the neck glands may swell slightly in the event of a cold or flu, but this is usually a temporary phenomenon that lasts only a week or two.

Hodgkin's disease is a form of lymphoma, a cancer that affects the lymphatic system. Lymphomas are the third most common form of cancer in children. Hodgkin's disease generally occurs in 2 age groups: in individuals between 15 years and 40 years and in those over 55 years.

Causes
As with most cancers, the exact cause of Hodgkin's disease is unknown. Studies have shown a higher risk of disease in people who have already contracted Epstein-Barr virus, suggesting to researchers that viral factors may play a role in the development of this type of cancer. This hypothesis is however not yet proven.

Other possible risk factors include HIV infections, a family history of Hodgkin's lymphoma, chemotherapy treatments, or radiation exposure. People whose immune systems are depressed by certain medications or medical conditions may also have a higher risk of this disease.

Symptoms and Complications
People with Hodgkin's disease may experience any of the following signs and symptoms:
An increase in the volume of the spleen
Intense itching (rare);
Difficulty breathing
Swelling of the legs
Persistent fatigue;
Fever and shivering;
A painless swelling of the lymph nodes in the armpits, neck or groin;
Loss of appetite
Weight loss (involuntary);
Night sweats;
A cough.
If you discover a painless mass, especially in the neck area, and it does not disappear after a few weeks, you should consult a doctor to check the nature of this mass. In most cases, and especially in children, a painless swelling of the lymph nodes is the only telltale symptom of Hodgkin's disease.

Diagnosis
To diagnose Hodgkin's disease, the doctor must perform a rigorous physical examination during which he checks for signs of swelling at the lymph nodes. In some cases, a single touch can reveal a suspicious mass. Some lymph nodes inside the body may not be easily detected.

Occasionally, the volume of the spleen increases (under the left side of the rib cage) and the Doctor is able to feel it at the touch. Biopsy of a lymph node (removal of certain tissues from the lymph node for analysis) determines the cause of gland swelling and confirms the diagnosis of cancer.

Other tests may be considered necessary such as blood and urine tests and special radiological examinations such as computer tomography or positron emission tomography (PET). These explorations help the doctor to see if the cancer has spread to other parts of the body.

It is also possible to perform a bone marrow biopsy. The bone marrow is the spongy tissue that is found in the center of most bones. This test is carried out to determine if the lymphoma has spread to the bone marrow.

This is the way to determine the "stage of cancer", which indicates whether it is a beginning or stage of disease already advanced. The determination of the stage of cancer is important because the planning of the treatment depends on it.

4 stages are distinguished in Hodgkin's disease. Stage 1 corresponds to the lightest form, and stage 4 to the most advanced stage.

Stage 1: Cancer is still located in a region of the lymph nodes, i.e. it has not yet spread.
Stage 2: The cancer has spread to a small extent to the surrounding areas of the lymph nodes, while remaining on the same side of the diaphragm (the muscle separating the thorax from the abdomen).
Stage 3: Cancer has spread to areas of the lymph nodes above and below the diaphragm.
Stage 4: The cancer has spread outside the lymphatic system. The areas that are frequently affected are liver and bone marrow.
Treatment and prevention
The treatment is intended to obtain a complete remission, which means the total absence of signs or symptoms of the disease. The type of treatment depends on the stage of the cancer.

For stages 1 and 2, radiotherapy is usually used. High energy radiation, made up of invisible particles, is penetrated into the body to destroy the cancer cells. Radiation therapy lasts several weeks. It is sometimes combined with chemotherapy, a treatment that includes anti-cancer drugs to eliminate tumors or cancer cells.

For stages 3 and 4, the primary treatment is intensive chemotherapy usually followed by radiation therapy. Although it is possible to obtain a remission of cancer using chemotherapy, it causes unpleasant side effects (e.g. nausea, vomiting, weakness) and inhibits the person's immune system. Chemotherapy, which requires the absorption of a combination of anti-cancer drugs, is frequently used to treat Hodgkin's disease. Chemotherapy treatments can last from 3 to 6 months, including alternate treatment cycles with drug-free periods to allow the body to recover.

In the case of relapse after chemotherapy, the cancer will be treated again. The method of treatment will depend on the location of the cancer and the components administered during the previous treatment. Higher doses of anti-cancer drugs may be necessary and chemotherapy should sometimes be combined with radiation therapy.

In cases where the cancer reappears, an autologous bone marrow transplant is often performed – an operation by which the patient's bone marrow is taken before chemotherapy and then re-injected into the body. This procedure is done to allow the body to receive higher doses of anti-cancer agents. The fact that it is a autologous transplant, that is to say that the patient receives his own marrow, there is no risk of rejection and antirejection drugs are not necessary, unlike allogeneic transplants (from another donor).

If Hodgkin's disease is diagnosed early and treated quickly, the cure rate is very high – up to 90% of cases.