Lymphoma is a cancerous blood disease that affects blood cells known as lymphocytes and immune system in general. Lymphocytes are the cells of the immune system. Lymphocytes constitute about 25% of white blood cells and include B cells, which participate in making antibodies, and T cells, which function in cellular immunity. Lymphoma manifests itself when lymphocytes start mutating and transforming into malignant ones. Lymphoma originates mainly from gathering of the abnormal lymphocytes inside the body due to their definite features: cancerous lymphocytes multiply faster, and their life duration is longer compared to normal cells. Multiplication of malignant lymphocytes and their gradual accumulation within the body causes lymphoma.
There are two main types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. The two lymphomas have definite common and distinctive features. It is important to know the similarities and differences between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma in order to choose a right treatment and nursing. Lack of medical knowledge prevents us from detecting a disease on time or paying attention to anxious signs. Such unawareness may result in severity of the disease and, consequently, in various complications that can even be fatal.
The purpose of this essay is to fill the gap in medical knowledge and make us capable in recognizing sicknesses such as Hodgkin’s lymphoma and other types of lymphomas, their symptoms and treatment.
“Hodgkin’s lymphoma is a type of cancer involving tissues of the lymphatic system, or lymph nodes” (Ford-Martin & Odle, 2005). Various medical sources define the Hodgkin’s disease as cancer of the lymphatic system.
From pathophysiological point of view, the disease occurs when the lymphocyte’s DNA is injured. “The altered DNA in the lymphocyte produces a cancerous change that — if untreated—results in the uncontrolled growth of the cancerous lymphocyte” (Walter, 2012). Hodgkin’s lymphoma appears due to uncontrollable multiplication of abnormal B-lymphocytes. Such B-cell malignant disorder affects the reticuloendothelial and lymphatic systems. The characteristic cells associated with Hodgkin's disease are called Reed-Sternberg cells. Manifestation of such cells during biopsy helps in diagnosing lymphoma. Till today, the exact causes of Hodgkin’s lymphoma remain unknown. Presently, the medical researchers have dissected certain risky factors which increase the possibility of having the above-mentioned illness. Patients carrying EBV (Epstein-Barr virus) and human immunodeficiency virus are more susceptible to Hodgkin’s lymphoma than the others. However, other researchers in this field additionally include other viruses such as H. pylori infection, human T-cell leukemia virus (HTLV), and Kaposi’s sarcoma-associated herpes virus (KSHV) that can be linked to Hodgkin’s disease.This indicates a definite viral nature of Hodgkin’s lymphoma. Though, people with transplanted organs are also in a risky group as far as they have a compromised immune system and take special immunosuppressive medication. Patients with autoimmune disorders may be vulnerable to the discussed sickness. One may come to a conclusion that either viral or bacterial exposure of the immune system may somehow cause Hodgkin’s lymphoma.
Hodgkin’s lymphoma germinates inside the lymphatic nodes. The abnormal malignant lymphocytes travel along the entire lymphatic system as far as the lymphatic tissues tightly interact with each other. This explains why Hodgkin’s lymphoma spreads from one lymphatic node to another within the lymphatic system and affects other organs and systems outside it. The disease can progress either slowly or aggressively.
Clinical manifestations of Hodgkin’s lymphoma are quite common with the other medical conditions of a viral as well as of bacterial etymology. Careful study of the combined symptoms in conjunction with the necessary tests helps to identify the disease and prescribe a required treatment and medication.
The disease is characterized by primarily painless swollen lymphatic nodes in the neck area, or arm pit, or groin, or collarbone, insufficient fever, excessive sweating or night sweats, unreasonable fatigue, weakness, pain in the back, constant feeling of tiredness, pain in the lymphatic nodes after drinking alcohol beverages, unexplainable weight loss, loss of appetite, severe itching, red patches on the skin. Such symptoms as splenomegaly (enlargement of spleen), hepatomegaly (lever enlargement), spleen and lever enlargement both, abdominal pain can signify Hodgkin’s disease. The following signs such as coughing, shortness of breath, suffocation also can be the symptoms of Hodgkin’s lymphoma. These signs can be witnessed in connection with the malignancy within lymphatic tissues of respiratory organs.
