Hodgkin’s Lymphoma

Hodgkin’s lymphoma is a type of cancer. It’s also known as Hodgkin’s disease. It starts in the lymphatic system.

With Hodgkin’s lymphoma, cells in the lymphatic system grow out of control. This most often happens in the lymph nodes. The mass of extra cells form a tumor. Sometimes tumors form in the spleen or in other organs.

The lymphatic system is part of your immune system. It helps your body fight infection. It also helps maintain fluid balance in different parts of your body. The lymphatic system includes:

• Lymphocytes. These are a type of white blood cell. They fight infection and disease.

• Lymph. This is a clear fluid that contains lymphocytes.

• Lymph vessels. These are tiny tubes. They carry lymph fluid from areas of the body back to the bloodstream.

• Lymph nodes. These are small organs about the size of a pea. They are found in your underarms, groin, neck, chest, abdomen, and other parts of your body. They filter the lymph fluid as it moves around your body.

• Other organs and body tissues. The lymphatic system includes the bone marrow where blood is made. And it includes your spleen, thymus, adenoids, tonsils, skin, and digestive tract.

When you have Hodgkin’s disease, cells in your lymphatic system (usually in your lymph nodes) grow out of control. Lymph nodes are small collections of cells called lymphocytes in various places in your body, such as your armpits and groin. They help your body fight infection. The mass of extra cells form a tumor. Sometimes tumors form in the spleen or in other organs. Hodgkin’s disease is unusual in that only a minority of the cells in the tumor are malignant (cancer

Hodgkin’s lymphoma can start in any part of your lymphatic system. It can then spread to more than one area of your body. The lymphoma may also spread to your bone marrow and other organs in your body. Lymphoma can spread in different ways. It depends on the type of lymphoma and where it started growing.

Lymphoma that begins in an organ that is not a lymph node, such as the stomach, is called extranodal lymphoma. This type of lymphoma tends to spread first to the lymph nodes near that organ or to sites other than the lymph nodes.

Hodgkin’s lymphoma is different from other types of lymphoma. The other types of lymphoma are grouped together and called non-Hodgkin’s lymphomas. With Hodgkin’s lymphoma, cancer cells only make up a small part of the cells in a cancerous lymph node. The rest of the cells are normal immune cells. The cancer cells are usually special cells called Reed-Sternberg cells. In non-Hodgkin’s lymphomas, cancer cells make up most of a tumor. There are no Reed-Sternberg cells in the tumor.

Hodgkin’s and non-Hodgkin’s lymphoma also differ in the way they spread and in how they are treated. Hodgkin’s lymphoma is one of the most curable forms of cancer.

There are two main types of Hodgkin’s lymphoma. Each type of Hodgkin’s lymphoma grows in slightly different ways. The types are:

• Classic Hodgkin’s lymphoma.

• Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL). 

Classic Hodgkin’s lymphoma has four subtypes:

• Nodular sclerosis (NS). This is the most common subtype. In every 5 people with Hodgkin’s lymphoma, about 3 to 4 have this subtype. It occurs more often in adolescents and adults under age 50. It’s more common in women than in men. Most people with NS don't have any initial symptoms. When the disease is found, it is usually at an early stage.

• Mixed-cellularity (MC). This is the second most common subtype of Hodgkin’s lymphoma. About 3 in 20 to 3 in 10 people with Hodgkin’s lymphoma have this subtype. It can occur in all age groups, but it occurs more often in older adults. It is more common in men. Most people aren't diagnosed until the disease is in a later stage. Symptoms of fever, night sweats, and weight loss (B symptoms are very common. These often help the doctor diagnose the disease.

• Lymphocyte rich (LR) or lymphoid proliferative (LP). LP Hodgkin’s disease is usually found in people in their 30s and 40s. It accounts for fewer than 1 in 20 cases. More men than women get LP Hodgkin’s disease. The cure rate is very high. B symptoms are very uncommon.

• Lymphocyte depleted (LD). This is the fastest-growing type of Hodgkin’s lymphoma. This subtype is very rare. Only 1 in 100 people with Hodgkin’s lymphoma have this subtype. It is more common in older adults. Most people with LD are diagnosed at an advanced stage.

Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) makes up about 1 in 20 to 1 in 10 of all Hodgkin’s lymphomas. It is more common in men than in women. It usually affects people younger than 35. Most people are diagnosed at an early stage. Most people have a full response to treatment. Classic Reed-Sternberg cells are not seen in tumors, or are very uncommon. Instead, a tumor has large cells called popcorn cells. The recovery for NLPHL tends to be very good overall. But a small number of people will go on to develop a type of non-Hodgkin’s lymphoma that grows more quickly.

Hodgkin’s lymphoma, also called Hodgkin’s disease, can have many different symptoms. These are the most common:

• Swollen lymph nodes. These cause lumps under your skin. They’re often the first symptom you may notice. But swollen lymph nodes are most often caused by infection and are very common. Your healthcare provider may give you antibiotics to see if they make the nodes shrink. The most common areas for swelling are your neck, shoulders (below and above the collarbone), and underarms. Usually, the swollen nodes don’t cause pain, or hurt to touch. You may notice them when you wash, shower, or shave.

• Tiredness or weakness. You may feel weak or have severe tiredness that doesn't get better with rest.

• Cough, trouble breathing, or chest pain. These problems can be caused by enlarged lymph nodes in your chest that are pressing on your windpipe or trachea.

• Itchy skin. You may notice that you are always scratching your skin. This may happen when you don’t seem to have skin irritation. If this is the case, tell your healthcare provider.

• Pain in your lymph nodes when drinking alcohol. Experts don’t know what causes this symptom, but it is linked with Hodgkin’s lymphoma.

Other symptoms may also occur. They are known as B symptoms:

• Weight loss. You may lose your appetite and lose weight without trying.

• Fever. You may have fevers over a long period of time with no other signs of infection.

• Drenching night sweats. You may sweat to the point of soaking your clothes and bed sheets. These sweats often happen at night, but not all the time.

B symptoms can mean that the cancer is more likely to grow quickly. If you have B symptoms, you may need different kinds of treatment.

Many of these symptoms may be caused by other health problems. But it’s important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer

Risk factors for Hodgkin’s lymphoma include:

• Age. Hodgkin’s lymphoma occurs most often in people in their 20s or after age 55.

• Gender. More men than women get Hodgkin’s lymphoma.

• Family history. If you have a brother or sister with Hodgkin’s lymphoma, you are at higher risk. Having an identical twin with Hodgkin’s lymphoma also raises your risk. But most people with this type of cancer don’t have a family history of it.

• Where you live. Hodgkin’s lymphoma is most common in the U.S., Canada, and Europe. It is least common in Africa and Asia.

• Socioeconomic status. People in wealthier families have a higher risk for Hodgkin’s lymphoma than those in families that are less wealthy. Doctors don't know why this is so.

• Epstein-Barr virus (EBV) infection. EBV is the virus that causes mononucleosis, also called mono. People who have been infected with EBV may have a slightly higher risk of Hodgkin’s lymphoma. But many people are infected with EBV, and few of them get Hodgkin’s lymphoma.

• HIV infection. HIV is the virus that causes AIDS. People who are infected with HIV are at greater risk for Hodgkin’s lymphoma.

Talk with your healthcare provider about your risk factors for Hodgkin’s lymphoma. Ask if there are things you can do to lower your risk. Most of the known risk factors for Hodgkin’s lymphoma can't be changed. These include your age, gender, and family history. It's also not possible to prevent infection with EBV. There are things you can do to lower your risk for HIV infection. But HIV doesn't play a role in most cases of Hodgkin’s lymphoma.

There are no regular screening tests to look for Hodgkin’s lymphoma in people who don’t have symptoms. But you should know about possible symptoms of Hodgkin’s lymphoma. This is even more important if you have known risk factors for it, such as a strong family history. If you have symptoms such as enlarged lymph nodes that don’t go away after a few weeks, see your healthcare provider.

If you have questions about Hodgkin’s lymphoma, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.