Hodgkin lymphoma: the cancer diagnosis given to Wales and Bournemouth star David Brooks

By Mark Smith

Football fans across the globe were left stunned at news Wales star David Brooks has been diagnosed with cancer.

After leaving international duty last week, the 24-year-old underwent medical examinations when it was confirmed he has stage 2 Hodgkin lymphoma.

In a statement on Wednesday, the Bournemouth midfielder said: "Although this has come as a shock to myself and my family, the prognosis is a positive one and I am confident that I will make a full recovery and be back playing as soon as possible.

"I'd like to show my appreciation to the doctors, nurses, consultants and staff who have been treating me for their professionalism, warmth and understanding during this period.

"I want to thank everyone at the Football Association of Wales because without the swift attention of their medical team we may not have detected the illness."

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Here, we explain more about Hodgkin lymphoma and what the different stages of the cancer mean for treatment and survival rates. This information came from a number of reputable sources including Cancer Research UK, Macmillan and the NHS website.

What is Hodgkin lymphoma?

Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes.

In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making someone more vulnerable to infection.

Who typically gets Hodgkin lymphoma?

Around 2,100 people are diagnosed with Hodgkin lymphoma in the UK each year.

It can develop at any age, but it mostly affects young adults in their early 20s and older adults over the age of 70. Slightly more men than women are affected.

What are the symptoms of Hodgkin lymphoma?

The most common symptom of Hodgkin lymphoma is a painless swelling in a lymph node. This can be in an area of the body such as the neck, armpit or groin.

Lymph nodes commonly swell if we have an infection but they usually go back to normal over a short time. With lymphoma, the lymph nodes often grow slowly and may be there for months or years before they're noticed. However sometimes they grow very quickly.

Usually, the swollen nodes don't hurt, but some people say their lumps ache or are painful. And for some they are painful after drinking alcohol.

Other general symptoms include:

  • heavy sweating, especially at night;
  • high temperatures that come and go with no obvious cause, often overnight;
  • losing a lot of weight over a short period of time despite eating well;
  • itching, which may be worse after drinking alcohol;
  • cough or shortness of breath;
  • tummy (abdominal) pain or vomiting after drinking alcohol.

In addition, swollen lymph nodes can:

  • press on nerves and cause pain;
  • cause swelling in arms or legs by blocking the flow of lymphatic fluid around the body;
  • cause yellowing of the skin and eyes (jaundice) by blocking the flow of bile from the liver.

However, the final three symptoms are less common.

What are the different stages of Hodgkin lymphoma?

The stages of Hodgkin lymphoma tell you about the number and places in the body that are affected by lymphoma.

Knowing the stage of Hodgkin lymphoma helps your doctor to decide what treatment a patient needs.

Doctors look at whether the lymphoma is on one side or both sides of the diaphragm, as well as whether it is inside or outside of the lymphatic system. They will measure the size of the lymphoma. They do this by carrying out various tests, such as a CT or PET scan. They will also check whether you have any symptoms.

The diaphragm, the big breathing muscle that separates the chest from the tummy, is used as a guide because it is about halfway down the body.

Doctors look at whether the lymphoma is affecting:

  • the nodes and organs of the lymphatic system – these are called lymphatic sites
  • areas outside of the lymphatic sites – called extranodal (or extralymphatic) sites

In total there are four stages:

Stage 1:

  • lymphoma in a single lymph node or one group of lymph nodes, or an organ of the lymphatic system (such as the thymus);
  • lymphoma in an extranodal site (1E).

Treatment for stage 1 Hodgkin lymphoma is usually two to four cycles of chemotherapy. You might also have radiotherapy.

Around 90 out of 100 people (90%) will survive their Hodgkin lymphoma for five years or more after diagnosis.

Stage 2:

This means one of the following:

  • your lymphoma is in two or more groups of lymph nodes;
  • your lymphoma is in an extranodal site and one or more groups of lymph nodes (2E).

In both cases, the two sites of lymphoma are on the same side of the diaphragm.

Treatment for stage two Hodgkin lymphoma is usually two to four cycles of chemotherapy. You might also have radiotherapy.

Around 90 out of 100 people (around 90%) will survive their Hodgkin lymphoma for five years or more after diagnosis.

Stage 3:

This means that you have lymphoma on both sides of the diaphragm.

One example is that the lymphoma is in lymph nodes on both sides of the diaphragm. Another example is that the lymphoma is in lymph nodes above the diaphragm, as well as lymphoma in the spleen.

Treatment for stage 3 Hodgkin lymphoma, is generally between six to eight cycles of chemotherapy. You might have steroids and radiotherapy as part of this.

Around 80 out of 100 people (around 80%) will survive their Hodgkin lymphoma for five years or more after diagnosis.

Stage 4:

Stage 4 means one of the following:

  • your lymphoma is in an extranodal site and lymph nodes are affected
  • your lymphoma is in more than one extranodal site, for example the liver, bones or lungs

Treatment for stage 4 Hodgkin lymphoma is usually between six to eight cycles of chemotherapy. You might have steroids and radiotherapy as part of this.

More than 70 out of 100 people (more than 70%) will survive their Hodgkin lymphoma for five years or more after being diagnosed.

What's the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

The primary difference between these two categories of lymphatic cancer is the type of lymphocyte that is affected.

Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, which a physician can identify using a microscope. In non-Hodgkin lymphoma, these cells are not present.

In addition to the presence or lack of Reed-Sternberg cells, other differences between Hodgkin and non-Hodgkin lymphoma include:

  • Non-Hodgkin lymphoma is more common than Hodgkin lymphoma;
  • The majority of non-Hodgkin patients are over the age of 55 when first diagnosed, whereas the median age for diagnosis of Hodgkin lymphoma is 39;
  • Non-Hodgkin lymphoma may arise in lymph nodes anywhere in the body, whereas Hodgkin lymphoma typically begins in the upper body, such as the neck, chest or armpits.

Despite the many differences between these two types of lymphatic cancer, both have similar symptoms such as enlarged lymph nodes, fatigue, weight loss and fever.

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