Hodgkin lymphoma is a rare cancer that develops in the lymphatic system, which circulates through the spleen, lymph nodes and other organs, filtering out impurities and infections. Hodgkin lymphoma develops in lymphocytes, immune cells that are found in blood and lymph fluid. When these cells mutate, they grow out of control and may overtake the lymph system and spread to other parts of the body. The disease is named for Dr. Thomas Hodgkin, a British physician who first recognized its symptoms in 1832. It was formerly called Hodgkin’s disease.
The primary difference between Hodgkin and non-Hodgkin lymphoma is whether Reed-Sternberg cells are found in a lymph node biopsy. Reed-Sternberg cells are found in patients diagnosed with Hodgkin lymphoma. These mutated B lymphocytes are very large compared to other cells. The various shapes of Reed-Sternberg cells often help pathologists determine the specific type of Hodgkin lymphoma. A common variety of these cells has at least two nuclei, giving them the appearance of owls’ eyes. Reed-Sternberg cells are named for the two scientists who first identified them under a microscope.
Leukemia and lymphoma share many common symptoms and characteristics. Both diseases are considered blood cancers, or liquid cancers, and originate in lymphocytes, which are the white blood cells that help the body fight off disease. In patients with leukemia and lymphoma, white blood cells grow out of control and crowd out healthy cells. When the mutated cells are found in the blood, the disease is diagnosed as leukemia. When the cells are found in the lymph nodes, the cancer is considered lymphoma.
Leukemic cells are more likely to remain in the blood and circulate throughout the body. Lymphoma cells may also circulate, but they are more likely than leukemic cells to develop into solid tumors in the lymph system, such as in lymph nodes or the spleen.
Patients may undergo a variety of tests to determine whether they have lymphoma or leukemia and, if so, to diagnose the stage or progression of the disease. In most cases, a biopsy is performed, retrieving a tissue sample from a lymph node. The sample is then examined under a microscope by a pathologist. A blood test may also be performed to rule out infection or other diseases.
Other tests used to diagnose the type or stage of the disease include flow cytometry(used to look for abnormal DNA), blood tests and imaging tests, such as a CT scan.
- Stage I: The lymphoma is found in 1 lymph node region. Or, the lymphoma has invaded 1 extralymphatic organ or site (identified using the letter “E”) but not any lymph node regions (stage IE); this is rare in Hodgkin lymphoma.
- Stage II:: Any of the following conditions applies:
- Stage II:The lymphoma is in 2 or more lymph node regions on the same side of the diaphragm.
- Stage IIE:The lymphoma involves 1 organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without lymphoma in other lymph node regions on the same side of the diaphragm.
- Stage II bulky:Either stage II or stage IIE applies, plus there is a mass in the chest. The mass is either larger than one-third the diameter of the chest or larger than 10 centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.
- Stage III:There is lymphoma in lymph node areas on both sides of the diaphragm, meaning above and below it.
- Stage IV:The lymphoma has spread to 1 or more organs beyond the lymph nodes. Hodgkin lymphoma usually spreads to the liver, bone marrow, or lungs.
The stage of Hodgkin lymphoma describes the extent of the spread of the tumor, using the terms “stage I” to “stage IV” (1 through 4). As explained in Symptoms and Signs, each stage may also be further divided into “A” and “B” categories, based on whether or not the person is experiencing specific B symptoms.
The primary treatments for Hodgkin lymphoma are chemotherapy, radiotherapy, immunotherapy and stem-cell transplant. These therapies may be used alone or in combination with one another.
Radiation therapy may be used to kill cancer cells that accumulate in the lymph nodes, spleen or related organs and cause pain and swelling.
Before a stem cell transplant, a patient will receive high-dose chemotherapy, to destroy as many cancer cells as possible. Then stem cells are given intravenously (similar to a blood transfusion). Stem cells then travel to the bone marrow and produce healthy new blood cells in a process known as engraftment.
- Fertility issues
- Infections
- Thyroid problems
- Secondary cancers
- Lung damage
Because lymphoma affects the lymphatic system, treatment for the disease may lead to a condition called lymphedema, which is swelling caused by a buildup of lymphatic fluid.
Other common side effects include:
Tips For Follow-up after Hodgkin Lymphoma
Even if you’ve completed treatment, your doctors will still want to watch you closely. It’s very important to go to all your follow-up appointments because HL can sometimes come back even many years after treatment.
Some treatment side effects might last a long time or might not even show up until years after you have finished treatment (see Late and Long-term Side Effects of Hodgkin Lymphoma Treatment). These doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of HL or other cancers.
Hodgkin lymphoma does come back (recurs) at some point, your treatment options will depend on where the lymphoma is, what treatments you’ve had before, how long it’s been since treatment, and your current health and preferences. For more on how recurrent HL is treated, see Treating Classic Hodgkin Lymphoma, by Stage.
People who’ve had Hodgkin lymphoma can still get other cancers. In fact, HL survivors are at higher risk for getting some other types of cancer. Learn more in Second Cancers After Hodgkin Lymphoma.
