Diagnoses , Staging Feb to March 2014

Diagnoses & Staging

There are two main types of Hodgkins Lymphoma

Non Hodgkin Lymphoma & Hodgkin Lymphoma.

I am only covering Hodgkin Lymphoma on this site

Causes of Hodgkin lymphoma  

Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called B lymphocytes, although the exact reason why this happens is not known.

The DNA gives the cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions so that the cells keep growing. This causes them to multiply uncontrollably.

The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, it is possible for the abnormal lymphocytes to spread into other parts of your body, such as your bone marrow, spleen, liver, skin and lungs.

Who is most at risk?

While the cause of the initial mutation that triggers Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition:

• having medical treatment that weakens your immune system –for example, taking medication to suppress your immune system after an organ transplant
• being previously exposed to the Epstein-Barr virus (EBV), a common virus that causes glandular fever
• having previously had non-Hodgkin lymphoma, possibly because of treatment with chemotherapy or radiotherapy
• having a medical condition that weakens your immune system, such as HIV

Hodgkin lymphoma isn’t infectious and isn’t thought to run in families. Although your risk is increased if a first-degree relative (parent, sibling or child) has had lymphoma, it is not clear if this is because of an inherited genetic fault or lifestyle factors.

Hodgkin lymphoma can occur at any age, although most cases are diagnosed in people in their 20s or 70s. The condition is slightly more common in men than women.

Hodgkin lymphoma is a relatively aggressive cancer and can quickly spread through the body. Pending on the Stage of the cancer will define the steps the medical team will need to perform. This is also quiet a rare cancer in 2014 there were only 24 cases of this cancer diagnosed in Ireland with only 5 of these staged at Stage 3 or higher.

What Are the Symptoms of Hodgkin’s Disease ?

The most common symptom of HLD is swelling of the lymph nodes, which causes a lump to form under the skin. This lump usually isn’t painful. It may form in one or more of the following areas:

• on the side of the neck
• in the armpit
• around the groin

Other symptoms of HLD include:

• night sweats
• itchy skin
• fever
• fatigue
• unintended weight loss
• persistent cough
• pain in the lymph nodes after consuming alcohol
• enlarged spleen

Call your doctor right away if you have any of these symptoms. They can be signs of other conditions, and it’s important to get an accurate diagnosis

How Is Hodgkin Lymphoma Disease Diagnosed?

To diagnose HD, your doctor will perform a physical exam and ask you about your medical history. Your doctor will also order certain tests to make a proper diagnosis. The following tests may be done:

• imaging tests, such as X-rays or CT scans
• lymph node biopsy, which involves removing a piece of lymph node tissue to test for the presence of abnormal cells
• blood tests, such as a complete blood count to measure levels of red blood cells, white blood cells, and platelets
• immunophenotyping to determine the type of lymphoma cells that are present
• lung function tests to determine how well your lungs are working
• an echocardiogram to determine how well your heart is working
• bone marrow biopsy, which involves the removal and examination of marrow inside your bones to see if the cancer has spread
• Lumbar punch to check if the disease has spread to the spine.

Staging

Once an HD diagnosis has been made, the cancer is assigned a stage. Staging describes the extent and severity of the disease. It will help your doctor determine your treatment options and outlook.

There are four general stages of HLD

The stage of lymphoma describes the extent of the spread of the tumor, using the terms stage I through IV (1 through 4). Each stage may also be further divided into “A” and “B” categories, based on whether or not the patient is experiencing specific symptoms.

Stage I: The cancer is found in 1 lymph node region above or below the diaphragm.

Stage II: Either of the following conditions applies:

• The cancer is in 2 or more lymph node regions on the same side of the diaphragm (stage II).
• The cancer involves 1 organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III: There is cancer in lymph node areas on both sides of the diaphragm, meaning above and below it (stage III). In addition, an extralymphatic organ may be involved (stage IIIE), or the spleen (using the letter “S,” stage IIIS), or both (stage IIIES).

Stage IV: The lymphoma has spread to organs beyond the lymph nodes. Common places that Hodgkin lymphoma usually spreads to include the liver, bone marrow, or lungs.

Recurrent: Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body.

Recurrence may occur at any time, including shortly after the first treatment or years later. If the lymphoma does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how well this treatment will work. For patients with Hodgkin lymphoma, several factors can predict whether the disease will return and which treatments will be successful. A patient may be described as having high-risk disease or low-risk disease based on how many of the following prognostic factors there are.

Factors that are considered less favorable and lead to a poorer prognosis include:

• Low blood albumin (a type of protein) levels, defined as less than 4 g/L
• Low hemoglobin (red blood cell count), defined as less than 10.5 g/dL
• Being male
• Age 45 and older
• Stage IV disease
• White blood cell count that is more than 15,000 per cubic millimeter (mm³)
• Lymphocyte count that is less than 600 per mm³, less than 8% of the total white blood cell count, or both

Other prognostic factors that are considered, especially for early-stage Hodgkin lymphoma, include:

• A higher ESR (described in theis associated with a poorer prognosis.
• People with lymphocyte-predominant Hodgkin lymphoma, nodular sclerosis Hodgkin lymphoma, and lymphocyte-rich classical Hodgkin lymphoma have a better prognosis, compared with other subtypes of Hodgkin lymphoma.
• A large mediastinal mass is a large lymph node mass in the center of the chest that is larger than 10 centimeters (cm). It is associated with a poorer prognosis. Small mediastinal masses are not associated with a poorer prognosis.
• Having a high number of lymph node sites involved is associated with a poorer prognosis

The following test were preformed on me

1. Multi blood test including microbiology and immunophenotyping

2. Biopsy to right side neck

3. CT Scan

4. MRI

5. Bone Marrow sample

6. Lumbar Punch biopsy

7. P.E.T Scan

8. Echocardiogram

9. Respiratory function test

Conclusion from these test determined that I was at an advanced level of this cancer Hodgkin Lymphoma  Stage IV B