Lymphatic System
Case Study
Olivia R, a thirty-year-old female who came into the clinic and highlighted the symptoms she had
been experiencing for longer than a month. The first symptoms she described as having was a
painless lump and swelling on her neck only on the right side which increased in size progressively.
The next symptom experienced was a constant irritation in various places of her body. No matter
where Olivia had itched to relieve the irritation and discomfort, she felt as if it was underneath her
skin and impossible to be relieved despite her efforts. In addition, at nights she would experience
excessive sweating which only started less than a month ago.
The irritations and swelling of Olivia suggest this could be a viral infection such as lymphadenopathy
(the swelling of lymph nodes) as these symptoms correlate with infections. However, the lump as
described being present on one side of her neck, and therefore not symmetrical, in addition to the
night sweats, indicates cancer. An examination was conducted to identify the lump on the
individual’s neck. The lump measured 3cm X 3cm and affected the cervical lymph nodes. Olivia
states she had not left the country or travelled near the time of the first symptoms. I have
concluded the disease that can be diagnosed from these symptoms is Hodgkin’s Lymphoma.
Classical Hodgkin’s lymphoma is a type of abnormal blood cancer of the immune system, most
commonly affecting those aged twenty to forty. The exact cause for Hodgkin’s is unknown. Lymph is
a colourless fluid that flows through the lymphatic vessels and nodes of the system. This lymph
contains white blood cells called lymphocytes with a function to fight infections. In this disorder, B
lymphocyte cells start to multiply, expand in volume, and increase the quantity in an abnormal and
uncontrollable manner due to a mutation of DNA. This mutation causes the development of Reed-
Sternberg cells, which are giant cells that are binucleated or multinucleated. They derive from b-
lymphocytes. They start to circulate around the system, collect and build up in certain areas such as
the lymph nodes which causes inflammation at those nodes. As there is an accumulation of Reed-
Sternberg cells, the lymph nodes are overwhelmed with B lymphocytes (with limited quantity of T
cells inside the nodes), which can alter the anatomy and structure of lymph nodes, such as altering
shape to an irregular shape. Compared to a normal lymph node with an oval or bean shape and with
a sufficient and controlled quantity of b and t-lymphocytes to operate. Therefore, the nodes will no
longer function correctly to remove pathogens or dead cells from the lymph. The affected
lymphocytes lose their normal infection-fighting properties, such as no longer recognising and
binding to antigens or eliminating them via production of antibodies. When this lymph is returned to
the circulatory system, the body is more susceptible to catching infections, as the node has not
filtered the lymph prior for pathogens.
These swollen lymph nodes can cause pressure on neighbouring areas and nerves which may result
in damage inflicted, in severe cases. They can also block lymphatic vessels from the flow of lymph,
this prevents and limits the fluid from drainage around the system. When this possible obstruction
occurs, the normal functioning of the lymphatic system is compromised. Enlarged nodes form
rubbery lumps on the skin which can commonly appear in the areas such as the neck but also spread
to surrounding/adjacent lymph nodes and organs such as the spleen, liver and bone marrow. As
other nodes can be affected, this will also cause them to function incorrectly. This results in the
lymphatic system malfunctioning.
Classical Hodgkin’s lymphoma may also spread to organs of the body such as the spleen. In the
spleen this disease is known as secondary splenic lymphoma. The spleen has a function to filter the
blood from pathogens, bacteria, and viruses, as well as removing damaged or old erythrocytes. In
addition, the spleen can produce lymphocytes and antibodies to aid in reducing infections. Abnormal
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, Lymphatic System
lymphoma cells catn build up and collect in the organ. Therefore, this leads to an enlarged and
swollen spleen (splenomegaly). Due to a mutation, the lymphocytes lose their ability to function
correctly to produce antibodies. This results in the organ being compromised as filtration of blood is
reduced and the human body is more vulnerable to infections.
Some symptoms of Hodgkin’s include:
• Swollen and Painless lymph nodes in the neck, armpits, or groin
• Fatigue and constant lack of energy
• Fever and/or chills
• Night sweats
• Unexplained and rapid weight loss
• Irritations to the body
A biopsy of the neck, along with blood tests, CT scan and a PET scan was conducted on Olivia and
confirmed the disease of Nodular Sclerosing Classical Hodgkin’s Lymphoma (NSCHL) at Stage 2B –
affecting the cervical lymph nodes which has enlarged.
Corrective Treatments
The first treatment provided is ABVD Chemotherapy. The letters stand for the drugs utilised in this
treatment. ‘A’ is for Adriamycin (doxorubicin), ‘B’ is for bleomycin, ‘V’ is for vinblastine, and ‘D’ is for
dacarbazine. This can be given in drug/pill form or injections. As Olivia’s disease is at stage two, the
cancer is likely to be cured, therefore intravenous chemotherapy (a drip connecting directly into the
vein) is utilised, to allow the medicine to get into the system and circulate around the body. The
drugs involved are doxorubicin, bleomycin, vinblastine, and dacarbazine. The drug dacarbazine is an
alkylating agent which functions to damage DNA to stop mutated lymphocyte cells reproducing and
spreading to other areas of the body. This will slow down Hodgkin’s disease. The drugs doxorubicin
and bleomycin are anti-tumour antibiotics. They function by binding to the DNA of lymphocytes; this
interferes with the enzymes and the DNA replication process. This will ensure enzymes are no longer
aiding in cell chemical reactions which slows down the disease and acts as a barrier or block from
further cancer replication. The drug vinblastine is a vinca alkaloid they also function to block cell
reproduction. They do this by damaging the cell, as well as stopping production of proteins by
enzymes.
The advantages of using ABVD Chemotherapy is that there are many drugs which all have specific
functions to stop and interfere with cell replication and multiplying to prevent the cancer spreading.
These drugs are exposed to the whole body, this can ensure the cancer cells throughout the body
die. Chemotherapy is the most common treatment to tackle Hodgkin’s disease and other cancers.
This treatment is proven to be effective to treat cancers with a lower chance of redevelopment
(especially for the early-stage cancers). The disadvantages towards using chemotherapy are the side
effects including tiredness, anaemia, hair loss, or nausea. This can be controlled taking certain
medications, resting well, and taking breaks from treatment, or wearing a cold cap to reduce the
blood and medications getting to the scalp. Certain drugs of the ABVD chemotherapy may affect the
heart, lungs or liver. To prevent further damage, tests are carried out throughout to monitor
progression or switch treatments if necessary.
A second treatment available is Radiotherapy. This is mainly utilised in initial stages of cancer such as
stage 1 or 2 where the cancer has not spread to other regions of the body. External therapy is a
commonly used form of radiotherapy which utilises beams of radiation from a machine directly to
the region of the cancer. The machine will mainly emit beams of photons instead of particles of
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