Hodgkin lymphoma
Hodgkin lymphoma or Hodgkin’s lymphoma (HL) is a blood cancer that occurs in the lymph system, also called the lymphatic system. It is marked by the involvement of Reed-Sternberg cells, which differentiates it from Non-hodgkin lymphoma (NHL).
Hodgkin lymphoma: learn more
Overview
The lymph system helps control the flow of fluids in the body and is part of the immune system. The lymph system consists mainly of a type of white blood cell called lymphocytes—there are two main types:
- T lymphocytes (T cells). There are many types of T cells. Some T cells destroy germs or abnormal cells in the body, while other T cells help boost or slow the activity of other immune system cells.
- B lymphocytes (B cells). They make proteins called antibodies that help protect the body from bacteria and viruses. Hodgkin lymphoma usually starts in B cells.
Lymph tissue is in many parts of your body, so Hodgkin lymphoma can start almost anywhere.
Major sites of lymphoid tissue
- Lymph nodes. Lymph nodes are bean-sized collections of lymphocytes and other immune system cells. They’re found throughout the body, including inside the chest, abdomen (belly), and pelvis. They’re connected to each other by a system of lymphatic vessels.
- Lymph vessels. A network of tiny tubes (a lot like blood vessels) that connect lymph nodes and carry immune cells in a clear fluid called lymph. Lymph is collected from around the body and put into the bloodstream.
- Spleen. The spleen is an organ that’s under the lower ribs on your left side. The spleen is part of your immune system. It makes lymphocytes and other immune system cells. It also stores healthy blood cells and filters out damaged blood cells, bacteria, and cell waste.
- Bone marrow. The bone marrow is the liquid, spongy tissue inside certain bones. New blood cells (including some lymphocytes) are made there.
- Thymus. The thymus is a small organ behind the upper part of the breastbone and in front of the heart. It’s important for T lymphocyte development.
- Adenoids and tonsils. These are collections of lymph tissue in the back of your throat. They help make antibodies against germs that are breathed in or swallowed.
- Digestive tract. The stomach, intestines, and many other organs also have lymph tissue.
Although Hodgkin lymphoma can start almost anywhere, most often it starts in lymph nodes in the upper part of the body. The most common sites are in the chest, neck, or under the arms.
Hodgkin lymphoma most often spreads through the lymph vessels from lymph node to lymph node. Rarely, late in the disease, it can invade the bloodstream and spread to other parts of the body, such as the liver, lungs, and/or bone marrow.
Symptoms and risk factors
Symptoms
The most common symptom of HL is a painless lump in the neck, under the arm or in the groin. This lump is an enlarged lymph node, and it may become painful after drinking alcohol. The lump might get bigger over time, or new lumps might appear near it or even in other parts of the body.
In addition, some people may have B symptoms:
- Fever without an infection
- Night sweats
- Weight loss without trying
- Itchy skin
- Fatigue
- Loss of appetite
- Cough, trouble breathing or chest pain
Risk factors
Research has identified a few risk factors that make people more likely to develop HL, but we are not sure why:
- Epstein-Barr virus (EBV). EBV causes infectious mononucleosis.
- Age. Hodgkin lymphoma is most common in the 20s and after age 55.
- Gender. Occurs slightly more often in males than in females.
- Family history.
- Weakened immune system. The risk of Hodgkin lymphoma is increased in people infected with HIV, the virus that causes AIDS.
Questions and answers (FAQs)
Yes. These side effects depend on the type of treatment and the patient’s age when treated, and may include:
- Second cancers
- Solid tumors
- Infertility
- Hypothyroidism
- Heart disease, such as heart attack
- Lung problems, such as trouble breathing
- Avascular necrosis of bone
- Severe infection
- Chronic fatigue
The 5-year combined relative survival rate for HL is 87%.
Source: National Cancer Institute
Yes. Depending on the type of HL, early diagnosis and treatment, and the condition of the patient, HL can be cured.
Diagnosis and staging
Diagnosis
To properly diagnose Hodgkin lymphoma, your doctor will start by taking your medical history and performing a physical examination, paying close attention to the lymph nodes and other parts of your body that might be affected, like the spleen and liver. Other diagnostic tests may follow, including:
Biopsy
This is the only way to be sure of the diagnosis. Your doctor will choose the best type of biopsy to do based on your situation:
Excisional or incisional biopsy. Your doctor cuts through the skin to remove the lymph node. If the whole lymph node is removed, it’s an excisional biopsy—if a small part of a larger tumor or node is removed, it’s an incisional biopsy.
Needle biopsy. A needle biopsy is less invasive than excisional or incisional biopsies. There are two main types:
- A fine needle aspiration (FNA) biopsy uses a very thin, hollow needle attached to a syringe to take out (aspirate) a small amount of fluid and tiny bits of tissue.
- A core needle biopsy uses a larger needle to remove a slightly larger piece of tissue.
Other techniques
Immunohistochemistry. This lab test looks for certain proteins on cells, such as CD15 and CD30. These are found on the surface of the Reed-Sternberg cells in classic Hodgkin lymphoma (cHL).
Imaging tests. X-rays, sound waves, magnetic fields, or radioactive particles make pictures of the inside of the body. The imaging tests most commonly used:
- Chest X-ray.
- Computed tomography (CT) scan.
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) scan.
- PET/CT scan. Some machines can do both a PET scan and a CT scan at the same time.
Staging
UCHealth follows the Lugano classification for staging Hodgkin lymphoma. It has 4 stages, labeled I, II, III, and IV.
For limited stage (I or II) HL that affects an organ outside of the lymph system, the letter E is added to the stage (for example, stage IE or IIE).
