Lymphoma is a cancer of the lymphatic system, a part of the immune system. There are two main types of lymphoma: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).
Lymphomas are the fifth most common type of cancer in the UK. They can occur at any age but in most cases, are nearly always treatable. Most lymphomas are non-Hodgkin lymphoma. Only around 20 per cent are Hodgkin lymphoma.
When someone has lymphoma, some of their ‘lymphocytes,’ the specialised white blood cells used for killing bacteria and fighting infection, act abnormally and collect and multiply in the lymph nodes, spleen and other areas such as the chest, bowel, skin and liver.
Hodgkin lymphoma is a rare cancer. Around 1,800 people are diagnosed with the disease every year in the UK.
Hodgkin lymphoma commonly affects people aged 20-34 and 70-79, but it can occur at any age. It occurs more commonly in men although women can also be affected. It is not infectious.
There are two types of Hodgkin lymphoma. Firstly, the classical type, of which there are four sub-types: nodular sclerosing, mixed cellularity, lymphocyte-depleted, and lymphocyte-rich. Then, there’s the much rarer nodular lymphocyte-predominant type.
Hodgkin lymphoma develops when a person’s lymphocytes become abnormal and begin dividing uncontrollably. Over time the excess production of abnormal lymphoma cells form a tumour.
The exact causes of Hodgkin lymphoma are unknown at present but contributing factors may include lowered immune systems due to recent surgery or conditions such as HIV, previous glandular fever, a family history of Hodgkin lymphoma, and lifestyle factors such as smoking and being very overweight.
Lymphoma cells usually begin growing in the lymph nodes and most commonly appear in the neck, chest, abdomen, groin, and armpits. Lymphoma cells can spread via the lymphatic system, forming secondary tumours and affecting organs such as the spleen, liver, lungs and bone marrow.
A common initial symptom of Hodgkin lymphoma is a painless swelling in the neck, armpit or groin. These swellings are enlarged lymph nodes. Other common symptoms include fatigue, rapid weight loss, coughing or breathlessness, itching, high unexplained temperatures, abdominal pains, excessive bleeding and night sweats.
Testing and Diagnosis
Although many of the above symptoms are common to other conditions, it is still important to have them checked by your GP who may then refer you to a specialist and arrange for you to have any appropriate tests or x-rays.
You may be referred for a lymph node biopsy whereupon a cell or tissue sample will be taken under anaesthetic from the affected area and analysed under a microscope. Following the operation it is normal to feel a little sore and bruised around the sample area but any related pain will disappear after a few days.
Biopsy results usually take up to two weeks to come back as various tests need to be conducted to determine whether or not Hodgkin lymphoma is present. If a biopsy is positive, further tests will be needed to allow doctors to decide on the best possible course of treatment.
Pinpointing whereabouts in the body cancer is present, the size of tumours, and whether the cancer is localised in one area of the body or has spread from its initial location, helps doctors decide on the most effective treatment needed.
Early stage Hodgkin lymphoma
- Stage 1 indicates that only one group of lymph nodes is affected or lymphoma is present in just one organ.
- Stage 2 indicates that two or more groups of lymph nodes are affected on the same side of the diaphragm.
Advanced stage Hodgkin lymphoma
- Stage 3 means the lymph nodes are affected on both sides of the diaphragm.
- Stage 4 indicates the lymphoma has spread to many groups of lymph nodes as well as organs such as the lungs, liver or bones.
For early stage Hodgkin lymphoma, radiotherapy may be used to target lymphoma cells in one or two groups of lymph nodes in a specific part of the body. For advanced Hodgkin lymphoma, radiotherapy can be used to shrink enlarged lymph nodes. Radiotherapy is usually given after a course of chemotherapy.
Side effects from radiotherapy vary but may include fatigue, nausea and hair loss. Side effects usually disappear following treatment but some people may suffer long-term effects such as skin discolouration, risk of secondary cancer, heart problems, risk of infertility and pneumonitis.
Chemotherapy uses anticancer drugs known as cytotoxic drugs to destroy cancer cells. A combination of chemotherapy drugs and in some cases, steroids, may be given either intravenously or in tablet form to target lymphoma cell sites anywhere in the body and prevent cancer cells from growing. Treatment usually lasts between two and six months and is given in cycles over one to three days with breaks of a few weeks in between to allow patients to recover from side effects.
Chemotherapy drugs can cause a number of side effects that will depend on the drugs given. They include anaemia, hair loss, nausea, fatigue, mouth ulcers, infertility and commonly, an increased risk of infection. Side effects are generally short-term and will improve following treatment.
Other treatments for Hodgkin lymphoma may include biological therapies to stimulate the immune system and restrict the growth of cancer cells, and stem cell and bone marrow transplants to allow patients to receive and cope with much higher doses of chemotherapy.
Early Diagnosis is Crucial
Treatment for Hodgkin lymphoma is usually very successful even when lymphoma cells have managed to spread throughout the body, but it’s important that doctors are able to tell the difference between Hodgkin and non-Hodgkin lymphomas as they are two different diseases, requiring different treatments.
As Hodgkin lymphoma is rare and symptoms are often the same as a number of other medical conditions, the National Institute for Health and Care Excellence (NICE) has produced referral guidelines for GPs to help them decide which patients may need urgent referral to a specialist.
If lymphoma is diagnosed early, the chances of curing the disease are often good. A delay of just a few months in diagnosing Hodgkin lymphoma is unlikely to make any difference, but if tumours are allowed to grow then advanced stage lymphoma can spread to other parts of the body. Mistakes in diagnosing Hodgkin lymphoma can, therefore, potentially be very serious.
Paul Sankey is a clinical negligence solicitor at Slater and Gordon Lawyers in London.
Slater and Gordon Lawyers help people who have suffered from delayed or wrong diagnosis of cancer due to medical negligence. For a free consultation call our medical negligence solicitors on freephone 0800 916 9049 or contact us online.