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Hodgkin Lymphoma

​This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed March 2016

The basics
  • Guidelines for treating this cancer have been developed by the Lymphoma Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines: Hodgkin Lymphoma.
  • The name of this cancer may be given as Hodgkin, Hodgkins, or Hodgkin's; it is also called Hodgkin Disease. Dr. Thomas Hodgkin first described lymphoma in the 1830s.
  • Lymphomas are cancers that start in lymphocytes, which are types of white blood cells that circulate primarily through the lymphoid system. The lymphoid system is part of the immune system, which protects against infection.
    • The lymphoid system consists of: lymph nodes, lymphatic vessels, lymph fluid and lymph tissue in other organs such as the spleen, thymus, bone marrow.
    • The lymph nodes are small organs occurring in many places in the body, particularly in the chest, neck, armpit, groin and amongst the blood vessels of the intestines. Lymphatic vessels are a network to carry lymph fluid between the nodes and through the body.
  • Lymphomas are called B-cell or T-cell lymphoma depending on the type of lymphocyte that has become cancerous. Hodgkin lymphoma usually starts with a B-cell lymphocyte.
  • Abnormal or cancerous lymphocytes (T-cell or B-cell) may:
    • stay in the lymph nodes, or
    • form solid tumours in the body, or
    • rarely, like leukemia, circulate in the blood
  • Hodgkin lymphoma is recognized under the microscope by a distinctive looking cancer cell called the "Reed-Sternberg cell."

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.
  • The cause of Hodgkin lymphoma is not yet known.
  • Both men and women are diagnosed with Hodgkin lymphoma and it can occur at any age, more commonly in adults aged 15 - 35, or over 50, but there is generally no increased risk with aging.
  • Some researchers suspect a problem in the body's immune (infection-fighting) system plus response to an external stimulant, such as a virus. Hodgkin lymphoma is more common in countries where people get fewer common childhood infections, and it is less common in developing countries, where adults have survived many exposures to disease.
  • Infection with the Epstein-Barr virus can increase risk.
  • An unusual diagnosis in blood cells, called PTGC (Progressive Transformation of Germinal Centres), has been associated with Hodgkin lymphoma.
  • Having someone in the immediate family (parents, brothers, or sisters) with Hodgkin Lymphoma may mean a higher risk, but no gene has been identified.
  • Some additional factors seem to increase risk, but probably do not cause Hodgkin lymphoma: previous stem-cell transplant, immunodeficiency, auto-immune diseases such as rheumatoid arthritis, tobacco use, and infectious mononucleosis.
  • Lymphomas (all kinds together) are the seventh most common cause of cancer deaths and the fifth most common cancer diagnosed in men or women. Hodgkin lymphoma occurs in 10-14% of all lymphomas. It is not very common.
  • Statistics

Can I help to prevent it?

There is no effective prevention known for Hodgkin lymphoma.

Screening for this cancer

No effective screening program exists for this cancer yet.

Signs and symptoms

Most symptoms of Hodgkin lymphoma are also common in other, less serious disorders. They are more often caused by something else, and not likely a sign of lymphoma. However, it is always important to have symptoms checked by a health professional. Symptoms include:
  • Painless enlarged lymph nodes in neck, groin or armpit
  • Fatigue
  • Shortness of breath
  • Itchiness on the trunk of the body
  • Unusual back or abdominal pain
  • Abdominal swelling
The following are known as "B" symptoms and affect the staging and treatment of Hodgkin lymphoma:
  • Persistent fever whose cause is unknown
  • Unexplained night sweats, sometimes so severe the bedclothes have to be changed
  • Unexplained weight loss
Diagnosis & staging
Diagnosis


These are tests that may be used to diagnose this type of cancer.

  • A very thorough medical and physical examination will be done, with attention to lymph nodes, spleen, liver and pain in bones.
  • Blood and urine samples will be taken for laboratory testing, including a complete blood count, blood chemistry tests, and cell and tissue analyses.
  • A chest X-ray will be taken.
  • CT scans will be done, of the chest, abdomen and/or pelvis, to look for signs of cancer in those organs and nearby lymph nodes.
  • Biopsy surgery removes the affected lymph node(s) or other tissue, and specialists will look at the cells under a microscope to find out what kind of Hodgkin lymphoma it is, and where.
  • Additional imaging scans of bones or organs such as the liver and spleen may be done.

