An Overview of Hodgkin Lymphoma

Hodgkin lymphoma (HL) is one of two types of cancer that develop in white blood cells called lymphocytes. A primary symptom of HL is swelling of the lymph nodes in the neck, armpits, and groin, which usually will prompt a healthcare provider to do lab and/or imaging tests to diagnose the disease.

HL is relatively rare, accounting for only around 10% of all cases of lymphoma and affects fewer than 200,000 people in the United States each year. It's diagnosed mostly among people between ages 15 and 40 and older adults over 55. The other type of lymphoma, non-Hodgkin lymphoma, is considerably more common.

Types

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% of all cases of HL in developed countries.

Symptoms

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.

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, which 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, they are collectively called B symptoms. These may include:

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

A rare symptom of Hodgkin lymphoma 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.

Causes

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, which help protect the body from bacteria and viruses.

According to the National Cancer Institute (NCI), changes in the DNA of B lymphocytes transforms them from normal cells to large, abnormal ones called Reed-Sternberg cells, which often contain more than one nucleus.

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

Risk Factors

There are several recognized risk factors for the disease. The presence of these risk factors does not mean a person is destined to develop Hodgkin lymphoma, just that they are more likely to have it than others:

• Epstein-Barr virus: This is the same microbe that causes mononucleosis and also may be linked to chronic fatigue syndrome (ME/CFS). 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 from taking 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 healthcare provider.

If after talking to you about your health history and doing a physical exam they are concerned about the possibility of lymphoma, there are several diagnostic steps that may be taken.

Tissue sampling:

• Lymph node biopsy (full node or a portion)
• Fine needle aspiration (FNAC)

Imaging:

• Positron emission tomography (PET) scan
• Computerized tomography (CT) scan

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

• Complete blood count (CBC), to assess the levels of various cells in the blood
• Erythrocyte sedimentation rate (ESR), to measure inflammation

Treatment

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

• Chemotherapy: There are many chemo medications approved for treating Hodgkin lymphoma, according to the NCI.
• 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

Coping

From the moment of diagnosis to the last day of treatment and beyond (survivorship), coping with Hodgkin lymphoma will present challenges on multiple fronts. You will inevitably have to deal with a range of emotions.

Among the ways to deal with the intense and ever-changing ebb and flow of feelings, accepting them as normal (and not a sign of weakness) and educating yourself about the unknown, and seeking support from others are solid first steps.

Coping with the side effects from treatment also will be paramount during your Hodgkin lymphoma journey. Your healthcare provider will be able to guide you toward ways to alleviate and even prevent many of these physical repercussions of both the disease itself and therapies used to address it.

Because the experience of diagnosis and treatment for a disease like Hodgkin lymphoma will span weeks if not months, your day-to-day will be affected in many ways as well (routines, work, finances, etc.) It's important that you seek assistance both from support programs and those around you to get through and focus on your health.

Prognosis

Many factors are involved in the inexact art of determining survival rates for cancer. According to the American Cancer Society, specific variables related to Hodgkin lymphoma include age, whether this is the first bout with the disease or a recurrence, overall health, response to treatment, and numerous factors regarding various blood components and certain symptoms.

With these considerations in mind, the five-year survival rates for Hodgkin lymphoma, which are based on the NCI's SEER database of survival statistics for many types of cancer, are grouped according to three stages: localized, regional, and distant.

^{*Tumors in the chest at least a third as wide as the chest, or tumors in other areas at least 10 centimeters (about 4 inches) across}

A Word From Verywell

A diagnosis of Hodgkin lymphoma can be frightening and trying to understand the disease and treatment options daunting. Ask your healthcare provider 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.