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There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. Your doctor will not be able to tell the difference just by examining you as it is only detectable under the microscope. Hodgkin lymphoma is most commonly found in young people in their 20s.
The lymphatic system
The lymphatic system is part of the body’s defences against infection and disease. It runs throughout the body and is made up of vessels, organs and nodes. Organs that form part of the lymphatic system include bone marrow, tonsils and the spleen. Nodes are found in clusters in different parts of the body, but the major sites for nodes are the neck, armpits and groin.
The vessels of the lymphatic system carry lymph, a white liquid made up of white blood cells called lymphocytes. Lymphocytes play an important role in helping to fight infections.
Causes of Hodgkin lymphoma
When a patient has Hodgkin lymphoma, the cells no longer divide and reproduce in the normal ordered way. Malignant cells divide rapidly before they are mature, increasing the number of immature cells in the bone marrow and causing them to spill over into the blood. A tumour or lump may form in one of the group of lymph nodes. Lymphoma cells can spread to lymph nodes in other parts of the body via the lymphatic system.
The signs and symptoms of Hodgkin lymphoma may include the following:
- a painless swelling in your neck, groin or armpit
- night sweats
- weight loss
- widespread itching
- pain in the affected lymph node after drinking even small amounts of alcohol.
The most common symptoms are high temperatures, sweating and weight loss. These are known as ‘B Symptoms’.
You may have experienced some or all of these symptoms, which may be why you went to your family doctor in the first place. Your doctor will carry out a full physical examination and ask you how you are feeling. The symptoms of lymphoma can be caused by other less serious complaints and your doctor will ask you to have several tests to confirm a diagnosis.
A series of tests or investigations will be done to confirm or rule out a diagnosis of Hodgkin lymphoma and to check on your general health.
A chest X-ray will be taken to examine your lungs and the lymph nodes in your chest.
A biopsy is the removal of a small sample of tissue, for example a swollen lymph node, for examination under the microscope. This is usually done under a general anaesthetic. You may be asked to attend hospital as a day case or to be admitted overnight.
The lymph node will be examined by the pathologist. If a diagnosis of lymphoma is confirmed, you will be asked to have further tests. Both Hodgkin lymphoma and non-Hodgkin lymphoma have sub-groups based on what the cells look like under the microscope. When the pathologist examines the lymph node they will be able to tell exactly what type of lymphoma you have.
A lymphoma can occur in any part of the lymphatic system or at a single site outside it, such as the stomach, gut or eye. Like all cancers it can spread if left untreated and this spread may be within the system or outside it.
Bone marrow sample
In order to confirm what type of leukaemia you have and to plan your treatment, it is necessary to examine a small sample of bone marrow. This is normally taken from the hip bone and is examined to determine whether any blast cells are present.
The process is conducted under local anaesthetic and takes five to ten minutes. It is not painful, although some patients find it uncomfortable. The procedure will be explained to you before it is carried out and you will be able to ask any questions or raise any concerns you might have.
Blood samples will be taken to check your general health and how well certain organs in your body are working, for example your liver and kidneys. If you want more details about these, please ask your doctor or nurse.
Blood tests will be taken throughout your treatment to monitor how you are responding and how effective your treatment is.
The main types of treatment for Hodgkin lymphoma are chemotherapy and radiotherapy. Your treatment will be planned by a team of specialists and will be based on the results of the tests you have had. Factors taken into account when planning your treatment will include:
- your age
- your general health
- the size of affected lymph nodes
- whether the lymphoma has spread to other organs
- whether you have experienced any B symptoms.
Your doctor will explain the planned treatment and take the time to answer any questions you may have.
Early-stage Hodgkin lymphoma
Patients with early-stage Hodgkin lymphoma may be treated with radiotherapy alone or in combination with chemotherapy (anti-cancer drugs).
Late-stage Hodgkin lymphoma
Chemotherapy is the main treatment for more widespread disease. You may be offered high-dose chemotherapy with bone marrow or stem cell transplant.
Steroids are generally given with chemotherapy to lessen their side effects. If you have to take steroids for more then a few months you may experience a range of side effects. Your doctor will be able to give you information on how to cope with them. All side effects are temporary and you will notice them disappearing once you finish the treatment.
The doctor will ask you to attend hospital at regular intervals during and after your treatment for Hodgkin lymphoma. You will be given a clinic appointment, and these will probably become less frequent as time passes.
At each checkup your doctor will examine you. Blood tests, X-rays or scans may be repeated to check your recovery and make sure the cancer hasn't returned.
If you are worried about anything between your appointments, for example any unexplained aches or pains, please contact your hospital doctor. Your family doctor will also have been sent details of your treatment and progress.
It's important that you discuss anything unusual and don't worry needlessly. Please use your clinic appointment to discuss any concerns you may have about your recovery and return to your usual lifestyle.