Hodgkin's Lymphoma

Types

Hodgkin's lymphoma has been divided into subtypes according to how the lymph nodes look under the microscope. The type of tumor provides important information that may affect treatment choices.

Nodular Sclerosing Hodgkin's Lymphoma: The affected lymph nodes have mixed areas of normal cells, Reed-Stemberg cells, and prominent scar tissue. This is the most common type, making up 60% to 80% of all cases. It is more common in adolescents and young adults, but can occur at any age.

Lymphocyte-Rich Classical Hodgkin's Lymphoma: A newly created subtype that was sometimes confused with some lymphocyte predominant cases. It behaves more like mixed cellularity Hodgkin's lymphoma.

Mixed Cellularity Hodgkin's Lymphoma: The affected lymph nodes contain many Reed-Stemberg cells in addition to several other cell types. Mixed cellularity accounts for about 5% to 30% of all cases of Hodgkin's lymphoma. It primarily affects older adults.

Lymphocyte Depletion Hodgkin's Lymphoma: There are large numbers of Reed-Stemberg cells, but very few other cell types are found in the lymph nodes. It is the least common form of Hodgkin's lymphoma and found in less than 5% of the cases. It is seen more often in elderly or in patients with AIDS.

Nodular Lymphocyte Predominance Hodgkin's Lymphoma: This is not considered a classic Hodgkin's lymphoma, because it lacks some of the features that identify Hodgkin's lymphoma and also Non-Hodgkin's lymphoma. Most of the lymphocytes found in the lymph nodes are normal. Abnormal cells, known as "popcorn cells" are a special type of B-cell found in the nodular variety. NLPHL accounts for about 5% or 6% of the cases of Hodgkin's lymphomas. It affects more men than women. The average age of patients is in their mid-30s. This type of Hodgkin's lymphoma is usually diagnosed at an early stage and the prognosis is excellent.

Symptoms

Common symptoms of Hodgkin's lymphoma may include:

• Painless swelling of lymph nodes (often occurring in the neck or under the arm)
• Fever or chills
• Night sweats
• Unexplained weight loss
• Lack of energy or fatigue
• Itching

A cough and shortness of breath or chest discomfort may be early signs of Hodgkin's lymphoma in the chest. Enlargement of the liver and spleen may also occur.

Having one or more of the symptoms listed above does not necessarily mean you have Hodgkin’s lymphoma. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.

Since the causes of Hodgkin’s lymphoma are unknown at this time, it is not possible to prevent the disease. There are a few risk factors that may make a person more susceptible to develop Hodgkin’s lymphoma, but most cases of this disease occur in people without any identifiable risk factors. 

Risk Factors

Age: Hodgkin’s lymphoma is most common in early adulthood (15 to 40 years) and late adulthood (55+ years)

Viruses: The Epstein-Barr virus (EBV) or the human immunodeficiency virus (HIV) may increase the possibility of developing Hodgkin’s lymphoma, although the overall risk is still very small.

Family History: Family members of a person having Hodgkin’s lymphoma, have an increase risk of also developing the disease.

Tests & Procedures

Biopsy: A piece of tissue from an area of suspected cancer is removed from the body for examination under the microscope. Hodgkin's lymphoma is diagnosed by looking at cancer cells and determining how they are growing in the lymph nodes or other tissues.

X-Ray: This procedure uses radiation to take pictures of the area inside the body.

Computerized Axial Tomography (CT Scan): X-rays are taken from different angles around the body. The pictures are then combined using a computer to give a detailed image. The most common CT scans ordered are of the neck, chest, abdomen and/or pelvis.

Positron Emission Tomography (PET) Scan: PET combines the fields of medicine, computer science, chemistry, physics and physiology to study the function of organs such as the heart, brain and bone. It is different from conventional imaging methods such as x-rays, CTs, ultrasounds or MRIs, because PET images provide information about how tissue functions. The other imaging methods show what the tissues look like.

Magnetic Resonance Imaging (MRI): An MRI is similar to a CT scan but uses magnets and radio frequency waves instead of x-rays. A MRI can provide important information about tissues and organs that is not available from other imaging techniques. It is less used in Hodgkin's lymphoma than are CT scans, but it can be useful in evaluation of the bones and brain.

