Hodgkin Lymphoma

Hodgkin lymphoma is a cancer which begins in the lymphatic cells of the immune system. Although Hodgkin lymphoma can develop anywhere in the body, it most frequently begins above the diaphragm. This cancer, which is also called Hodgkin disease, is diagnosed in more than 8,000 people in the United States each year.

Risk Factors

The reasons why people develop Hodgkin lymphoma are not well understood. Although there are risk factors which increase the chance of developing the disease, most people who have the risk factors do not develop Hodgkin lymphoma. Statistically, there is less than 1/500th of 1% lifetime chance of a person developing the disease. Risk factors include:

• HIV (human immunodeficiency virus) infection. (It is not necessary for the HIV infection to progress to AIDS to greatly increase the risk of non-Hodgkin lymphoma.)
• Epstein-Barr virus infection.
• Weak immune system. This may be the result of heredity or may be caused by immunosuppressant drugs used to reduce the possibility of rejection in organ transplants.
• Age. People between 15 and 35 years old and those over 55 are most susceptible to Hodgkin lymphoma.
• Family history. People with siblings or other family members who have Hodgkin lymphoma have a greater chance of developing the condition.

Warning Signs

The warning signs of Hodgkin lymphoma can also be symptoms of other conditions. Most people with these symptoms do not have Hodgkin lymphoma. However, people who experience these symptoms for more than two weeks should consult a doctor:

• Swollen but not painful lymph nodes in the neck or armpit.
• Less frequently, swollen but not painful lymph nodes in the groin.
• The effects noticed after drinking alcohol are increased.
• Lymph nodes may hurt after drinking alcohol.
• Unexplained weight loss.
• Lingering fever.
• Soaking night sweats.
• Skin itch.
• Lingering fatigue.
• Respiratory problems like cough or trouble breathing.
• Chest pain.

Detection, Diagnosis and Staging

Detection

Hodgkin lymphoma is usually detected when patients consult with a doctor about symptoms. Since many other conditions have the same symptoms as Hodgkin lymphoma, blood tests and x-rays are used to detect the disease.

Diagnosis

When a condition which may be Hodgkin lymphoma is detected, a biopsy is performed to diagnose the disease. The biopsy is done by surgically removing all or part a swollen lymph node for microscopic examination by a pathologist.

The pathologist determines whether Hodgkin lymphoma is present and whether it is classical Hodgkin lymphoma or nodular Hodgkin lymphoma.

Staging

Staging Hodgkin lymphoma depends on the location and extent of malignancies, and whether the cancer has spread to the bone marrow, spleen, liver or lung.

• Stage I: lymphoma cells are in one group of lymph nodes or part of one organ only.
• Stage II: lymphoma cells are in more than one group of lymph nodes on the same side of the diaphragm or in one or more group(s) of lymph nodes and part of one organ on the same side of the diaphragm.
• Stage III: lymphoma cells are found in lymph nodes above and below the diaphragm. Lymphoma cells may also be present in tissue (especially the liver, lung, spleen or bone) near the lymph nodes.
• Stage IV: lymphoma cells are found in multiple parts of one or more tissues or organs or in one organ and lymph nodes in another part of the body.
• Recurrent: Lymphoma that returns after treatment.

In addition to the staging numbers, Hodgkin lymphoma may be classified as type A or B.

• A: The patient has not lost weight or had night sweats or fever.
• B: The patient has had weight loss and night sweats and/or fever.

Diagnostic procedures used to stage Hodgkin lymphoma

• Biopsy. A hollow needle takes small sample of marrow from a bone. The sample is examined microscopically by a pathologist.
• MRI. A magnetic resonance imaging scan provides precise images of areas of interest.
• CT. A computed tomography scan with contrast agent provides a precise structural image of swollen lymph nodes.
• PET (positron emission tomography) scan to detect unusual metabolic activity at a molecular level to find cancer undetectable by other methods.
• PET-CT. A combined PET and CT scan can simultaneously find microscopic cancers, determine how aggressive they are and locate them precisely.

Treatment

The appropriate treatment for non-Hodgkin lymphoma depends on the specific type of non-Hodgkin lymphoma, the stage, whether it is slow-growing or aggressive and the age and health of the patient.

Chemotherapy

Chemotherapy attacks Hodgkin lymphoma with drugs that either kill cancer cells or stop them from dividing or with drugs that prevent the growth of new blood vessels needed to sustain a tumor.

Chemotherapy for Hodgkin lymphoma is systemic chemotherapy, in which drugs are injected into the blood stream and affect all parts of the body.

The drugs used to treat Hodgkin lymphoma can cause sterility. Patients who may want to have children after treatment should investigate sperm banking or egg harvesting.

Radiation therapy

Radiation therapy for Hodgkin lymphoma uses external beams shaped to the contours of the area to be treated. This IMRT (intensity modulated radiation therapy) delivers an optimum dose to the tumor with minimum effect on other areas of the body.