Hodgkin Lymphoma

What is Hodgkin Lymphoma

Hodgkin lymphoma, also called Hodgkin disease, is a cancer that happens when the white blood cells that make up your lymphatic system turn into cancer cells.

Hodgkin lymphoma often affects the lymph nodes. It can spread from lymph node to lymph node and to areas of the body where there is lymph tissue, including to the center of the bones (bone marrow). Advanced Hodgkin lymphoma can spread into blood vessels and be carried almost anywhere in your body.

Hodgkin Lymphoma accounts for about 25% to 30% of lymphomas. Of patients with mediastinal involvement by lymphoma, 85% may have Hodgkin lymphoma.

Hodgkin lymphoma occurs with a bimodal age distribution, with peaks during adolescence and early adulthood and after the fifth decade of life, most often occurring above the diaphragm.

The diagnosis is established on pathologic study by identification of Reed-Sternberg cells, generally in a background of inflammation and fibrosis. On imaging, one generally observes enlarged lymph nodes or conglomerate masses, sometimes with hemorrhagic, necrotic, cystic, or calcific change, and almost always involving the anterior mediastinum, often involving contiguous nodal groups.

Avid uptake of FDG on PET imaging is often seen. The Ann Arbor staging system is used in patients with lymphoma 

What are the causes?

The cause is not known.

What increases the risk?

You may be at higher risk for Hodgkin lymphoma if:

• You are 15‒40 years old or older than 55 years.
• You are male.
• You have been infected with the virus that causes mononucleosis (Epstein-Barr virus).
• You have a brother or sister with Hodgkin lymphoma.
• You have HIV.

What are the symptoms of Hodgkin Lymphoma?

The first sign of Hodgkin lymphoma is often a painless swelling in a lymph node. The swelling may be felt in the neck, under the arm, or in the groin. Other signs and symptoms are:

• Fever.
• Drenching night sweats.
• Feeling tired all the time.
• Cough.
• Shortness of breath.
• Itchy skin.
• Loss of appetite.
• Weight loss.
• Pain in the lymph nodes after drinking alcohol.

How is Hodgkin Lymphoma diagnosed?

To make a diagnosis, your health care provider will ask about your symptoms and perform a physical exam. If you have an enlarged lymph node, your health care provider may order a test in which the lymph node or a piece of it is removed and studied under a microscope (biopsy). Your health care provider may also order tests to find out how advanced the cancer is and whether it has spread. You may have:

• Blood tests to see if you have abnormal numbers of red or white blood cells.
• A chest X-ray to look for swollen nodes.
• Imaging tests to see if and where the cancer has spread in your body. These may include CT, MRI, or PET scans.
• A biopsy of bone marrow to see if disease has spread to the bone marrow.

How is this treated?

Your treatment will be depend on the type of cancer cells you have, the stage of your cancer, your age, and your overall health. Treatment usually starts with one of the following:

• Chemotherapy. Chemotherapy is the use of medicines to stop or slow the growth of cancer cells.
• Radiation therapy. Radiation therapy is the use of high-energy X-rays to kill cancer cells.
• A combination of chemotherapy and radiation therapy.

If chemotherapy and radiation therapy are not completely successful, you may have treatment with:

• Man-made proteins called monoclonal antibodies. These proteins attack cancer cells.
• Very high doses of chemotherapy followed by a stem cell transplant. Stem cells are cells that can develop into other types of cells.

Follow these instructions at home:

• Take medicines only as directed by your health care provider.
• Make sure you are getting enough sleep on a regular basis. Most adults need 6–8 hours of sleep each night. During treatment you may need more sleep than that.
• Maintain a healthy weight, eat a healthy diet, and exercise regularly.
• Do not use any tobacco products, including cigarettes, chewing tobacco, or electronic cigarettes. If you need help quitting, ask your health care provider.
• Consider joining a cancer support group, especially if you are struggling with the stress of dealing with cancer.
• Cancer treatment may increase your risk for other cancers and for infections. After treatment:
  • Make sure you get all vaccinations as recommended by your health care provider.
  • Have regular cancer screenings as recommended by your health care provider.

Contact a health care provider if:

• You have fever or other signs of infection.
• You develop new symptoms or your old symptoms come back.

Get help right away if:

• You have chest pain.
• You have trouble breathing.