Lymphangiogram: A dye (contrast medium) is injected into the lymphatic vessels in both feet. When the body is X-rayed, the lymph nodes and lymphatic vessels containing the dye are more clearly seen on the film as compared to images obtained with regular X-rays.

Gallium (Radioisotope) Scan: Radioactive gallium is a chemical that collects in some tumors. A small amount of gallium is injected into a blood vessel, and it circulates throughout the body. The body is then scanned from several angles to see if the gallium has collected in a tumor. This test can be very useful in management of Hodgkin's lymphoma.

Blood Tests: These are performed to determine if different types of blood cells are normal in numbers and appearance when viewed under the microscope and if blood chemistry is normal. Other standard tests include liver and kidney function tests, B2 microglobulin and LPH tests and other chemical tests.

Bone Marrow Aspiration and Biopsy: Bone marrow is obtained by numbing the skin, tissue and surface of the bone with a local anesthetic. A thin needle is then inserted into the hip or another large bone and a small sample is collected.

Echocardiogram: This diagnostic test is ordered to evaluate the size and function of the heart.

Pulmonary Function Test: determines how well the lungs function. It is an important test since some drugs used to treat Hodgkin's Lymphoma may affect the lungs.

Staging

After diagnosis your doctor will order tests that will help determine the extent of your disease. This is known as "staging". The stage describes the extent to which the tumor has spread in the body. Staging is important since it helps to predict outcome or prognosis and determines the treatment approach.

Stage I (early stage): One lymph node region is involved.

Stage II (locally advanced disease): The cancer is found in two or more lymph regions on one side of the diaphragm or the cancer is found in one lymph node region plus a nearby area or organ, a situation known as "extension," or "E" disease.

Stage III (advanced disease): The disease involves lymph nodes both above and below the diaphragm or one node area and one organ on opposite sides of the diaphragm ("E" disease).

Stage IV (widespread disease): The lymphoma is outside the lymph nodes and spleen and has spread to one or more organs such as bone, bone marrow, skin and other organs.

The treatment for Hodgkin's disease depends on the disease stage. The treatment may consist of chemotherapy, radiation therapy, bone marrow and stem cell transplantation or a combination of these four types of treatments.

Chemotherapy

Chemotherapy is the use of medications to treat cancer. There are many different types of drugs available to treat lymphomas. Doctors may prescribe a single drug but more often combinations of many drugs are used. Chemotherapy drugs have varying ways to kill cancer cells and different side effects. Giving several drugs at once may increase their effectiveness but also may increase the number of side effects.

Radiation Therapy

Radiation is a special kind of energy carried by waves or a stream of energy particles. It may be delivered by a radiation machine or from radioactive substances injected through the bloodstream. External beam radiation equipment is used to aim the radiation at tumors or areas of the body where there is lymphoma. It kills the cells in the area where the radiation beam was aimed.

Bone Marrow & Stem Cell Transplantation

Autologous or allogeneic bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) are procedures that restore the supply of normal stem cells that are destroyed by high-dose chemotherapy and/or radiation therapy. In autologous transplantation, the bone marrow or blood stem cells are collected from the patient. In allogeneic transplantation, the bone marrow or blood stem cells are collected from a matched donor of a related or unrelated (non-family) individual.

In bone marrow transplantation, stem cells are taken from inside the donor or patient's hip bone. In peripheral blood stem cell transplantation, the cells are collected from the blood using a procedure called pheresis, similar to donating blood. Before the transplant procedure, patients receive large doses of anti-cancer drugs, alone or in combination with radiation, in order to destroy as many cancer cells. They then receive the bone marrow or stem cell transplant. Bone marrow collection for transplants is very seldom done. Instead, peripheral stem cell collection is used most often to collect stem cells.

Clinical Trials

New treatments are always being tested in clinical trials and some patients with Hodgkin’s lymphoma may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Search M. D. Anderson's clinical trials database for a current listing of Hodgkin’s lymphoma clinical trials.

Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, support is available. Listed below are just some of the ways to find help...and hope.

Learn more about patient and family support programs

Support Groups

Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support web sites or message boards for those who may not have access to a traditional meeting. 

Find a support group

Complementary Therapies

Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, tai chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture. 

Find complementary therapies at M. D. Anderson

Physical Activity

Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.

Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.

Journaling/Blogging

Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers. 

Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.