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and stages

Types

  • Hodgkin lymphoma is one kind of lymphoma. It has been classified by several systems, using different names.
  • There are five different types of Hodgkin lymphoma, based on the exact kind of cell seen under a microscope. Treatments are similar for all five types.
  • Classification according to the World Health Organization (WHO):
    • Classical Hodgkin lymphoma (this lymphoma includes four of the five types):
      • Nodular sclerosis – about 75% of Hodgkin cases; more common in women than men; less common in people over the age of 50
      • Lymphocyte-rich – rare
      • Mixed cellularity – about 20% of cases
      • Lymphocyte depletion – rare
    • Nodular lymphocyte predominance – rare, and different than the four "classical" types.

Stages

Staging describes the extent of a cancer. The stage of the cancer is used to plan the treatment.

Careful diagnostic and staging procedures will identify the pattern of spread.

Staging of Hodgkin lymphoma based on the Ann Arbor system:

Stage I 
Involves a single lymph node region 

Stage II  
Involvement of two or more lymph node regions on the same side of the diaphragm* 

Stage III   
Involvement of lymph node regions on both sides of the diaphragm* 

Stage IV 
Spread of the disease outside the lymph system, into other organs or kinds of tissue 

* The diaphragm is a large muscle below the ribs, which divides the body into top and bottom, separating the chest area from the abdomen.

  • Each stage is divided into A and B categories.
  • "A" patients have no specific symptoms from the "B" list.
  • "B" patients have had unexplained weight loss of more than 10% in the six months before diagnosis, or unexplained fevers above 38 C (100.4 F), or persistent heavy night sweats.
  • Hodgkin lymphoma is considered "aggressive," which means that it will spread and grow, so treatment is required. Treatment is very effective for most patients.
  • Hodgkin lymphoma is usually predictable and spreads to adjacent lymph nodes, unlike Non-Hodgkin's lymphomas which spread with no regular pattern.
Treatment

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.
 
  • Hodgkin lymphoma responds extremely well to treatment.
  • Patients are usually treated in outpatient clinics.
  • The chance of curing Hodgkin lymphoma is good.
  • The type of treatment recommended is important and depends on the results of a variety of diagnostic tests.
  • Patients who have a lymphoid cancer should receive certain immunizations to help boost or maintain their immunity.
  • 10% to 30% of Hodgkin lymphomas come back. Further treatment after recurrence is often successful.
Chemotherapy
  • Chemotherapy, with or without radiation therapy, is used to treat Hodgkin lymphoma.
  • Most patients begin with chemotherapy, and then further tests will be done.
  • Advanced, metastatic or recurrent Hodgkin lymphoma can still be treated with chemotherapy.
  • Very high dose chemotherapy may be part of a Bone Marrow Transplant process.
Radiation therapy
  • After the initial chemotherapy, radiation therapy or more chemotherapy may be given.
Bone Marrow Transplant

Follow-up after treatment

  • Guidelines for follow-up after treatment are covered on our website.
  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • After treatment for Hodgkin lymphoma, a few patients develop side effects much later. These side effects can be helped, so patients should talk about concerns with their health care provider.
    • Dental problems such as a dry mouth or cavities, especially after radiation therapy to the head area. Looking after the teeth can prevent serious problems.
    • Thyroid problems, particularly if the throat region has had radiation, can develop. The symptoms may not seem related to the cancer, but can be treated. Hypothyroidism is explained on HealthlinkBC and MedlinePlus.gov.
    • Patients may also experience infertility, or early menopause (for women), and related problems.
    • Patients can get different cancers or recurrence of the Hodgkin lymphoma.
    • Women who had a specific type of radiation for their Hodgkin lymphoma, called "mantle' radiation, are at a significant risk for a subsequent breast cancer. In BC, mantle radiation was used from the early 1970's to the late 1990's, but is only used in very rare circumstances today. If you had mantle radiation for Hodgkin lymphoma or had radiation for Hodgkin during those years, please discuss this information with your doctor. More information is at http://www.screeningbc.ca/breast/mantleradiation.
  • Followup testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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SOURCE: Hodgkin Lymphoma ( )
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