Hodgkin lymphoma

Hodgkin lymphoma 

Overview

Hodgkin lymphoma is a type of cancer that affects the lymphatic system. The lymphatic system is part of the body's germ-fighting and disease-fighting immune system. Hodgkin lymphoma begins when healthy cells in the lymphatic system change and grow out of control.

The lymphatic system includes lymph nodes. They are found throughout the body. Most lymph nodes are in the abdomen, groin, pelvis, chest, underarms and neck.

The lymphatic system also includes the spleen, thymus, tonsils and bone marrow. Hodgkin lymphoma can affect all these areas and other organs in the body.

Hodgkin lymphoma, which used to be called Hodgkin disease, is one of two broad types of lymphoma. The other is non-Hodgkin lymphoma.

Advances in diagnosis and treatment of Hodgkin lymphoma have helped give people with this disease the chance for a full recovery.

Types of Hodgkin lymphoma

There are four classic Hodgkin lymphoma subtypes:

Nodular sclerosis Hodgkin lymphoma. This is the most common classic Hodgkin lymphoma subtype. It often affects young adults, especially females. It typically affects lymph nodes in the central part of your chest.

Mixed cellularity Hodgkin lymphoma. This subtype typically affects people in their 60s. It sometimes develops in your belly (abdomen).

Lymphocyte-rich classic Hodgkin lymphoma. This Hodgkin lymphoma subtype affects about 6% of people with Hodgkin lymphoma. It’s more common in males.

Lymphocyte-depleted Hodgkin lymphoma. This subtype only affects about 1% of people with Hodgkin lymphoma. It’s most common in people who are older than 60 years and people who have HIV/AIDS

Symptoms

The most common first sign of Hodgkin lymphoma is painless swollen lymph nodes in your neck, underarm or groin. Other symptoms include:

Persistent fatigue. This is feeling much more tired than usual for at least several days.

Unexplained fever. A high fever that remains for two or more hours after home treatment or lasts longer than two days may be a sign of a serious issue.

Drenching night sweats. This is sweating that’s so intense it drenches your sheets and clothes.

Unexplained weight loss. This is losing body weight without trying. Losing 10% or more of your total body weight over six months is a sign of unexplained weight loss.

Itchy skin (pruritus). Some people with Hodgkin lymphoma have very itchy skin after drinking alcohol or taking a bath.

Belly (abdominal) pain or swelling. Not all belly pain is a sign of serious illness. Contact a healthcare provider if you have severe pain that doesn’t go away.

Chest pain. This may be a symptom of Hodgkin lymphoma in your lung tissues or lymph nodes inside of your chest.

Shortness of breath. This could be a sign of Hodgkin lymphoma in your lungs or of a large mass in your chest.

Healthcare providers call fever, unintended weight loss and drenching night sweats associated with lymphoma “B symptoms.” The presence or absence of these symptoms helps your provider determine your prognosis (the likely outcome of your condition) and plan treatments.

Causes

Healthcare professionals aren't sure what causes Hodgkin lymphoma. It begins with changes in the DNA of a disease-fighting blood cell called a lymphocyte. A cell's DNA contains the instructions that tell the cell what to do.

The DNA changes tell the cells to multiply quickly and live when other cells would naturally die. The Hodgkin lymphoma cells attract many healthy immune system cells to protect them and help them grow. The extra cells crowd into the lymph nodes and cause swelling and other symptoms.

There are multiple types of Hodgkin lymphoma. The type of lymphoma you have is based on the characteristics of the cells involved in your disease and their behavior. The type of lymphoma you have helps determine your treatment options.

Classical Hodgkin lymphoma

Classical Hodgkin lymphoma is the more common type of this disease. People diagnosed with this type have large lymphoma cells called Reed-Sternberg cells in their lymph nodes.

Subtypes of classical Hodgkin lymphoma include:

Nodular sclerosis Hodgkin lymphoma.

Mixed cellularity Hodgkin lymphoma.

Lymphocyte-depleted Hodgkin lymphoma.

Lymphocyte-rich Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma

This type of Hodgkin lymphoma is much rarer. It involves lymphoma cells sometimes called popcorn cells because of how they look. Usually, it is diagnosed early and may need less intensive treatments than the classical type of Hodgkin lymphoma.

Risk factors

Factors that can increase the risk of Hodgkin lymphoma include:

Your age. Hodgkin lymphoma is most often diagnosed in people in their 20s and 30s and those over age 65.

A family history of Hodgkin lymphoma. Having a blood relative with Hodgkin lymphoma increases the risk of Hodgkin lymphoma.

Being male. People who are assigned male at birth are slightly more likely to develop Hodgkin lymphoma than are those who are assigned female at birth.

