Research Paper on Hodgkin Lymphoma and Non-hodgkin Lymphoma

Introduction

Cancer is one of the fatal chronic epidemics that is facing the world today. There are various types of cancer and among them is lymphoma. Lymphoma can be generally defined as a cancer of the blood that originates in the lymphatic system (Leukemia and Lymphoma society, p12a). According to studies, lymphoma develops when a certain type of white blood cells known as lymphocyte undergoes a malignant change and multiplies thus getting out of control. Due to their multiplication, the deadly lymphocytes crowd out the healthy cells and they amass themselves in the lymph nodes, liver, spleen, and other parts of the body. Lymphoma is however categorized into two main groups namely, Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).

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According to studies, estimates of 79,990 people living in America were diagnosed with lymphoma in 2014 whereby 9,190 were diagnosed with of HL while 70,800 were diagnosed with NHL (Leukemia and Lymphoma society, p12a). Studies have shown that NHL is among the leading new cancer diagnoses in men and women. It accounts for approximately 4% of new diagnoses and 4% of cancer deaths. Studies also show that an estimate of 65,540 new cases of NHL was diagnosed in 2010 and that in the same year an overwhelming estimate of 20,210 patients succumbed to the disease (Zelenetz et al., P484)

Hodgkin lymphoma which is commonly referred to as Hodgkin's disease was named after Thomas Hodgkin a British pathologist who diagnosed various cases of cancer that affected the lymph nodes. According to studies, the Hodgkin lymphoma is caused by an injury or damage to the DNA of the lymphocyte which is acquired or develops after birth but not inherited. Ones the DNA is altered, it changes and becomes cancerous and if untreated, it leads to uncontrolled growth of cancerous lymphocytes that form tumor masses which accumulate in the lymph nodes and other parts of the body (Leukemia and Lymphoma society, p6b). According to studies, the major distinction of Hodgkin lymphoma is the presence of "Reed-Sternberg cells" which are usually type B cells but with some variations and differences to B cells. In addition to "Reed-Sternberg cells" other types of cells associated with Hodgkin lymphoma are commonly referred to as Hodgkin cells.

Studies show that there are different types and subtypes of Hodgkin lymphoma and that these types and subtypes are determined by the frequency at which the Reed-Sternberg cells are seen and the variations observed. The common types of Hodgkin lymphoma include the classical HL and the nodular lymphocyte predominant HL (Ansell, p436). According to Ansell, the classical HL is the commonly diagnosed type of HL. The classical HL is usually diagnosed when large malignant multinucleated Reed-Sternberg cells are observed in the reactive cellular background. Ansell further states that the classical HL's common clinical manifestation is the painless enlargement of the lymph which is clinically referred to as lymphadenopathy. There are however several subtypes of classical HL, they include; nodular sclerosis, mixed cellularity HL, lymphocyte depletion HL, and the lymphocyte-rich classical HL.

Despite lymphadenopathy being a common clinical manifestation of classical HL, each subtype has its unique clinical features. For instance, nodular sclerosis affects the cervical, supraclavicular and mediastinal regions. The nodular sclerosis is common among adolescents and young adults. On the other hand, the mixed cellularity HL is common with children and the elderly and is often associated with diseases at advanced stages and inaccurate prognosis. Lymphocyte depletion HL, on the other hand, occurs mostly in elderly patients and is often associated with people suffering from HIV and Aids. Lastly, the lymphocyte-rich classical HL's clinical manifestation is similar to that of nodular lymphocyte predominant HL with the only distinctive feature being the consistency of its Reed-Sternberg cells with classical HL (Ansell, p436).

The nodular lymphocyte predominant HL is the rarely diagnosed type of HL compared to classical HL. This type of HL has a unique clinical manifestation distinct from that of the Classical HL. For instance, unlike the classical HL, the nodular lymphocyte predominant HL lacks the Reed-Sternberg cells. Instead, the lymphocyte predominant HL is characterized with lymphocytic and histiocytic (L&H) cells. Studies show that these cells are neoplastic, large, and that they have folded lobulated nuclei. The nodular lymphocyte predominant HL usually affects men and is associated with nodal diseases that affect the neck region. According to studies, this type of HL is unique since it rarely presents symptoms and it has the tendency of late recurrence compared to the classical HL.

In spite of Hodgkin lymphoma being as a result of cancerous lymphocytes, it however can be treated. According to studies, HL treatment strategies vary with different stages of HL and prognostic features. That is to say, if the HL is at an early stage and it has favorable prognostic features or if it is an early stage HL with poor prognostic features or the HL disease is at an advanced stage, a unique treatment strategy will b used on each stage (Ansell, p436). For instance, studies show that early stage favorable HL can be treated through the combination of short duration chemotherapy and involved-field radiation therapy (IFRT). The treatment is given in 2-4 cycles of chemotherapy followed by IFRT and in a dosage of 20-35 Gy (Ansell, p437). On the other hand, a combination of chemotherapy and radiation therapy is recommended for the treatment of patients with early-stage unfavorable HL, that is stages I and II. However under this stage, the most accepted cycles of chemotherapy and IFRT combination is 4 cycles unlike 2-4 cycles under early-stage favorable HL. Lastly, patients with advanced stage HL can be treated by the use of the ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine). Additionally, studies also recommend that more intensive dosage plans such as BEACOPP that is, (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) should also be considered for treatment of advanced stage HL and multiple poor prognostic factors (Ansell, p439).

