Hodgkin’s lymphoma is a lymphatic cancer. Because lymphatic tissue is found in numerous parts of the body, Hodgkin’s disease can originate almost anywhere but usually occurs in the lymph nodes in the upper body such as the chest, neck or armpits.
This cancer generates a widening of the lymphatic tissue, which can cause pressure on some important structures of the body. The most common way Hodgkin’s disease spreads through the lymphatic vessels to other lymph nodes. On most occasions this disease spreads to the nearest lymph nodes in the body and not to distant ones. It rarely makes it into the blood vessels and can spread to almost any other part of the body, including the liver and lungs.
Incidence of Hodgkin’s lymphoma
In Spain, in 2016, the incidence of this pathology was 12.3 /100,000 inhabitants. Every year there are about 1,500 new cases in our country diagnosed by Hematology specialists. Since many sufferers are young, they often live more than 40 years after treatment.
- Incidence: in Europe it is estimated to have an incidence of 1000 new cases per year per 100,000 inhabitants. Unlike other lymphomas, its incidence is stable over time.
- Age: Hodgkin’s lymphoma has a bimodal distribution, with the first peak often appearing in youth, between 20 and 35 years of age, and then decreasing. The second peak appears at older ages, after 50 years of age, like all other lymphomas. It is uncommon for it to appear before the age of 10 years.
- Sex: Hodgkin’s disease is more common in men than in women.
- Geographic region: it is more common in developed countries, in Europe and the United States, with the exception of Japan, than in developing countries.
- Socioeconomic level: it generally occurs in people with a high socioeconomic level. However, people of low socioeconomic status have a worse prognosis. Socioeconomic status accounts for geographic and racial differences.
Causes of Hodgkin’s lymphoma
There are several causes of Hodgkin’s disease:
- Genetic factors: although there are familial cases, most cases with Hodgkin’s disease are not hereditary in origin. However, it is 99 times more frequent in a homozygous twin of an affected subject than in the general population, which supports the suspicion of a hereditary factor. What is not clear is the association with the histocompatibility system (HLA).
- Medical history: Hodgkin’s disease has only been associated with some congenital and acquired immunodeficiencies (HIV) and autoimmune diseases. They have also described an increased risk in tonsillectomized and appendectomized patients.
- Occupational factors: it is linked to some industrial jobs related to lead, wood, organic substances, but requires further confirmation.
- Epstein-Barr virus infection: it has been shown that more than half of patients with Hodgkin’s disease have been in contact with Epstein-Barr virus (EBV), as they have either had infectious mononucleosis, or have high levels of antibodies to EBV or the virus is present in lymphoma cells.
Symptoms of Hodgkin’s disease
There are several symptoms that may imply the appearance of Hodgkin’s lymphoma:
- Incidental detection: the patient may palpate a sudden enlargement of nodes in the neck, armpit or English area, or the specialist may observe a mediastinal mass on a chest X-ray that has been performed for another reason.
- B symptoms: these are general symptoms consisting of an unexplained fever lasting more than 3 days, a loss of body weight in the last 6 months and profuse sweating, usually at night. Of these symptoms, the most important are fever and weight loss. Pruritus is not considered a B symptom, except when it appears suddenly with recurrent, persistent and generalized lymphadenopathy. Pel-Ebstein’s fever is an unusual type of temperature increase over several days, which then disappears for several days or weeks before reappearing.
- Painful adenopathy: although the nodes affected by Hodgkin’s disease are not painful, it is characteristic that the patient presents pain in the enlarged node when alcohol is ingested. This is known as Hoster’s sign.
Other symptoms are cough, chest pain or dyspnea, in cases of involvement of the mediastinum, lungs, pleura or pericardium. Asthenia or weakness is also common in cases of anemia due to bone marrow involvement.
The patient may also present with other less frequent symptoms depending on the anatomical location affected.
Treatment of Hodgkin’s lymphoma
There are several treatments for Hodgkin’s lymphoma. Generally, current treatment plans for Hodgkin’s lymphoma use new types and doses of chemotherapy and radiation therapy directed at smaller areas of the body.