Hodgkin Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma, sometimes called Hodgkin’s Disease, is a cancer that starts in the lymphatic tissue. Lymphatic tissue is found in the lymph nodes and related organs (spleen, bone marrow, tonsils and thymus) that make up the body’s immune and blood-forming systems. Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma can occur in both adults and children.

What causes Hodgkin lymphoma?

Lymph nodes make and store infection-fighting white blood cells called lymphocytes. The cancer cells in Hodgkin Lymphoma are called Reed-Sternberg cells (after two doctors who discoverd them). Reed-Sternberg cells are a type of malignant B lymphocyte and distinguish Hodgkin lymphoma from other types of lymphoma.

Being young or in late adulthood, being male, being infected with the Epstein-Barr virus, and having a first-degree relative with the disease all increase the risk of developing Hodgkin lymphoma.

How is Hodgkin lymphoma diagnosed?

The most common early sign of Hodgkin lymphoma is a painless swelling in the lymph nodes of the neck, upper chest, interior of the chest, armpit, abdomen, or groin. Other symptoms include fever, sweating (especially at night), weight loss, and itching. While uncommon, some people may feel pain in the lymph nodes after drinking alcohol, a distinctive sign of Hodgkin lymphoma. In some cases the spleen is enlarged.

One of the unique features of Hodgkin lymphoma is the way it spreads. It usually begins in the lymph nodes in one region of the body, and as the disease progresses, spreads predictably from one part of the lymph system to the next before finally moving into organs, including the lungs, liver, bone, and bone marrow.

The diagnosis of Hodgkin lymphoma requires the biopsy of an involved lymph node or tumor site. The presence of Reed-Sternberg cells distinguishes Hodgkin lymphoma from other types of lymphomas. Doctor’s may use the following tests to diagnose and stage Hodgkin lymphoma:

• Physical examination and history
• Complete blood count, sedimentation rate and other blood work
• Computed tomography (CT) of the neck, chest, abdomen or pelvis
• Positron emission tomography (PET) scan
• Bone marrow biopsy
• Chest x-ray

There are five different types of Hodgkin lymphoma: nodular sclerosing Hodgkin lymphoma, (by far the most common) mixed cellularity Hodgkin lymphoma, lymphocyte depletion Hodgkin lymphoma, Lymphocyte-rich classical Hodgkin lymphoma, and nodular lymphocyte-predominant Hodgkin lymphoma.

Once Hodgkin lymphoma has been diagnosed, tests may be conducted to see if the cancer has spread. The spread of most cancers is usually described as stages. There are four stages of Hodgkin lymphoma.

• Stage I – the apparent involvement of a single lymph node region or a single organ, such as bone.
• Stage II – the involvement of two or three lymph node regions that are close to each other.
• Stage III – the involvement of several lymph node regions in the neck, chest, and abdomen.
• Stage IV – widespread involvement of lymph nodes and other organs such as the lungs, liver, and bone.

The four stages of Hodgkin lymphoma are divided into A, B, E, and S. In A, the patient has no symptoms of the disease. In B, the patient has symptoms like fever, weight loss, or night sweats. In E, the cancer has been found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas. In S, the cancer has spread to the spleen.

What are the treatment options?

The prognosis (chance of recovery) and treatment options depend on the patient’s symptoms, stage of cancer, type of Hodgkin lymphoma, blood test results and the patient’s age, gender, and general health. Whether the cancer is recurrent (has come back) or progressive (is spreading aggressively) also affect treatment options. Adult Hodgkin lymphoma can usually be cured if found and treated early.

Stage I Treatments:

• Stage IA
  • Combination chemotherapy with or without radiation therapy
  • Radiation therapy to lymph nodes in the neck
  • Clinical trial of combination chemotherapy with or without radiation therapy
  • Radiation therapy to the groin
  • Clinical trials
• Stage IB
  • Combination chemotherapy with or without radiation therapy

Stage II Treatments:

• Stage IIA
  • Combination chemotherapy with or without radiation therapy
  • Clinical trials
• Stage IIB
  • Chemotherapy with or without radiation therapy

Stage III Treatments:

• Stage IIIA
  • Combination chemotherapy with or without radiation therapy
• Stage IIIB
  • Combination chemotherapy with or without radiation therapy

Stage IV Treatments:

• Combination chemotherapy

Recurrent Treatments

• Combination chemotherapy
• Combination chemotherapy followed by high-dose chemotherapy and stem cell transplantation with or without radiation therapy (usually the best option)
• Radiation therapy with or without chemotherapy
• Chemotherapy as palliative therapy to relieve symptoms and improve quality of life
• Clinical trial of high-dose chemotherapy and stem cell transplantation