Hodgkin's Lymphoma

What you should know about a common type of cancer that affects the lymphatic system.

By Jenny Ewen, BA, NREMT
Editor-In-Chief

hodgkins lymphoma

Overview

Hodgkin’s Lymphoma is a common type of cancer that involves the lymphatic system. Over 9,000 people (ages 16-34 and over 55) in the US are diagnosed with Hodgkin’s lymphoma each year. Cancer occurs when cells begin growing out of control (making new cells) and overcrowd the normal cells, preventing the body from functioning the way it should. When these cells move out of one area of the body and into another, causing more problems, that’s called metastasis, but is still known as the type of cancer for where it originated.

There are two main types of lymphoma (which are cancers that start in white blood cells known as lymphocytes): Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. The lymphatic system is part of the immune system, and helps with the flow of fluids throughout the body. Lymphocytes (which are the main cells that make up the lymph system) can be divided into two types: B lymphocytes (which make antibodies to protect the body from viruses and bacteria) and T lymphocytes (which destroy germs or abnormal cells).

Since lymph tissue is found all over the body, Hodgkin’s lymphoma can start almost anywhere, but often starts in:

  • Lymph nodes (which are small collections of lymphocytes and immune system cells)
  • Lymph vessels (connect lymph nodes and carry immune cells)
  • Spleen
  • Bone marrow
  • Thymus (responsible for T cell development)
  • Adenoids and tonsils (lymph tissue in the back of the throat)
  • Digestive tract

Types of Hodgkin’s Lymphoma

There are two main types of Hodgkin’s lymphoma: Classic Hodgkin’s Lymphoma (which accounts for 9 out of 10 diagnosed cases), and nodular lymphocyte-predominant Hodgkin’s lymphoma (about 5% of cases, and is more common in men than women, and the cells involved are much larger, known as “popcorn cells”, but it’s typically diagnosed early with a strong survival rate).

Classic Hodgkin’s lymphoma can be divided into four categories:

  • Nodular sclerosis Hodgkin lymphoma: this is the most common type seen in developed countries (60%-80%) , and is most common in young adults and teenagers. It often starts in the lymph nodes in the neck or chest.
  • Mixed cellularity Hodgkin lymphoma: this is the second most common type, and is mostly diagnosed in people with HIV, typically occurring in lymph nodes in the upper half of the body.
  • Lymphocyte-rich Hodgkin lymphoma: this type is not common, and is typically found in just a few lymph nodes.
  • Lymphocyte-depleted Hodgkin lymphoma: this is the most rare form of the disease, and is diagnosed in older people and those with HIV. It’s an aggressive cancer that is usually advanced by the time it’s found in the abdomen, spleen, liver, and bone marrow.

Certain viruses may contribute to the risk of developing Hodgkin’s lymphoma, and a family history of the disease could increase risk. Most diagnoses are in young adults of 15-40 years, and older adults over 55.

Signs and Symptoms

Many young adults who develop Hodgkin’s lymphoma don’t actually show any symptoms for a length of time due to otherwise being young and healthy. Sometimes the symptom is only pain-free swelling of the lymph nodes in the neck or under the arm, and diagnosis is made based on the patient seeing a doctor about the swelling.

Symptoms vary widely, but some of them include:

  • Pain in swollen lymph nodes after alcohol consumption
  • Night sweats
  • Fever or chills through the day/night
  • Unexplained weight loss and loss of appetite
  • Fatigue
  • Dry and itchy skin or a red rash
  • Cough and shortness of breath caused by a swollen lymph node in the chest
  • Enlarged liver or spleen

Diagnosis

After going to a doctor regarding a symptom (most often swelling of lymph nodes, with or without pain), the doctor will likely complete a physical exam to look for swollen lymph nodes, blood tests (to see if there is any indication of cancer), imaging tests to check for any other areas of Hodgkin’s lymphoma, lymph node biopsy (to determine both if cancer is present and what type of Hodgkin’s lymphoma it is), or taking a bone marrow biopsy to check for Hodgkin’s lymphoma cells.

Further tests and procedures may be used to narrow down and confirm the diagnosis. After a diagnosis of Hodgkin’s lymphoma has been made, the doctor will do further testing to determine the stage of the cancer.

Stage I means the cancer is limited to one lymph node or organ; Stage II is two lymph node regions (or organ and lymph nodes); Stage III is lymph nodes both above and below the diaphragm; Stage IV is the most advanced stage, with multiple areas of cancer cells and both lymph nodes and other parts of the body are affected (including liver, lungs, or bones).

The letters A and B are also assigned to further categorize the cancer - A means no significant symptoms and B means significant signs and symptoms.

Treatment

A well-diagnosed and categorized diagnosis is what determines treatment. There are some different options of treatment, depending on the category of Hodgkin’s lymphoma and the personal preferences of the patient.

  • Chemotherapy: this is the main therapy for Hodgkin’s lymphoma to kill the lymphoma cells by traveling through the bloodstream to reach all areas of the body
  • Radiation therapy: high-energy beams are used to kill cancer cells (often used after chemotherapy for Hodgkin’s lymphoma treatment)
  • Bone marrow transplant (also known as stem cell transplant): replaces diseased bone marrow with stem cells that are healthy to grow new bone marrow - this is often an option if Hodgkin’s lymphoma returns after treatment
  • Other drug combinations to destroy cancerous cells (immunotherapy drugs)

Clinical trials are also an option for some patients to figure out new treatment options and procedures.

At some point, a patient could choose to no longer pursue treatment (when treatment has not been controlling the cancer, and the symptoms as a result of the treatment make it not worthwhile). This is when supportive care is utilized.

Alternative medicine isn’t used to treat Hodgkin’s lymphoma; however, it can help cope with the stress of a cancer diagnosis and side effects from treatment. Art and music therapy, exercise, meditation, relaxation techniques, and spirituality can all help a cancer patient to cope better.

Sources and More Information

American Cancer Society, “What is Hodgkin Lymphoma?” https://www.cancer.org/cancer/hodgkin-lymphoma/about/what-is-hodgkin-disease.html

“What is Cancer?” https://www.cancer.org/cancer/cancer-basics/what-is-cancer.html

Mayo Clinic, “Hodgkin’s lymphoma (Hodgkin’s disease)” https://www.mayoclinic.org/diseases-conditions/hodgkins-lymphoma/symptoms-causes/syc-20352646
MD Anderson Cancer Center, “Hodgkin’s Lymphoma” https://www.mdanderson.org/cancer-types/hodgkins-lymphoma.html

 

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