Hodgkin lymphoma, sometimes called “Hodgkin disease,” is a type of blood cancer called a “lymphoma.” Lymphomas form in the lymphatic system, which is part of both the immune system and the circulatory system. The lymphatic system includes lymph nodes and organs including the spleen and thymus gland. The lymphatic system’s purpose is to remove waste, bacteria, and extra fluid from the body.
There are two main types of lymphoma, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). There are many subtypes of each.
Hodgkin lymphoma is less common than non-Hodgkin lymphoma. It is a very treatable cancer with an excellent survival rate after treatment. A hallmark of Hodgkin lymphoma is that it spreads through the body in a predictable pattern. NHL spreads less predictably.
The causes of Hodgkin lymphoma are not fully understood. It can occur due to DNA mutations in lymphocytes, a type of immune cell. Mutations of oncogenes (genes that help cells grow) or tumor suppressor genes (genes that slow cell division) also can cause cancer.
Some of the main risk factors for developing Hodgkin lymphoma include being previously infected with the Epstein-Barr virus (the virus that causes mononucleosis), having a compromised immune system, and being infected with HIV.
Learn more about what causes Hodgkin lymphoma.
Both Hodgkin and non-Hodgkin lymphomas have many of the same symptoms. Three of these symptoms — fever, night sweats, and unexplained weight loss — are called “B symptoms.” B symptoms are used to help determine the stage of Hodgkin lymphoma, as well as its prognosis.
Common signs and symptoms of Hodgkin lymphoma include:
These symptoms can occur in other medical conditions, including other types of cancer. They become a cause for concern when they are unexplained by other causes and last for longer than a few days or weeks.
Read more about the symptoms of Hodgkin lymphoma.
Diagnosis of Hodgkin (and non-Hodgkin) lymphoma begins with a thorough medical history to identify symptoms and risk factors for lymphoma, as well as a physical exam to identify any physical signs of disease.
Tests to accurately diagnose and stage Hodgkin lymphoma include biopsies of tumors and bone marrow, imaging tests, and blood tests. A pregnancy test is also very important in women of reproductive age.
Determining the stage of Hodgkin lymphoma involves identifying which organs are affected and how far the disease has spread in the body. Staging helps doctors determine the most appropriate treatments and prognosis.
A thorough physical exam for lymphoma includes careful palpation (feeling by hand) of the neck, armpits, and groin for swollen lymph nodes. Palpation of the abdomen is also important to check for enlargement of the spleen.
In a biopsy, a small sample of a tumor or tissue is removed from the body for testing. Pathologists analyze the sample under a microscope to look for abnormalities in cells. They can determine whether the sample is cancer and, if so, what kind of cancer it is. Doctors may also use genetic testing to look for specific proteins and DNA mutations to diagnose lymphoma. Genetic testing is more common in non-Hodgkin lymphoma.
Types of biopsies used for Hodgkin lymphoma include:
Imaging tests can help locate tumors in the body. Tests may include:
The most important blood tests for Hodgkin lymphoma are complete blood count and erythrocyte sedimentation rate (ESR) tests. Blood tests for liver and kidney function and conditions such as HIV, hepatitis B, and hepatitis C are also needed to determine the best treatments for an individual.
Complete blood count testing measures the amount of red blood cells (erythrocytes), hemoglobin, white blood cells (leukocytes), and platelets in a person’s blood. Further testing can show the different types of white blood cells in a blood sample and whether they appear abnormal.
ESR is a measure of inflammation in the body. It is important in the diagnosis of Hodgkin lymphoma.
Learn more about diagnosing Hodgkin lymphoma.
Different types of cancer use different systems for staging. Cancer stages are described as stage 1, 2, 3, or 4 with subclassifications. Cancer stages are sometimes noted with Roman numerals, as stages I through IV. Both Hodgkin and non-Hodgkin lymphoma are staged using the Lugano classification system.
Stages are based on whether the lymphoma is localized or widespread. One very important factor in lymphoma staging is whether the lymphoma has spread from one side of the diaphragm (the muscle under the lungs separating the chest from the abdomen) to the other. Stages are defined further by the size of the tumor and whether B symptoms are present.
Lymphoma stages include:
Read more about the stages of Hodgkin lymphoma.
Hodgkin lymphoma has two main subtypes: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Identifying the subtype of lymphoma helps determine how to best treat it.
This is an uncommon form of Hodgkin lymphoma, accounting for roughly 5 percent of cases. It is highly curable, but it may transform into an aggressive non-Hodgkin lymphoma.
Read more about types of Hodgkin lymphoma.
Treatment of classic Hodgkin lymphoma usually includes a combination of therapies, such as chemotherapy, radiation therapy, targeted therapy, and stem cell transplant. The best course of treatment for Hodgkin lymphoma is determined by the lymphoma’s subtype and stage as well as the person’s age and overall health.
Chemotherapy for Hodgkin lymphoma varies by subtype. According to the American Cancer Society, chemotherapy combinations used to treat Hodgkin lymphoma include:
Several types of radiation therapy are used to treat Hodgkin lymphoma. Radiation therapy is usually used in addition to chemotherapy, but sometimes it is used alone. External beam radiation therapy can be used in a small, limited area where the cancer is located.
Targeted therapy includes immunotherapy with monoclonal antibodies and treatment with small-molecule drugs. Monoclonal antibodies attach to specific proteins found on the surface of cancer cells. Different treatments are used depending on the type of Hodgkin lymphoma.
Some monoclonal antibodies used to treat Hodgkin lymphoma include:
Stem cell transplantation is frequently used with high-dose chemotherapy. Stem cells are collected from a person’s own blood or bone marrow prior to chemotherapy. After the person completes the chemotherapy course, their stem cells are transplanted back into their blood or bone marrow.
Another important part of any cancer treatment plan is palliative care. Palliative care aims to help people deal with the complications of cancer and cancer treatment. Palliative care focuses on improving quality of life by treating symptoms caused by illness and treatment. It also connects people undergoing cancer treatment — and their caregivers — with emotional and spiritual support.
Learn more about treatments for Hodgkin lymphoma.
A diagnosis of Hodgkin lymphoma usually has an excellent prognosis; the overall five-year survival rate in the United States is 88.3 percent. A diagnosis of stage 1 or stage 2 Hodgkin disease improves the five-year survival rate to over 90 percent. A stage 4 diagnosis still has a 78.5 percent survival rate, which is better than the overall five-year survival rate for all cancers combined (67.7 percent).
Read more about Hodgkin lymphoma survival rate and outlook.
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