Hodgkin's Lymphoma

More than 9,000 people are diagnosed with Hodgkin’s lymphoma in the United States each year. It occurs mainly in individuals:

• Between 16 and 34 years of age
• Over age 55

Most patients with Hodgkin’s lymphoma, even in advanced stages, can be treated successfully. However, treatment may cause late side effects, and sometimes the disease returns.

Lymphoma is a general term for cancers that develop in the lymph system, which is part of the body’s immune system. Hodgkin’s lymphoma is a type of lymphoma that develops in the white blood cells. Almost all Hodgkin’s lymphoma cases contain Reed-Sternberg cells, a specific type of large cancer cell that is not found in non-Hodgkin’s lymphomas. While Hodgkin’s lymphoma can start in the lymph nodes, it can spread to almost any organ or tissue, including the liver, bone marrow and spleen.

Hodgkin’s Lymphoma Types

Hodgkin’s lymphoma is divided into two major types according to how the lymph cells look under a microscope and whether Reed-Sternberg cells are present. Knowing the type of lymphoma helps doctors determine your best treatment.

Classical Hodgkin’s Lymphoma is the most common type in the United States. It accounts for about 95% of cases and is the most curable Hodgkin’s lymphoma. Subtypes include:

• Nodular Sclerosing Hodgkin’s Lymphoma: The affected lymph nodes have mixed areas of normal cells, Reed-Sternberg cells and prominent scar tissue. This is the most common type, making up 60% to 80% of cases. It is more common in adolescents and young adults, but it can occur at any age.
• Lymphocyte-Rich Hodgkin’s Lymphoma: This recently created subtype in the past was confused sometimes with lymphocyte-predominant lymphoma. It is similar to mixed cellularity Hodgkin’s lymphoma.
• Mixed Cellularity Hodgkin’s Lymphoma: The affected lymph nodes contain many Reed-Sternberg cells in addition to several other cell types. Mixed cellularity accounts for about 25% to 30% of cases of Hodgkin’s lymphoma. It primarily affects older adults.
• Lymphocyte Depletion Hodgkin’s Lymphoma: Large numbers of Reed-Sternberg cells, but very few other cell types, are found in the lymph nodes. This is the least common form of Hodgkin’s lymphoma, and it is seen more often in people who are elderly or have AIDS.

Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma: This rare disease accounts for just 5% of Hodgkin’s lymphoma diagnoses and is most common among men between 35 and 40. Unlike other types of Hodgkin’s lymphoma, it produces no Reed-Sternberg cells. It is usually diagnosed at an early stage and has an excellent survival rate.

Hodgkin's Lymphoma Risk Factors

Anything that increases your chance of getting Hodgkin’s lymphoma is a risk factor. Although Hodgkin’s lymphoma usually develops in people who have no risk factors, the following things may mean you are more likely to develop it:

• Age: Hodgkin’s lymphoma is most common in young adults (15 to 40 years) and older adults (over 55 years old).
  
• Gender: Males are slightly more likely to develop Hodgkin’s lymphoma.
• Viruses: The risk is small, but some viruses may make you more likely to get Hodgkin’s lymphoma. These include:
  • Epstein-Barr virus (EBV)
  • Infectious mononucleosis (mono)
  • Human immunodeficiency virus (HIV)
  • Human T-cell lymphocytotropic virus (HTLV)
• Family history: If you have a parent, brother or sister with Hodgkin’s lymphoma, you have an increased risk of developing the disease.

Not everyone with risk factors gets Hodgkin’s lymphoma. However, if you have risk factors, you should discuss them with your doctor.

Hodgkin’s lymphoma often develops in people between the ages of 16 and 34. These younger patients are usually otherwise healthy. Because of this, their bodies can withstand the disease without showing any symptoms for a long period of time.

Other times, the only symptom will be painless swelling of the lymph nodes usually in the neck or under the arm, as well as in the upper chest, abdomen and groin. Patients often visit a physician because of this swelling, which eventually leads to a diagnosis.

Other symptoms vary from person to person and may include:

• Pain in the swollen lymph nodes after drinking alcohol.
• Heavy night sweats, with or without a fever.
• Fever or chills at night or during the day.
• Unexplained weight loss.
• Loss of appetite.
• Fatigue or lack of energy.
• Dry, itchy skin.
• A widespread, red rash.
• Cough and shortness of breath or chest discomfort caused by a large lymph node mass in the chest.
• An enlarged liver or spleen.

These symptoms do not always mean you have Hodgkin’s lymphoma. However it is important to discuss any signs with your doctor, since they may signal other health problems. In rare cases, Hodgkin's lymphoma can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.

Successfully treating Hodgkin’s lymphoma depends upon an accurate and precise diagnosis. However, the disease may be hard to diagnose. It is important for a specialist familiar with Hodgkin’s lymphoma to analyze your biopsy.

