These are cancers of the lymph glands. While most cancers occurring anywhere spread into lymph glands, lymphomas primarily involve the lymph nodes. On account of their characteristics, lymphomas are divided into two categories:
1. Hodgkin’s lymphoma
2. Non-Hodgkin’s lymphoma
Hodgkin’s Lymphoma
The disease is characterized by progressive painless enlargement of lymph glands. It occurs in both sexes, more often in males. Its incidence is low in children, maximum around the age of 20 years, decreases after this age but occurs in older people.
It is distinguished from non-Hodgkin’s lymphoma by histological examination of the involved gland, which shows the presence of Reed-Sternberg cells, now thought to be cancer cells.
Cause(s)
It is not known.
Symptoms
Painless swelling of a group of glands, more often on one side of the neck. The involvement of the glands may be present in the thorax or the abdomen.
· Loss of weight
· Diminished appetite
· Feeling of ill health
· Fever which comes on and abates, leaving behind increasing weakness.
Diagnosis
Routine: Blood: Hb, RBC, TLC may be normal. DLC may show some increase of eosinophil cells.
Special: Biopsy examination of the involved lymph gland shows the characteristic microscopic picture of Hodgkin’s disease, thus clinching the diagnosis.
Additional: X-ray of the chest may show opacities of the Hodgkin’s disease if the lung is involved. Ultrasound examination and CT scan, may show the involvement of the organ such as the liver.
Treatment
Hodgkin’s disease is thought to arise in one region of the body and spread from there to others. It is, therefore, important to establish the extent of the disease at the time of diagnosis because staging largely determines the way the treatment is to be given. There arc four clinical stages, based primarily on the extent of the disease.
Stage I: Only one group of glands is involved anywhere in the body.
Stage II: More than one group of glands is involved, but only on one side of the body.
Stage III: More than one group of glands are involved, but on both sides of the body.
Stage IV: Besides the glands, there is involvement of the lungs, liver, bones.
Surgery: In stage I, surgery is resorted to, in order to remove the involved lymph nodes.
Radiation: In stage II and III, radiation is the treatment of choice. It is given 4 to 5 days a week, for 3 to 4 weeks. The usual side-effects arc nausea, vomiting, tiredness, soreness over the radiated area.
Chemotherapy: When the disease is widespread, only chemotherapy may be of help. Different group of drugs are given.
MOPP: Nitrogen Mustard, Vincristine, also called Oncovin, Prednisolone, Procarbazine.
MVPP: Nitrogen Mustard, Vinblastine, Prednisolone, Procarbazine.
ABVD: Adriamycin, Bleomycin,Vinblastine, DTIC. The drugs are usually given intravenously and repeated weekly. Tablets are taken by mouth about a fortnight after the injection.
Prognosis
The results of treatment are best in those with a localized disease, discovered early.
Early Detection
Signs & Symptoms
· Painless swelling in a group of glands, more often on one side of the neck.
· Fever which comes on and abates frequently.
· Loss of weight.
· Loss of appetite.
Investigations
· Raised ESR.
· Biopsy examination of the involved lymph gland in the neck or abdomen or other sites.