This type of cancer is also called Hodgkin disease. Every year in the United States, more than 8,000 people learn they have this disease. Cancer research has led to real progress against Hodgkin lymphoma. Most people diagnosed with Hodgkin lymphoma can now be cured, or their disease can be controlled for many years. Continuing research offers hope that, in the future, even more people with this disease will be treated successfully.
Hodgkin lymphoma is a cancer that begins in cells of the immune system. The immune system fights infections and other diseases. The lymphatic system is part of the immune system. The lymphatic system includes the following:
Lymph vessels: The lymphatic system has a network of lymph vessels. Lymph vessels branch into all the tissues of the body.
Lymph: The lymph vessels carry clear fluid called lymph. Lymph contains white blood cells, especially lymphocytes such as B cells and T cells.
Lymph nodes: Lymph vessels are connected to small, round masses of tissue called lymph nodes. Groups of lymph nodes are found in the neck, underarms, chest, abdomen and groin. Lymph nodes store white blood cells. They trap and remove bacteria or other harmful substances that may be in the lymph.
Other parts of the lymphatic system: Other parts of the lymphatic system include the tonsils, thymus and spleen. Lymphatic tissue is also found in other parts of the body including the stomach, skin and small intestine.
Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it’s first found in a lymph node above the diaphragm, the thin muscle that separates the chest from the abdomen. But Hodgkin lymphoma also may be found in a group of lymph nodes. Sometimes it starts in other parts of the lymphatic system.
- Swollen lymph nodes (that do not hurt) in the neck, underarms or groin
- Becoming more sensitive to the effects of alcohol or having painful lymph nodes after drinking alcohol
- Weight loss for no known reason
- Fever that does not go away
- Soaking night sweats
- Itchy skin
- Coughing, trouble breathing or chest pain
- Weakness and tiredness that don’t go away
Most often these symptoms are not due to cancer. Infections or other health problems may cause these symptoms. Anyone with symptoms that last more than 2 weeks should see a doctor so that problems can be diagnosed and treated.
If you have swollen lymph nodes or another symptom that suggests Hodgkin’s lymphoma, your doctor will try to find out what’s causing the problem. Your doctor may ask about your personal and family medical history.
You may have some of the following exams and tests:
Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms and groin. Your doctor also checks for a swollen spleen or liver.
Blood tests: The lab does a complete blood count to check the number of white blood cells and other cells and substances.
Chest X-rays: X-rays may show swollen lymph nodes or other signs of disease in your chest.
Biopsy: A biopsy is the only sure way to diagnose Hodgkin lymphoma. Your doctor may remove an entire lymph node (known as an excisional biopsy) or only part a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose Hodgkin lymphoma. Removing an entire lymph node is best.
The pathologist uses a microscope to check the tissue for Hodgkin lymphoma cells. A person with Hodgkin lymphoma usually has large, abnormal cells known as Reed-Sternberg cells. They are not found in people with non-Hodgkin lymphoma.
Types of Hodgkin Lymphoma
When Hodgkin lymphoma is found, the pathologist reports the type. There are two major types of Hodgkin lymphoma:
Classical Hodgkin lymphoma: Most people with Hodgkin lymphoma have the classical type.
Nodular lymphocyte-predominant Hodgkin lymphoma: This is a rare type of Hodgkin lymphoma. The abnormal cell is called a popcorn cell. It may be treated differently from the classical type.
Your doctor needs to know the extent (stage) of Hodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease. Hodgkin lymphoma tends to spread from one group of lymph nodes to the next group. For example, Hodgkin lymphoma that starts in the lymph nodes in the neck may spread first to the lymph nodes above the collarbones, and then to the lymph nodes under the arms and within the chest. In time, the Hodgkin lymphoma cells can invade blood vessels and spread to almost any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.
Staging may involve one or more of the following tests:
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your chest, abdomen, and pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.
- MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones, brain, or other tissues. Your doctor can view these pictures on a monitor and can print them on film.
- PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells and areas with lymphoma look brighter on the pictures.
- Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for Hodgkin lymphoma cells in the sample.
Other staging procedures may include biopsies of other lymph nodes, the liver, or other tissue.
The doctor considers the following to determine the stage of Hodgkin lymphoma:
- The number of lymph nodes that have Hodgkin lymphoma cells
- Whether these lymph nodes are on one or both sides of the diaphragm
- Whether the disease has spread to the bone marrow, spleen, liver, or lung.
The stages of Hodgkin lymphoma are as follows:
Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ (such as the lung).
Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen.
Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes.
In addition to these stage numbers, your doctor may also describe the stage as A or B:
A: You have not had weight loss, drenching night sweats, or fevers.
B: You have had weight loss, drenching night sweats, or fevers.
Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs
The choice of treatment depends mainly on the following:
- The type of your Hodgkin lymphoma (most people have classical Hodgkin lymphoma)
- Its stage (where the lymphoma is found)
- Whether you have a mass or tumor that is more than 4 inches (10 centimeters) wide
- Your age
- Whether you’ve had weight loss, drenching night sweats, or fevers.
People with Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, or both. If Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with Hodgkin lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.
You may want to know about side effects and how treatment may change your normal activities. Because chemotherapy and radiation therapy often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. The younger a person is, the easier it may be to cope with treatment and its side effects. At any stage of the disease, you can have supportive care. Supportive care is treatment to prevent or fight infections, to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring.
New treatments are always being tested in clinical trials and some patients with cancer may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Talk to your doctor about the clinical trials that may be right for you.