Taking into consideration that Hodgkin’s lymphoma is a life-threatening disease, its treatment is a rather critical issue for achieving positive results and further stable recovery. In their booklet dedicated to the cancer diseases, Leukemia and Lymphoma Society state that more than 75 percent of all patients with Hodgkin’s lymphoma can be cured by current treatment approaches (Walter, 2012). Lymphoma is one of the most curable cancers, especially if it is diagnosed at an early stage. The efficiency of treatment of Hodgkin’s lymphoma is rather high for most people.
Chemotherapy and radiation therapy are the most frequently used treatments for Hodgkin's lymphoma. Chemotherapy is meant for destroying cancerous cells or stopping their further multiplication. In the booklet “Hodgkin Lymphoma” John Walter specifies, "radiation therapy targets the evident Hodgkin’s lymphoma cell masses, and chemotherapy is used to kill neighboring lymphoma cells" (Walter, 2012). If neither chemotherapy nor radiation therapy demonstrates positive dynamics, then a doctor may practice a combination of both chemotherapy and radiation therapy to fight the disease. Some patients can have surgery interference for tumor removal.
Bone marrow transplant can be observed as a way out in rather complicated cases of Hodgkin’s lymphoma. Treatment duration and its type depend on the patient’s health status, age, stage and subtype of the disease, location of malignancy, physical maturity etc.
If a patient undergoes chemotherapy or radiation therapy, one must take maximum precautions to escape any kind of infections, taking into consideration that the immune system is weakened. Such precautions include avoiding any dangerous contacts suspected of conveying the infection, eating only properly washed fruits and well-cooked food, and washing one’s hands. Patients who are treated for Hodgkin’s disease must stick to a healthy diet with enough calories and protein to assist the body to regain strength and energy. Considering that treatment disables any physical exercise, a patient should still stay active with minor forms of exercise such as walking.
In spite of the fact that Hodgkin’s lymphoma is a curable disease with substantially high survival rate after treatment, “the prognosis for patients diagnosed with Hodgkin's disease’ still ‘depends on the stage of the cancer, the response to treatment, and the age and general health of the patient”. Despite of the fact that the treatment of Hodgkin’s lymphoma shows high percentage of stable remission and positive recovery results in general, it also contains a negative point. The weakness of the treatment lies is in the possibility of various side effects and its high-level toxicity. Chemotherapy, as well as radiation therapy, may cause further complications and other life-threatening cancer diseases that may occur after treatment. Such post-factum diseases as leukemia, non-Hodgkin's lymphoma, and cancers of lungs, colon, bone, thyroid, and breast can be experienced by patients who have been treated for Hodgkin's disease.
Non-Hodgkin’s lymphoma is another type of lymphoma, and its definition is comparatively similar to that of Hodgkin’s lymphoma. American Cancer Society describes Non-Hodgkin’s lymphoma as “cancer that starts in cells called lymphocytes, which are part of the body's.” Non-Hodgkin’s lymphomas can be “divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells”. The disease has a tendency to germinate and progress in different lymphoid tissues, including lymph nodes themselves, in various areas and organs of the body, such as thymus, gastrointestinal tract, brain, lever, and spleen.
Even nowadays doctors do not know why one person gets non-Hodgkin’s lymphoma and the other does not. It is aforementioned in the essay that researches have emphasized certain risk factors that increase the chance of getting the disease. In general, non-Hodgkin’s lymphoma progresses on the ground of risks similar to those of the Hodgkin’s disease. The group of risk factors includes the following: a weakened or compromised immune system, age factor, definite infections of viral etymology such as EBV and HIV, Human T-cell leukemia/lymphoma virus type 1 (HTLV-1), infections of bacterial etymology as Helicobacter pylori, Hepatitis C.
People whose work is connected with herbicides and chemicals may be at increased risk of getting non-Hodgkin’s lymphoma. Such factor as obesity is also presently considered as a risky one for the illness.