While most cancer centers see only a few cases of Hodgkin’s lymphoma a year, MD Anderson has an internationally known program that focuses only on the disease. Our pathologists have some of the highest levels of expertise in Hodgkin’s lymphoma you’ll find anywhere. They use the latest technology and techniques to pinpoint disease.

Hodgkin’s Lymphoma Diagnostic Tests

If you have symptoms that may signal Hodgkin’s lymphoma, your doctor will examine you and ask you questions about your health, your lifestyle and family medical history.

One or more of the following tests may be used to find out if you have Hodgkin’s lymphoma. These tests also may help find out if your treatment is working.

• Lymph node biopsy: A small piece of tissue is removed from a lymph node and looked at under a microscope. Sometimes the entire node is removed.
• Imaging tests, which may include:
  • X-Rays
  • CT or CAT (computed axial tomography) scans
  • PET/CT (positron emission tomography/ computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
• Blood tests to evaluate liver and kidney function
• Echocardiogram
• Bone marrow aspiration and biopsy: A thin needle is inserted into the hip or other large bone, and a small sample of cells from tissue inside the bone is collected. The cells are then looked with a microscope.
• Immunophenotyping: Cells from a lymph node, blood or bone marrow are examined with a microscope to determine the type of Hodgkin’s lymphoma cells
• Pulmonary function test: Determines how well the lungs are working

In rare cases, Hodgkin’s lymphoma can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.

If you are diagnosed with Hodgkin’s lymphoma, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

(source: National Cancer Institute)

Stage I (early stage): 

• Stage I: Cancer is found in one lymph node region
• Stage 1E: Cancer is found outside the lymph system in one organ or area.

Stage II (locally advanced disease): Cancer is found in:

• Stage II: Cancer is found in two or more lymph regions on one side of the diaphragm
• Stage IIE: Cancer is found in one lymph node region plus a nearby area or organ. This is called "extension," or "E" disease

Stage 3 (advanced disease): Cancer is found in:

• Stage III: Cancer is found lymph nodes above and below the diaphragm
• Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and in a nearby area or organ
• Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm and in the spleen
• Stage IIIE,S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ and in the spleen.

Stage IV (widespread disease):

Cancer is found:

• outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
• outside the lymph nodes in one organ and has spread to areas far away from that organ; or
• in the lung, liver, bone marrow, or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.

At MD Anderson, our doctors have a full range of methods to help fight Hodgkin’s lymphoma in every stage, including disease that has returned after treatment. We are at the forefront of pioneering targeted therapies and other treatments that help your healthy cells fight cancer, while minimizing the impact to your body.

Because the standard chemotherapy for Hodgkin’s lymphoma may have long-term effects, especially for young people, we are working to develop effective – but more gentle – treatments. In young men and women, we make every effort to preserve fertility by using therapies that focus on treating the cancer but cause the least-possible damage to reproductive organs.

Hodgkin’s Lymphoma Treatments

If you are diagnosed with Hodgkin’s lymphoma, your doctor will discuss the best options to treat it. This depends on several factors, including:

• Type and stage of Hodgkin’s lymphoma
• If your disease has not responded to previous treatments
• If your disease has returned after treatment
• Your age
• Other medical problems, such as heart or kidney disease

Your treatment will be customized to your needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Chemotherapy

Treatment with drugs is the main therapy for Hodgkin’s lymphoma. Combination chemotherapy, a mixture of drugs with different properties, is used often. MD Anderson offers the most up-to-date and advanced chemotherapy options.

Radiation Therapy

Radiation therapy uses focused beams of energy to kill cancer cells. New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Proton Therapy

The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means that this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.

Proton therapy delivers high radiation doses directly to the tumor site, with minimal damage to nearby healthy tissue. For some patients, this therapy results in more-successful treatment with fewer side effects.

Immunotherapy

Instead of attacking the disease itself, immunotherapy drugs help the body fight cancer. Sometimes they have fewer side effects than other treatments.

We pioneered several immunotherapies, and several of them are found at only a few other cancer centers. Immunotherapy treatment methods may include:

• Antibodies drug conjugates, such as brentuximab vedotin
• Checkpoint inhibitors, including nivolomab and pebrolizumab
• Biological therapies that develop antibodies that destroy cancer cells
• Targeted therapies that fight cancer cells by using small molecules to block pathways cells use to survive and multiply

Stem Cell Transplantation

If Hodgkin’s lymphoma does not respond to frontline treatments or if it returns, a stem cell transplant may be recommended. These transplants can be either autologous (stem cells taken from the patient) or allogenic (stem cells from a donor).

MD Anderson has the largest bone marrow and stem cell transplant program in the nation, performing roughly 800 procedures per year. We pioneered the use of less toxic doses of chemotherapy, which result in higher success rates and are now the widely accepted standard.