Stage I: Either of the following means that the HL is stage I:
- HL is found in only 1 lymph node area or lymphoid organ such as the thymus (I).
- The cancer is found only in 1 part of 1 organ outside the lymph system (IE).
Stage II: Either of the following means that the HL is stage II:
- HL is found in 2 or more lymph node areas on the same side of (above or below) the diaphragm, which is the thin muscle beneath the lungs that separates the chest and abdomen (II).
- The cancer extends locally from one lymph node area into a nearby organ (IIE).
Stage III: Either of the following means that the HL is stage III:
- HL is found in lymph node areas on both sides of (above and below) the diaphragm (III).
- HL is in lymph nodes above the diaphragm and in the spleen.
Stage IV: HL has spread widely into at least one organ outside of the lymph system, such as the liver, bone marrow, or lungs.
Source: American Cancer Society
Treatment and recovery
Treatment for blood cancer varies greatly from person to person and depends on the type of blood cancer. Your medical team may use any combination of chemotherapy, drug therapy, bone and marrow transplants, radiation, or new targeted therapies to treat or control your Hodgkin lymphoma:
Chemotherapy. Drugs that slow down, damage, or kill cancer cells. It may involve single drugs or combinations of drugs taken intravenously or by mouth. Chemotherapy is often taken in cycles lasting three or four weeks each. Your team may also prescribe drugs to reduce or eliminate chemotherapy’s side effects.
Radiation therapy. X-rays and other types of medical radiation aimed at specific parts of the body. The radiation kills cancer cells, prevents cancer cells from developing or recurring, and improves many of cancer’s symptoms. For certain cancers, radiation therapy is combined with chemotherapy and called chemo-radiotherapy.
Targeted therapies. Single drugs or combinations of drugs taken through intravenous injections or as prescribed tablets/capsules help fight the cancer itself or the side effects from chemotherapy. Drugs may be taken in repeating patterns (cycles) that usually last three to four weeks. Anti-cancer drugs or other substances that directly interfere with cancer growth and progression at the molecular level may be taken-with few side effects on their own or combined with standard chemotherapy. Many new targeted therapies, including vaccines and gene therapies, are currently in development.
Blood and marrow transplantation. Because intensive chemotherapy and/or radiation treatment can severely damage the bone marrow’s ability to produce cells, stem cell transplantation helps restore normal blood production.
Platelet transfusion. Platelets are small cells that stick to the site of a blood vessel injury and seal it to stop bleeding. Apheresis is the process that removes platelets from a donor’s blood by a machine that then returns plasma and other cells to the donor. People experiencing lymphoma often need an infusion of donor platelets.
Bisphosphonates. This class of drugs, which includes pamidronate and zoledronic acid, helps limit bone loss, bone thinning, and fractures, especially in people experiencing myeloma.
Hodgkin lymphoma: causes
We know that Hodgkin lymphoma is linked with a number of risk factors, but we are still researching the cause of most lymphomas.
Genetic causes
We do have a better understanding now how certain changes in DNA can cause normal lymphocytes to become lymphoma cells. Oncogenes are genes that help cells grow, divide, and stay alive—tumor suppressor genes help keep cell division under control, or make cells die at the right time. We know that some lymphoma cancers are caused by DNA mutations that turn on oncogenes or turn off tumor suppressor genes. A family history of lymphoma does seem to increase the risk of lymphoma.
Types of Hodgkin lymphoma
Different types of HL can grow and spread differently and may be treated differently.
Classic Hodgkin lymphoma (cHL). Accounts for more than 90% of cases of Hodgkin lymphoma in developed countries. The cancer cells in cHL are called Reed-Sternberg cells, usually an abnormal type of B lymphocyte.
Classic HL has four subtypes:
- Nodular sclerosis Hodgkin lymphoma (NSCHL). The most common type of Hodgkin disease in developed countries, accounting for about seven out of 10 cases. Typically starts in lymph nodes in the neck or chest.
- Mixed cellularity Hodgkin lymphoma (MCCHL). The second-most common type, occurring mostly in people with HIV infection. It can start in any lymph node, but most often occurs in the upper half of the body.
- Lymphocyte-rich Hodgkin lymphoma. Not common. Usually occurs in the upper half of the body and is found in only a few lymph nodes.
- Lymphocyte-depleted Hodgkin lymphoma. A rare form of Hodgkin disease, occurring mainly in older people and those with HIV infection. Found most often in lymph nodes in the abdomen as well as in the spleen, liver, and bone marrow. It’s more aggressive than other types, and likely to be advanced when discovered.
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Accounts for about 5% of cases. The cancer cells are large and called popcorn cells because they look like popcorn—they are also called lymphocytic and histiocytic (L&H) cells—which are variants of Reed-Sternberg cells. NLPHL typically starts in lymph nodes in the neck and armpit and tends to grow slower and is treated differently from cHL types.
Five-year Hodgkin lymphoma cancer survival rates
Number of Patients Diagnosed – UCHealth 155 – State of Colorado – 140
Number of Patients Surviving – UCHealth 604 – State of Colorado – 532
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
References
The Leukemia & Lymphoma Society (LLS). Hodgkin’s Lymphoma (https://www.lls.org/lymphoma/hodgkin-lymphoma)
MedlinePlus: National Library of Medicine. Hodgkin Lymphoma (https://medlineplus.gov/hodgkinlymphoma.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Hodgkin Lymphoma (https://www.ncbi.nlm.nih.gov/books/NBK499969/)
National Cancer Institute (NCI). Adult Hodgkin Lymphoma Treatment (https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq)