An Overview of Hodgkin Lymphoma

Hodgkin lymphoma (HL) is one of two types of cancer that develop in lymphocytes, white blood cells of the lymphatic system that is a part of the immune system. A primary symptom of HL is swelling of the lymph nodes in the neck, armpits, and groin, which usually will prompt a doctor to do lab and/or imaging tests to diagnose the disease. Hodgkin lymphoma is relatively rare: It accounts for only around 10 percent of all cases of lymphoma and affects fewer than 200,000 people in the United States each year—mostly adolescents and young adults between 15 and 40 and adults over 55. The other type of lymphoma, non-Hodgkin lymphoma, is considerably more common.

The Lymphatic System

The lymphatic system is made up of small, bean-shaped organs called nodes that sit strategically along a network of lymph-fluid filled channels where they serve as checkpoints for the immune system.

Some lymph nodes can be felt as bumps near the surface of the skin, while others are located deep inside the body, near the heart, between the lungs, or deep within the abdomen. Node swelling from Hodgkin lymphoma is more likely to arise in the upper portion of the body, in lymph nodes of the neck, underarms, or within the chest.

Types of Hodgkin Lymphoma

There are five major types of HL. Four of these comprise what once was referred to as classical Hodgkin lymphoma and account for more than 95 percent of all cases of HL in developed countries.

Types of Hodgkin Lymphoma
Type Incidence Who it affects Characteristics
Nodular Sclerosing Hodgkin Lymphoma (NSHL) 60 percent to 70 percent of HL diagnoses Women and young people
 
Mainly affects nodes in neck, armpits, and chest
Mixed Cellularity Hodgkin Lymphoma (MCHL)P 15 percent to 30 percent of diagnoses People of all ages, mostly in developing countries
 
More likely to involve nodes in the abdomen than in the chest
Lymphocyte-rich Classical Hodgkin Lymphoma (LRCHL) 5 percent to 6 percent of diagnoses People in their 30s and 40s Rarely found in more than a few lymph nodes, mostly in the upper half of the body
Lymphocyte Depleted Hodgkin Lymphoma (LDHL) 1 percent of diagnoses Older people and also those infected with HIV Usually diagnosed in an advanced stage
Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) 4 percent to 5 percent of diagnoses No specifics Under a microscope, affected cells look more like those of NHL; very slow growing

Symptoms

The most common—and frequently only—symptom of Hodgkin lymphoma is a painless lump that can be felt in the neck, under an armpit, or in the groin that indicates an enlarged lymph node. Sometimes more than one node is affected.

HL also can affect lymph nodes deep in the chest that are difficult to detect without an imaging test.

If other symptoms develop as a result of Hodgkin lymphoma, collectively they are called B symptoms, and may include:

  • Loss of appetitie
  • Weight loss
  • Fever and chills
  • Itchy skin
  • Drenching night sweats

A rare symptom of HL is pain that occurs after drinking alcohol. It's unknown why this pain, which is focused in lymph nodes occurs. One theory is that it's due to dilation of the blood vessels in the glands in response to the alcohol.

Cause and Risk Factors

Little is known about what causes Hodgkin lymphoma beyond that it arises in a particular type of lymph cells—B-lymphocytes, or B cells. These are the immune system cells that make proteins called antibodies that help protect the body from bacteria and viruses.

According to the National Cancer Institute, changes in the DNA of B lymphocytes caused transforms them from normal cells to large, abnormal ones that often contain more than one nucleus called Redd-Sternberg cells.

If HL spreads, it tends to travel from lymph node to lymph node; only rarely and late in the disease does HL move into the bloodstream via which it can travel to other parts of the body.

There are several recognized risk factors for the disease. It's important to note that the presence of any of these risk factors does not mean a person is destined to The presence of these risk factors do not mean a person is destined to develop HL, but it can be helpful to be aware of them.

  • Epstein-Barr virus. This is the same microbe that causes mononucleosis and also may be linked to chronic fatigue syndrome). Some researchers theorize that infection with this virus may bring about the DNA changes in B cells that cause them to become the Reed-Sternberg cells, according to the American Cancer Society (ACA).
  • Family history. It's not clear why this may be. There may be an as-yet-unidentified gene that increases susceptibility to Hodgkin lymphoma, or that members of a family in which several people developed HL had similar childhood diseases that increased their risk.
  • Weakened immune system (as a result of HIV infection or other illnesses, for example, or taking from medications used to suppress the immune response)

Diagnosis

The first sign of Hodgkin lymphoma is an enlarged lymph node (or nodes), but this is hardly enough to diagnose the disease. There are many reasons for lymph node swelling and most do not involve cancer. In fact, enlarged lymph nodes usually are a symptom of an infection; once the infection clears the body, the swelling goes down.

However, an enlarged lymph node should never be ignored. If you discover one yourself, see your doctor. If after talking to you about your health history and doing a physical exam he or she is concerned about the possibility of lyphoma, there are several diagnostic steps to take.

Lymph Node Biopsy

A lymph node biopsy is a procedure in which a sample of tissue is removed from the body and sent to a laboratory for testing and evaluation. Typically, it is an outpatient procedure done in a freestanding surgical center or hospital operating room using local anesthetic. The exception is if the enlarged node is deep inside the body, in which case the procedure may involve scans of the body and imaging to guide a needle to the exact area of suspect tissue for removal.

There are several types of lymph node biopsy, according to the ACA. For example, in an excisional biopsy, the entire lymph node is removed. In an incisional biopsy, only a portion of a very enlarged node is removed.

Fine Needle Aspiration (FNAC)

FNAC of a suspicious lymph node is a simpler procedure in which a thin needle is used to suck out (aspirate) a sample of cells from the node for testing. It's a quick and virtually painless test that can be done in a doctor's office. Sometimes ultrasound is used to guide the needle. However, it's not as accurate as biopsy.

Imaging

Two types of imaging tests are useful for diagnosing Hodgkin lymphoma:

Positron emission tomography (PET) scan. PET scans, which make it possible to evaluate tissues and organs at the cellular level, have become vital for determining which of the four major stages of Hodgkin lymphoma the disease has reached. PET scans also can help tell the difference between active tumors and fibrous areas that remain in the body after a person with HL has been treated.

Computerized tomography (CT) scan. For a CT scan, multiple X-ray images of an organ or other internal structure are converted by a computer into a three-dimensional image that can be viewed from different angles.

Based on guidelines from the National Comprehensive Cancer Network, PET scans and CT scans ( PET/CT) often are done together to diagnose and evaluate Hodgkin lymphoma.

Blood Tests

There are no specific blood tests for Hodgkin lymphoma. However, certain blood tests can signal the possibility of HL or be used to monitor it.

  • Complete blood count (CBC). A CBC assesses the levels of various cells in the blood and can determine if abnormal blood counts point to HL. For example, a high white blood cell count is a possible sign of HL, although it can also be caused by infection.
  • Erythrocyte sedimentation rate (ESR). This test measures inflammation in the body, which can be high in people with Hodgkin lymphoma.

Treatment

When caught in an early stage, HL is one of the more treatable and curable forms of blood cancer. There are four standard approaches to treating lymphoma.

  • Chemotherapy, which uses drugs to kill cancer cells. There are many medications approved for treating Hodgkin lymphoma, according to the NCI. The one (or several) your doctor prescribes for you will depend on multiple factors, particularly the type and stage of HL you've been diagnosed with
  • Radiation therapy, most often used after chemo to target any cells that have managed to survive initial treatment
  • Immunotherapy therapy, in which medication is used to help the immune system better recognize and destroy cancer cells
  • Stem cell transplant/bone marrow transplant, which may be necessary in rare cases in which chemo and radiation aren't able to completely destroy cancer cells

In most cases, chemotherapy is the first and only form of treatment for Hodgkin lymphoma.

A Word From Verywell

A diagnosis of Hodgkin lymphoma can be frightening, and trying to understand the disease and treatment options daunting. Ask your doctor as many questions as necessary, even if it means asking the same things over and over. Sometimes it can be helpful to talk to someone who has been through Hodgkin lymphoma and all that diagnosis and treatment entails. Survivorship workshops, conferences, and even social media are excellent ways to connect with others who may share your struggles or have similar experiences and insights.

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