Hodgkin's lymphoma

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 18, 2016
StartHodgkin's lymphoma

Hodgkin’s lymphoma, often referred to as Hodgkin’s disease, is a cancer affecting the lymphatic system. The lymphatic system is a vital part of the body’s immune system. It helps to clean waste from the body and provides protection from disease and infection.

Contents

Definition & Facts

Hodgkin’s lymphoma primarily affects the white blood cells known as lymphocytes, which are responsible for attacking germs and infections that threaten the body. People with this condition have lymphocytes that spread beyond the lymphatic system and grow abnormally.

Approximately 8,500 cases of Hodgkin’s lymphoma are diagnosed each year in the United States. The disease is most common in young adults in their 20s. Survival rates for patients with Hodgkin’s lymphoma have improved over the past couple of decades due to advances in treatment. Currently, the one-year survival rate averages about 92 percent. The survival rates at five and ten years are 86 and 80 percent, respectively.

Symptoms & Complaints

The most characteristic symptom of Hodgkin’s lymphoma is swollen lymph nodes without any prior history of infection. This typically presents as a small, painless lump under the skin in the armpit, groin, or side of the neck. Other common symptoms include:

These symptoms can also indicate diseases and conditions other than Hodgkin’s lymphoma, so it is important to see a doctor right away for an accurate diagnosis. The number and severity of symptoms are often used to help stage the lymphoma and determine the proper course of treatment.

Causes

Researchers have yet to discover the exact cause of Hodgkin’s lymphoma. In most cases, the condition occurs when certain lymphocytes, called B cells, mutate. The genetic mutation allows the cell to divide rapidly and to survive when normal cells would die. These abnormal cells start to accumulate in the lymphatic system and crowd out the normal, healthy cells.

Hodgkin’s lymphoma is divided into two subtypes depending on the specific cells involved. The most common type is classical Hodgkin’s lymphoma. The more rare form is called lymphocyte-predominant Hodgkin’s lymphoma. Certain factors increase a person’s risk of developing Hodgkin’s lymphoma, including:

  • Age—Most cases of Hodgkin’s lymphoma are diagnosed in patients between the ages of 15 and 30.
  • Gender—Males have a slightly greater chance of developing the condition than females.
  • Past infections—Individuals who have had mononucleosis or Epstein-Barr virus have a greater likelihood of developing Hodgkin’s lymphoma in the future.
  • Compromised immune system—Individuals with HIV/AIDS or who take immunosuppressive drugs are at a greater risk for the condition.
  • Family history—The risk of Hodgkin’s lymphoma is higher for people who have a close relative who also has the condition.
  • Geography—Hodgkin’s is most prevalent in Canada, the United States, and Northern Europe. Asian countries have the lowest rates of Hodgkin’s.

Diagnosis & Tests

Diagnosis of Hodgkin’s lymphoma begins with a detailed physical examination. In addition to a thorough medical history, the doctor will check for the tell-tale sign of swollen lymph nodes in the neck, armpit, and groin. The physical exam is typically followed by various lab and imaging tests to confirm the diagnosis, including blood tests, CT scans, X-rays, echocardiograms, and bone marrow biopsies and lymph node biopsies.

Once the diagnosis is confirmed, the cancer is staged to determine the most appropriate treatment options and to provide a prognosis. Hodgkin’s lymphoma is classified according to the following stages:

  • Stage I—Only one lymph node or organ is affected.
  • Stage II—The cancer is limited to one region of the body, but two lymph nodes or one organ and nearby lymph nodes are affected.
  • Stage III—The cancer has metastasized, that is, spread to multiple areas of the body, affects tissues or organs near the lymph nodes, or affects the spleen.
  • Stage IV—The cancer is very advanced and may affect lymph nodes and other parts of the body, including the bones, liver, or lungs.

The cancer may be further classified with the letters A or B. Type A means the patient has no significant symptoms. Type B indicates the patient is experiencing symptoms such as weight loss, night sweats, or fever.

Treatment & Therapy

The treatment for Hodgkin’s lymphoma depends on the disease type and stage, the patient’s overall health, and personal preferences. Chemotherapy uses oral or IV drugs to kill the cancer cells. These powerful drugs carry significant side effects, including nausea, hair loss, fertility problems, and possible heart damage or lung damage.

Chemotherapy is often used in combination with radiation to treat early-stage classical Hodgkin’s lymphoma. Radiation attacks the cancer by directing high-energy beams at the affected parts of the body. Radiation is often used as a stand-alone treatment for early-stage lymphocyte-predominant Hodgkin’s lymphoma. Typical side effects of radiation treatment include hair loss, fatigue, skin redness, infertility, and thyroid problems.

In cases of recurrent Hodgkin’s lymphoma, doctors may use a stem cell transplant as a treatment. This requires that the patient’s own blood stem cells be removed and frozen. High-dose radiation and chemotherapy are used to kill the cancer cells. The stored stem cells are then thawed and reintroduced into the body in the hopes that they will help the body produce healthy bone marrow.

There are no alternative medicines available to treat Hodgkin’s; however, massage, aromatherapy, acupuncture, or meditation may help to relieve some of the stress associated with living with a cancer diagnosis.

Prevention & Prophylaxis

There are no specific techniques designed to prevent Hodgkin’s lymphoma. The best course of action is to be aware of the early warning signs and to seek prompt medical attention. Individuals should also make their doctor aware if they have any of the above-mentioned risk factors that make them more susceptible to developing the condition.

The prognosis for patients with Hodgkin’s lymphoma is generally favorable if they receive early treatment. New chemotherapy drugs and targeted therapies are currently being tested to improve the effectiveness of treatment while limiting the number of long-term side effects.