Hodgkin Lymphoma

What Are Lymphocytes?

To understand lymphoma, it is helpful to know what the lymphatic system is and how it works. Lymphocytes, the cells that cause lymphoma, are present in the lymph nodes and within most organs of the body. Lymphocytes circulate throughout the body and play a very important role in defending us from infections.

Different types of lymphoma are derived from different types of lymphocytes, including B-cells, T-cells and NK-cells. B-cell lymphoma and T-cell lymphoma are the more common types, while NK-cell lymphoma is rare.

What Is Hodgkin Lymphoma?

Lymphomas are cancers that begin in lymphocytes. There are two primary types of lymphoma:

• Hodgkin lymphoma (HL)
• Non-Hodgkin lymphoma (NHL)

The main difference between Hodgkin lymphoma and non-Hodgkin lymphoma has to do with the presence or absence of Reed-Sternberg cells, which are large, abnormal lymphocytes that may contain more than one nucleus, when the cancer is viewed under a microscope. If Reed-Sternberg cells are present, the cancer is classified as Hodgkin lymphoma. If Reed-Sternberg cells are not present, the cancer is classified as non-Hodgkin lymphoma.

Although Hodgkin lymphoma can begin almost anywhere in the body, most often it starts in the lymph nodes of the upper body, including those found in the chest, neck or underarms. Hodgkin lymphoma, which is also traditionally called classic Hodgkin lymphoma, includes four types, all of which are diagnosed and treated in a similar manner:

• Nodular sclerosis classical Hodgkin lymphoma (NSCHL)
• Mixed cellularity Hodgkin lymphoma
• Lymphocyte-rich Hodgkin lymphoma (LRCHL)
• Lymphocyte-depleted Hodgkin lymphoma (LDHL)

Symptoms of Hodgkin Lymphoma

Common Hodgkin lymphoma symptoms include:

• Painless swelling of one or more lymph nodes in the neck, armpits or groin
• Persistent fatigue
• Fever and chills that come and go
• Unexplained weight loss
• Loss of appetite
• Severe night sweats
• Itchy skin

Less common symptoms of the disease may include:

• Pain or feeling of fullness below the ribs due to a swollen spleen or liver
• Excessive sweating
• Skin blushing or flushing
• Pain in lymph nodes after drinking alcohol

The symptoms of Hodgkin lymphoma are similar to symptoms caused by a number of other conditions. Be sure to talk to a health care provider about any disease symptoms you have to determine their cause.

What Causes Hodgkin Lymphoma?

Experts do not yet understand the cause or causes of Hodgkin lymphoma. However, we know that all lymphomas begin when a lymphocyte develops a genetic mutation – the mutation causes the cell to multiply rapidly, creating many diseased lymphocytes that continue multiplying.

Hodgkin lymphoma occurs most often in people 15 to 35 years old and 50 to 70 years old. Previous infection with the Epstein-Barr virus (EBV) many contribute to some cases of the disease. In addition, people with HIV infection have an increased risk of developing Hodgkin lymphoma.

Diagnosis of Hodgkin Lymphoma

Tests and procedures used to diagnose Hodgkin lymphoma include:

• Physical exam: If your doctor suspects the possibility of Hodgkin lymphoma, they will check for swollen lymph nodes and other signs of the disease.
• Lymph node biopsy: In a lymph node biopsy, either a small piece of a lymph node or an entire lymph node is removed to be tested in a lab to see if lymphoma cells are present and to identify the type of lymphoma.
• Bone marrow aspiration and biopsy: In this procedure, the doctor inserts a needle into the hipbone to extract a bone marrow sample. Lab analysis will indicate if Hodgkin lymphoma cells are present in the sample.
• Imaging tests: Imaging tests such as positron emission tomography (PET) may be ordered to look for evidence of Hodgkin lymphoma in the body.
• Blood tests: Your doctor will order blood tests to assess the lymphoma and its effects on your body.

Treatment of Hodgkin Lymphoma

The main treatments for Hodgkin lymphoma are chemotherapy and radiation therapy. Treatment is tailored to each patient’s case, and one or both of these methods may be used.

Some Hodgkin lymphoma patients may be candidates for immunotherapy or a stem cell transplant, especially if other treatments have not been effective. Surgery is rarely used in the treatment of Hodgkin lymphoma.