Lymphoma less frequent than other types, Hodgkin’s lymphoma has an incidence of three cases per 100,000 inhabitants in Brazil per year, he told today to Brazil Agency the head of the Hematology Service of the José Alencar Gomes da Silva National Cancer Institute (Inca), Ricardo Bigni.
In a geographical cut, the regions that concentrate more cases are the Southeast and South, followed by the Northeast, Midwest and North regions. Reference in the state in the treatment of this cancer, Inca annually treats about 70 patients with Hodgkin’s lymphoma.
Two recent cases with this diagnosis were sports commentator Caio Ribeiro and football player David Brooks, from Bournemouth, England. According to an estimate by Inca, in 2020, 2,640 new cases were registered in the country, with 1,590 in men and 1,050 in women.
Hodgkin’s lymphoma is a cancer that originates in the lymphatic system, which is a part of the body’s defense immune system. “It is one of the types of cancer that can be cured,” said Bigni, noting that early diagnosis favors the chance of a cure, as this type of lymphoma evolves over months. “It makes a difference if you can detect it earlier. The chance of obtaining a cure is greater”.
Treatment requires intravenous chemotherapy. Radiotherapy can also be prescribed by the doctor, in specific cases, to enhance the effects of chemotherapy. “In general, a complement is made, for certain types of cases”. Some patients need to take supportive oral medications.
“We manage to minimize the intensity of treatment according to the stage of the disease,” said Bigni. In patients with the disease at a more advanced stage, treatment lasts, on average, six months. In earlier cases, a cure can be achieved in shorter periods, “as per the case”.
In general, Hodgkin’s lymphoma tumors present in the neck and chest. In advanced stages, there may be manifestations in the abdomen and bone marrow. Lymphoma mainly affects adolescents and young adults, but it can also occur in the elderly.
Symptoms
Physician for 20 years at the Hematology Service of the Federal University of Rio de Janeiro (UFRJ), Roberto Magalhães informed the Brazil Agency that Hodgkin’s lymphoma generally comes from the lymph nodes.
The main symptom that usually appears is a bulge, or lump, that is, an enlarged lymph node, in medical parlance. “It can emerge in any region of our ganglia. Therefore, it can appear in the neck, armpits, inguinal region and even in the lymphoid organs that are in our chest and abdomen”.
Other symptoms, called B-symptoms in medical terminology, may be associated with the tumor. One is the unexplained loss of at least 10% of weight in six months. “This weight loss is something significant. It’s strange and needs to be investigated”. Other symptoms include persistent evening fever but no other flu-like symptoms; night sweats that eventually causes the person to change the bedding and itchy body.
Diagnosis
Diagnosis of the disease requires the concept of multidisciplinarity. If a suspicious lump appears, a biopsy is needed. A pathologist specializing in hematology is responsible for the diagnosis, and if it is confirmed that it is Hodgkin’s lymphoma, the patient is referred to a hematologist to initiate treatment.
It is up to the hematologist to verify the stage or degree of involvement of the disease. “The disease can be highly localized; it can take only a region of lymph nodes, for example above the chest or below the abdomen; it can be a disease that is over the chest or abdomen; and, in addition, it may involve some organ that is outside the lymph nodes, such as the spleen or liver. All of this is very important in the initial phase”.
To make this assessment, the hematologist uses imaging techniques, in charge of a radiologist who can perform a tomography to know which organs were affected. “Eventually, it is also necessary to include the bone marrow biopsy because, sometimes, the bone marrow, which is the place where blood is produced, can be affected”, explains Roberto Magalhães.
Challenges
The hematologist at UFRJ explains that after the treatment it is still necessary to monitor the patient’s evolution. “We only say that the patient is cured, undergoing hemotherapy, when he has been in complete remission for five years”.
During these five years, the patient must undergo imaging exams every six months for the first two years, moving thereafter to annual exams. If the disease returns, Roberto Magalhães informed that there is still an option to treat it with autologous bone marrow transplant. “There are curable rates in at least 50% of cases.”
The hematologist admitted that there are challenges for treatment in the area of old medicines that are disappearing from the shelves, which can greatly harm SUS patients who do not have the resources to access more modern and sophisticated medicines that are emerging.
Magalhães also informs that there are no studies that prove what causes the emergence of these lymphoid tumors and lymphomas. “There is no specific cause. It is genetic and environmental factors that people are exposed to that can generate this, but there is no rule”.
Studies show the association of Hodgkin’s lymphoma with the mononucleosis virus, but this does not mean that everyone who has had mononucleosis will have lymphoma, pointed out Magalhães. “There are several factors. The genesis of lymphoma is multifactorial”
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