Hodgkin's lymphoma — formerly known as Hodgkin's disease — is a cancer of the lymphatic system, which is part of your immune system.
In Hodgkin's lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.
Most Hodgkin lymphomas are the classical type. The classical type is broken down into the following four sub-types:
- Nodular sclerosing Hodgkin lymphoma.
- Mixed cellularity Hodgkin lymphoma.
- Lymphocyte depletion Hodgkin lymphoma.
- Lymphocyte-rich classical Hodgkin lymphoma
Possible signs of adult Hodgkin lymphoma include:
- Painless, swollen lymph nodes in the neck, underarm, or groin.
- Fever for no known reason.
- Drenching night sweats.
- Weight loss for no known reason.
- Itchy skin.
- Feeling very tired.
It's not clear what causes Hodgkin's lymphoma.
Doctors know that most Hodgkin's lymphoma occurs when an infection-fighting cell called a B cell develops a mutation in its DNA. The mutation tells the cells to divide rapidly and to continue living when a healthy cell would die. The mutation causes a large number of oversized, abnormal B cells to accumulate in the lymphatic system, where they crowd out healthy cells and cause the signs and symptoms of Hodgkin's lymphoma.
- Your age. Hodgkin's lymphoma is most often diagnosed in people between the ages of 15 and 30, as well as those older than 55.
- A family history of lymphoma. Having a close family member who has Hodgkin's lymphoma or non-Hodgkin's lymphoma increases your risk of developing Hodgkin's lymphoma.
- Your sex. Males are slightly more likely to develop Hodgkin's lymphoma.
- Past Epstein-Barr infection. People who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin's lymphoma than are people who haven't had Epstein-Barr infections.
- A weakened immune system. Having a compromised immune system, such as from HIV/AIDS or from having an organ transplant requiring medications to suppress the immune response, increases the risk of Hodgkin's lymphoma.
Tests and procedures used to diagnose Hodgkin's lymphoma include:
- Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
- Blood tests. A sample of your blood is examined in a lab to see if anything in your blood indicates the possibility of cancer.
- Imaging tests. Imaging tests used to diagnose Hodgkin's lymphoma include X-ray, computerized tomography (CT) scan and positron emission tomography (PET).
- Surgery to remove a swollen lymph node. Minor surgery may be done to remove all or part of an enlarged lymph node for testing. The lymph node is sent to a laboratory for testing. A diagnosis of Hodgkin's lymphoma is made if the abnormal Reed-Sternberg cells are found within the lymph node.
- A procedure to collect bone marrow for testing. A bone marrow biopsy may be used to look for signs of cancer in the bone marrow. During this procedure, a small amount of bone marrow, blood and bone are removed through a needle.
After your doctor has determined the extent of your Hodgkin's lymphoma, your cancer will be assigned a stage. Your cancer's stage helps determine your prognosis and your treatment options.
Stages of Hodgkin's lymphoma include:
- Stage I. The cancer is limited to one lymph node region or a single organ.
- Stage II. In this stage, the cancer is in two lymph node regions or the cancer has invaded one organ and the nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
- Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
- Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.
Additionally, your doctor uses the letters A and B to indicate whether you're experiencing symptoms of Hodgkin's lymphoma:
- A means that you don't have any significant symptoms as a result of the cancer.
- B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer.
- The size of the tumor and how quickly it shrinks after initial treatment.
- The patient's symptoms when diagnosed.
- Certain features of the cancer cells.
Whether the cancer is newly diagnosed, does not respond to initial treatment, or has recurred.
Which treatment options are appropriate for your Hodgkin's lymphoma depends on your type and stage of disease, your overall health, and your preferences. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission.
Chemotherapy drugs can be taken in pill form, through a vein in your arm or sometimes both methods of administration are used. Several combinations of chemotherapy drugs are used to treat Hodgkin's lymphoma.
Side effects of chemotherapy depend on the specific drugs you're given. Common side effects include nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.
Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. For classical Hodgkin's lymphoma, radiation therapy can be used alone, but it is often used after chemotherapy. People with early-stage lymphocyte-predominant Hodgkin's lymphoma typically undergo radiation therapy alone.
During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease.
Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More-serious risks include heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as breast or lung cancer.
A stem cell transplant is a treatment to replace your diseased bone marrow with healthy stem cells that help you grow new bone marrow. A stem cell transplant may be an option if Hodgkin's lymphoma returns despite treatment.
During a stem cell transplant, your own blood stem cells are removed, frozen and stored for later use. Next you receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally your stem cells are thawed and injected into your body through your veins. The stem cells help build healthy bone marrow.
The FDA has approved the following drugs to treat Hodgkins Lymphoma:
- Nivolumab (Optivo): Classical Hodgkin lymphoma that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and post-transplantation brentuximab vedotin
- Brentuximub Vedotim (Adcetris) -The treatment of patients with Hodgkin lymphoma after failure of autologous stem cell transplant (ASCT) or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not ASCT candidates
Refer to Research Publications.