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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).
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:
Lymph tissue is in many parts of your body, so Hodgkin lymphoma can start almost anywhere.
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.
We know that Hodgkin lymphoma is linked with a number of risk factors, but we are still researching the cause of most lymphomas.
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.
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 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.