The other type of lymphoma is the Non-Hodgkin's lymphoma (NHL) which is a heterogeneous group of blood cancer that originates from the lymph system. Similar to the Hodgkin lymphoma, the non-Hodgkin lymphoma develops due to the damage of the DNA of a lymphocyte parent cell. The damaged DNA results in malignant transformation and uncontrolled growth of the lymphocyte and the formation of other cells. The cells then accumulate and lead to the growth of tumors found in the lymph nodes and other sites in the body. NHL therefore generally develops in the lymph nodes and lymphatic tissues in organs such as the stomach, intestines, and the skin (Leukemia and Lymphoma society, P7c).

The World Health Organization (WHO) classifies NHL into two broad classifications, the B-Cell Lymphoma and the T-Cell and Natural Killer (NK)-Cell Lymphoma. According to studies, There are however several subtypes of NHL within the main classification of lymphoma. For instance, in spite of the T-cell lymphoma being made up of several subtypes, the common types are the peripheral T-cell lymphoma- not otherwise specified (PTCL-NOS) and the Angioimmunoblastic Lymphoma. The peripheral T-cell lymphoma- not otherwise specified is a heterogeneous mix of different types of PTCL is the common subtype of T-cell NHL. PTCL-NOS is normally characterized with nodal lymphoma and it is predominant on adults (Wang and Vose, P35). Studies show that this type of T-cell lymphoma affects males more than females in a ratio of 1.5: 1.0. PTCL-NOS patients present advanced stage disease and whereby at least 60% of the patients have stage IV disease with most of them presenting unfavorable characteristics like B-symptoms, elevated lactic dehydrogenase (LDH), bulky disease, poor performance status, and extranodal disease. The Angioimmunoblastic Lymphoma is another common type of PTCL it accounts for approximately 18.5% of the PTCLs. Like the PTCL-NOS, this subtype is also common in adults and affects males more than females and that most Angioimmunoblastic Lymphoma patients present advanced stage disease (Wang and Vose, P35).

There are also a number of different subtypes of B-cell lymphoma. They include diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), the Mantle cell lymphoma (MCL), and many others (Nogai, Dorken and Genz, P1804). According to Nogai et al, the common subtypes of B-cell lymphoma are the DLBCL and the follicular lymphoma. The DLBCL is the common type of B-cell lymphoma and it accounts for approximately 30-40% of lymphoma cases in adults. The morphology, biology, and clinical presentation of DLBC are heterogeneous since it is comprised of other molecular subtypes GCB DLBCL, ABC DLBCL, and primary mediastinal B-cell lymphoma (PMBL) that arise from the B-cells during differentiation (Nogai et al., P1805). The follicular lymphoma is the second most common subtype of B-cell NHL. Studies estimate that follicular lymphoma accounts for 20% of all lymphomas. Follicular lymphoma is characterized by the translocation of chromosomes which promotes the survival of tumorous cells through the overexpression of the anti-apoptotic protein Bcl-2 (Nogai et al., P1805).

Likewise to HL, the NHL can also be treated upon proper diagnosis. Similar to HL, the treatment strategy applied on NHL will vary depending on the type and stage of HNL. For instance, stage I in follicular lymphoma should be treated through radiotherapy while the wait and see approach will be used for stage II-IV patients (Cwynarski, P21). The wait and see method can also be adopted when the patient has an HNL that is either not growing or growing slowly. Treatment will therefore start if the patient develops symptoms of HNL or if the HNL starts to grow. Chemotherapy given in cycles and combinations of drugs depending on the type of HNL may also be used to treat HNL (Leukemia and Lymphoma society, P21d).

Conclusion

Lymphoma is a type of blood cancer that develops in the lymphatic system. Lymphoma can be categorized into two categories namely the Hodgkin lymphoma (HL) and the non-Hodgkin lymphoma (HNL). The two categories of lymphoma are further subdivided into various types and subtypes. For instance, the HL is made up of two major types namely classical HL and the nodular lymphocyte predominant HL. On the other hand, the HNL is also divided into two main types namely B-cell lymphoma and T-cell lymphoma. In spite of lymphoma being a type of cancer it however treatable whereby unique treatment strategies such chemotherapy, radiotherapy, wait and see and the combination of drugs can be used depending on the type and stage of the disease.

Works Cited

Ansell, Stephen M. "Hodgkin lymphoma: 2016 update on diagnosis, risk-stratification, and management." American Journal of Hematology, vol. 91, no. 4, 2016, pp. 434-442.

Cwynarski, Kate. Guidelines for the management of non-Hodgkin's and Hodgkin's lymphoma in adults. 2015. www.londoncancer.org/media/134135/Lymphoma-_London-Cancer-Guidelines-2015.pdf.

Leukemia and Lymphoma society. Facts 2014-2015. Leukemia and Lymphoma society., 2015. www.lls.org/sites/default/files/file_assets/facts.pdf.

Hodgkin Lymphoma. Leukemia and Lymphoma society, 2013. www.lls.org/sites/default/files/file_assets/hodgkinlymphoma.pdf.

Non-Hodgkin Lymphoma. Leukemia and Lymphoma society, 2013. www.lls.org/sites/default/files/file_assets/nhl.pdf.

The Lymphoma Guide Information for Patients and Caregivers. Leukemia and Lymphoma society, 2013. www.lls.org/sites/default/files/file_assets/lymphomaguide.pdf.

Nogai, Hendrik, et al. "Patho...