Past Epstein-Barr infection. People who have had illnesses caused by the Epstein-Barr virus are at higher risk of Hodgkin lymphoma than are those who haven't. One example is infectious mononucleosis.

HIV infection. People who are infected with HIV have an increased risk of Hodgkin lymphoma.

There's no way to prevent Hodgkin lymphoma.

Diagnosis

Hodgkin lymphoma diagnosis often begins with an exam that checks for swollen lymph nodes in the neck, underarm and groin. Other tests include imaging tests and removing some cells for testing. The type of tests used for diagnosis may depend on the lymphoma's location and your symptoms.

Physical exam

A healthcare professional may start by asking about your symptoms. The health professional also may ask about your health history.

Next, the healthcare professional may feel and press on parts of your body to check for swelling or pain. To find swollen lymph nodes, the healthcare professional may feel your neck, underarms and groin. Be sure to say if you have felt any lumps or pain.

Blood tests

A sample of your blood is examined in a lab to understand your health and look for signs of cancer.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Hodgkin lymphoma, the biopsy typically involves removing one or more lymph nodes. The lymph nodes go to a lab for testing to look for cancer cells. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan. Sometimes a biopsy is taken from other parts of the body, such as the liver, to look for signs of Hodgkin lymphoma.

Imaging tests

Your healthcare team may recommend imaging tests to look for signs of lymphoma in other areas of your body. Tests may include a chest X-ray, CT, MRI and positron emission tomography scans, also called PET scans.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy are procedures that involve collecting cells from the bone marrow. The cells are sent for testing. Tests can look for Hodgkin lymphoma cells.

Hodgkin lymphoma stages

Your test results are used to assign a stage to your Hodgkin lymphoma. The stage helps determine the seriousness of your condition and the treatments most likely to help you.

Hodgkin lymphoma staging uses the numbers 1 to 4 to indicate the stage. A lower number means the lymphoma cells only involve one or a few areas of lymph nodes. An early-stage cancer is more likely to be cured. As the lymphoma grows to involve more areas of the body, the stage number goes up. A higher number means the cancer is more advanced.

Hodgkin lymphoma stages also may include the letters A and B. The letter A means that you don't have worrying symptoms of lymphoma. The letter B means that you have some symptoms, such as fever or weight loss.

Treatment

Many types of treatments exist for Hodgkin lymphoma. Treatment often starts with chemotherapy. Your healthcare team might check to see how the lymphoma is responding and decide whether you need more treatment. Your options might include radiation therapy, chemotherapy, immunotherapy, targeted therapy and bone marrow transplant, also called stem cell transplant. Sometimes, a combination of treatments is used.

The treatment that's best for you depends on the type of Hodgkin lymphoma that you have. Your healthcare team also might consider the stage of your lymphoma, whether you have any symptoms and your overall health.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form.

Classical Hodgkin lymphoma treatment usually involves a combination of chemotherapy and radiation therapy. Sometimes chemotherapy may be the only treatment needed. More-advanced disease may be treated with a combination of chemotherapy and medicines that attack specific chemicals in cancer cells, known as targeted therapy.

For nodular lymphocyte-predominant Hodgkin lymphoma, chemotherapy may be combined with targeted therapy and radiation therapy.

Side effects of chemotherapy depend on the medicines you're given. Common side effects are nausea and hair loss. Serious long-term complications can occur, such as heart disease, lung damage, fertility problems and other cancers.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

For Hodgkin lymphoma, radiation can be aimed at affected lymph nodes and the nearby areas where the disease might spread. It's usually used with chemotherapy. Radiation therapy may be the only treatment needed for early-stage nodular lymphocyte-predominant Hodgkin lymphoma.

Radiation therapy side effects include fatigue and a sunburn-like reaction on the skin at the site where the radiation is aimed. Other side effects depend on where the radiation is aimed. Radiation to the neck can cause dry mouth and hurt the thyroid. Radiation to the chest can hurt the heart and lungs.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. A bone marrow transplant may be an option if Hodgkin lymphoma returns or doesn't respond to other treatments.

During a bone marrow transplant, your own blood stem cells are removed, frozen and stored. Next, you receive high-dose chemotherapy and radiation therapy to destroy cancer cells in your body. Finally, the stored stem cells are thawed and put back in your body to help build healthy bone marrow.

There is an increased risk of infection after a transplant.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted therapy can cause cancer cells to die. Targeted therapy is often combined with chemotherapy for treating nodular lymphocyte-predominant Hodgkin lymphoma.

For classical Hodgkin lymphoma, targeted therapy might be an option in certain situations.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

For Hodgkin lymphoma, immunotherapy might be considered in certain situations, such as if the disease doesn't respond to other treatments.

Type of Doctor Department : A hematologist, medical oncologist, or radiation oncologist