What is Hodgkin’s disease :
The white blood cells are the cells involved in the body’s defense. Within find different types of leukocytes such as polymorphonuclear leukocytes, lymphocytes or monocytes, each with a specific function within the immune system.
Leukocytes originate in the bone marrow cells from immature blasts that are known to create differentiating different types of leukocytes. A leukocyte types that are created are lymphocytes, which are white blood cells responsible for the immune response to infection by antibodies. Lymphocytes, in order to recognize a noxious agent (bacteria, virus, …), should contact any antigen of the agent and create specific antibodies to recognize and activate the immune system to their presence. Lymphocytes leave the bone marrow, and go through the lymph to the lymph nodes, immune system structures scattered throughout the body, where they come into contact with the antigen, create antibodies against these and from there out to the blood to fight infection. When there is an infection, enlarged lymph because of the proliferation of lymphocytes that are within.
When for whatever reason are lymphocytes in lymph nodes become malignant, that is, start to proliferate uncontrollably, alter its structure and is not sensitive to programmed cell death signals, the natural death cells are defective or old, creates a tumor in these lymph nodes, which is what is known as a lymphoma.Within a special type lymphomas because the cell causing it and with clinical and prognostic differences that are peculiar: it is called Hodgkin’s lymphoma or Hodgkin’s disease.
How does it occur ?
Hodgkin lymphoma represents 1% of cancers in the world. It is more common in men (except in one of its varieties) and has two ages of highest incidence, between the 2nd and the 3rd decade of life and about 60 years.
It is not known what causes the lymphocytes that produce, especially of type B, lymph nodes and result malignicen Hodgkin’s disease, but it can be said that about half of cases has been detected virus material Epstein-Barr virus one can give rise to infectious mononucleosis.
Hodgkin’s disease is defined by a lymphoma in which to perform the affected lymph node biopsy, there is a cell called the Reed-Sternberg characterized by having two cores and have a specific cell markers, this cell, however , is not unique to this disease. A variant of it has only one core and is called cell lymphoma.Likewise, the biopsy will appreciate other cells of the immune system as a consequence of the inflammatory response generated by the tumor.
Depending on the cells that make up the tumor, there are four types of Hodgkin lymphoma with different incidences and prognoses:
lymphocyte-predominant, accounting for 5-15% of all cases and is the form of better prognosis.
nodular sclerosis, the most common (40-75%) is the prognosis for second best and is the most common form in women.
mixed cellularity, 20-40% of cases, usually spread easily.
lymphocytic depletion constitutes 5-15% of Hodgkin’s and is the form with worse prognosis.
Hodgkin’s disease Symptoms
The essential clinical lymphadenopathy is present, ie, enlarged lymph nodes, without an apparent infectious cause justifying them. Lymph most often affected are the cervical lymph nodes and the second located in the mediastinum. Can also occur at the level of abdomen and axillary nodes. They are not painful lymphadenopathy and sometimes can increase in size and decrease in cycles.
The spleen is usually affected in about one third of cases and liver by 5% of Hodgkin lymphomas, splenic involvement always prior.
There are a number of secondary symptoms that are called B symptoms include fever and tumor (fever secondary to the existence of a tumor), night sweats and weight loss of over 10% in 6 months without apparent cause. There is often itchy skin symptoms associated with B, but the itch is not considered in itself a symptom B.
Because of immunodeficiency in these patients may suffer repeated infections, especially certain viruses, fungi or parasites.
Hodgkin lymphoma is usually spread through the lymphatic route to neighboring nodal areas, but can also do it by blood or simply by contiguity to adjacent tissues.
Hodgkin’s disease Diagnosis
Lymphoma should be suspected in any patient presenting with palpable lymphadenopathy without an infectious cause that justifies it and in the case of Hodgkin if any of the symptoms mentioned B.
The blood tests will be appreciated leukocytes increased, with predominance of a particular type, eosinophils, and subsequently a decrease in the number of lymphocytes. It is frequently also a secondary to chronic anemia. The erythrocyte sedimentation rate (ESR), a parameter that makes the existence of an inflammatory response, will be high.
Computed tomography (CT) is the imaging test to use in order to assess whether there is lymph node involvement, especially in areas such as the mediastinum or abdomen that are not accessible by physical examination.
In the bone marrow biopsy may be found in Reed-Sternberg cells and fibrosis and a decrease in the proportion of fatty tissue in the bone. If the biopsy is positive not performed an exploratory laparotomy to biopsy of lymph nodes, liver, iliac crest, ovaries and remove the spleen, it indicates that there is dissemination. This laparotomy only performed if Hodgkin’s disease is localized and can be treated by radiotherapy.
To assess the extent and therefore therapeutic options using the Ann-Arbor classification, based on the number of nodal areas affected, the location of the same (varying stage if a same side of the diaphragm or both sides), the presence or absence of involvement by contiguity and the involvement of the spleen and other organs as well as the presence or absence of symptoms called B.
Hodgkin’s disease Treatment
Treatment of Hodgkin lymphoma is based on radiotherapy and chemotherapy. They use one, other or both depending on the stage of the Ann-Arbor classification.
In stages I and II, those in which there is involvement of one or more lymph node regions or territories affected by contiguity to the same side of the diaphragm, the treatment of choice is radiotherapy.
When there is involvement on both sides of the diaphragm, stages III and IV, will be chosen as chemotherapy treatment, with a minimum of 6 cycles.
In those cases where the lymphoma has a size greater than 10 cm, occupies more than one third of the chest radiograph or abdomen, or in stages I and II B showing symptoms will be chosen radiotherapy combined with chemotherapy.
In case of relapse, if local radiotherapy or chemotherapy will depending on whether the former has previously applied or not. If it is a recurrence diffuse chemotherapy was administered again, changing the pattern if the relapse is less than one year, a fact that indicates that there is resistance to treatment.
The main factors affecting poor prognosis are stage, Extralymphatic involvement, B symptoms, advanced age, the presence of a tumor mass of more than 10 cm, the type of cells that make up the tumor and the existence of more than 5 nodules in the spleen.
Precautions
Because of the unknown origin of Hodgkin’s disease, there are no measures to prevent its occurrence.