Group of cancers that affect the lymphocytes inside the lymphatic system; these cancerous cells proliferate within the lymph nodes and cause the lymph nodes to become abnormally large (lymphadenopathy)

Aetiology

Hodgkin lymphoma

• Accounts for 1/5 lymphomas
• Caused by proliferation of lymphocytes
• There is a bimodal age distribution with peaks around aged 20 and 75 years
• Risk factors:
  • Immunosuppression e.g. HIV, inherited immunodeficiency states
  • Autoimmune disorders e.g. rheumatoid arthritis, sarcoidosis
  • EBV
  • Family history

Non-Hodgkin lymphoma

• A group of lymphomas, there are almost endless types of lymphoma
• A few notable ones are:
  • Burkitt lymphoma: associated with Epstein-Barr virus, malaria and HIV
  • MALT lymphoma: affects the mucosa-associated lymphoid tissue, usually around the stomach - associated with H. pylori infection
  • Diffuse large B cell lymphoma: often presents as a rapidly growing painless mass in patients over 65 years
• Risk factors:
  • Infections: HIV, EBV, H. pylori
  • Hepatitis B or C infection
  • Exposure to pesticides and a specific chemical called trichloroethylene used in several industrial processes
  • Family history

Clinical features

• Lymphadenopathy - the enlarged lymph node or nodes might be in the neck, axilla, or inguinal region
  • Characteristically non-tender and feel ‘rubbery’
  • Some patients will experience pain in the lymph nodes when they drink alcohol
• ‘B’ symptoms are the systemic symptoms of lymphoma - fever, night sweats, weight loss
• Itch without rash
• Symptoms due to involvement of other organs e.g. if lung became involved there may be breathlessness and cough

Investigations

• Bloods:
  • Lactate dehydrogenase (LDH) is a blood test that is often raised in Hodgkin’s lymphoma but is not specific and can be raised in other cancers and many non-cancerous diseases
  • Certain blood results, notably elevated ESR and/or decreased haemoglobin, are associated with poor prognoses in HL
• Lymph node biopsy: key diagnostic test
  • The Reed-Sternberg cell is the key finding from lymph node biopsy in patients with Hodgkin’s lymphoma: abnormally large B cells that have multiple nuclei that have nucleoli inside them