Clinical manifestations of non-Hodgkin’s lymphoma are similar to those of the Hodgkin’s disease. The most conspicuous sign of the present medical condition is swollen lymph nodes in various parts of the body. The lumps on the neck, or in the armpit, or in the groin should not be neglected if they cause discomfort. This is a serious reason for consulting a doctor. Non-Hodgkin’s lymphoma is accompanied with fever, night excessive sweating, unexplainable weight loss, paleness (because of anemia). Lymph nodes can get swollen inside the abdomen, and this is manifested in painful or swollen stomach. A patient can experience pain, loss of appetite, nausea in case there are some malignant alterations inside the abdomen lymphatic tissue. Non-Hodgkin’s lymphoma is characterized by the shortness of breath and coughing in case cancer is developing inside the thymus or chest area. If lymphoma damages one’s brain, a patient may feel headaches, confusion, changes in personality, and sometimes even seizures. In case a patient is suspected to have got non-Hodgkin’s lymphoma, he may complain on severe itching and appearance of red spots on the skin.
Non-Hodgkin’s lymphoma can be cured by using either radiation therapy or chemotherapy. If the body does not respond to these variants of treatment, medication may involve a combination of radiotherapy and chemotherapy both to achieve a positive result. Taking such drug as rituximab (Rituxan) can be effective for B-cell non-Hodgkin's lymphoma treatment. The treatment sometimes proceeds to radio immunotherapy, which means “linking a radioactive substance to an antibody that targets the cancerous cells and injecting the substance into the body”. Immunotherapy is used to stimulate body’s defensive forces to fight cancer. Researchers work out monoclonal antibodies, i.e. specially designed antibodies to attack lymphoma cells.
In the most complicated cases, when disease is at the latest stage, doctors usually proceed to bone marrow or stem cells’ transplantation.
All the variants of treatment are aimed to destroy the most malignant cells and bring the disease to remission.
Considering the complexity of lymphoma’s treatment, nursing plays a significant role in the recovery process. Patients with non-Hodgkin’s lymphoma should be guarded against any kind of infections because of the vulnerability of the body. Any vaccinations should be either postponed or done a month prior to the treatment. Nutrition is to be rich with proteins, calories, and vitamins. Gentle exercises are allowable. When a patient undergoes chemotherapy, he/she may experience a mass of side-effects such as nausea, vomiting, poor appetite, and difficulty during swallowing. Care givers should help such patients to cope with the indicated side-effects or minimize them to the maximum extent possible.
The prognosis for non-Hodgkin’s lymphoma is rather favorable. In most cases, the disease is successfully cured and gives positive, stable results; however, unfortunately, many side effects may occur during the treatment as well as after it. Also, the treatment may result in further cancerous diseases.
Having reviewed each medical condition, we can make the following conclusions: The Hodgkin’s disease as well as Non-Hodgkin’s lymphoma is generated from malignant cells that occur and multiply inside the lymphatic system. The cancerous cells affect the lymphoid tissue and cause further malignancy of other vulnerable organs that contain maximum lymphoid tissue. Pathophysiology demonstrates a viral and bacterial etymology of the illnesses. However, non-Hodgkin’s lymphoma involves more viruses to get activated.
The symptoms and signs of the two medical conditions are very much similar. Both diseases may be signified by enlarged lymph nodes, swollen abdomen, increased spleen and lever. Also, they can be noticed in the thyroid, breast, gastrointestinal tract, brain, ovaries, testes, and skin, although Hodgkin’s lymphoma is rarely seen in these areas. On the ground of the given statements, we can admit that the clinical manifestations of non-Hodgkin’s lymphoma are wider. This can be explained by B-cell and T-cell malignant alterations in other lymphomas.
“The presence of the Reed-Sternberg cell is an important factor in differentiating Hodgkin’s disease from other lymphomas” (Vinson, 2000).
Both diseases are treated with radiation and chemotherapy or using a combined variant of treatment which can be adequately efficient. Non-Hodgkin’s lymphoma treatment may additionally include radioimmunotherapy or monoclonal antibodies to attack lymphoma or other cancerous cells. Non-Hodgkin’s lymphoma cure may also involve another drug use, such as Rituxan. Such types of treatment as radioimmunotherapy, monoclonal antibodies use, Rituxan drug use are not foreseen in Hodgkin’s disease medication.
Medicine is aware of 35 types of lymphoma. The Hodgkin’s disease has 5 subtypes, while Non-Hodgkin’s lymphoma has 35. In spite of a favorable prognosis in major lymphoma cases, especially at the early stage of diagnostic, researches show that Hodgkin’s lymphoma has a “higher survival rate than NHL ”.
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