Hodgkin Lymphoma

Symptoms, Doctors, Treatments, Advances & More

Hodgkin’s lymphoma, also known as Hodgkin’s disease, is one of the most common types of lymphatic cancer (cancer of the immune system) and is one of the most curable forms of cancer. Lymphoma is a term used to describe cancers that affect the lymph nodes and lymph system (immune system), which is also composed of many blood vessels and organs, including the spleen, areas of the intestines, thymus gland, tonsils, and adenoids. Hodgkin’s lymphoma has two main types: 1) Classical Hodgkin’s lymphoma, and 2) nodular lymphocyte-predominant Hodgkin’s lymphoma. Classical Hodgkin’s lymphoma is the most common type of Hodgkin’s lymphoma and is characterized by large, abnormal cells (Reed-Sternberg cells) in the lymph nodes and is divided into four subtypes: 1) nodular sclerosis Hodgkin’s lymphoma, 2) mixed cellularity Hodgkin’s lymphoma, 3) lymphocyte-depleted Hodgkin’s lymphoma, and 4) lymphocyte-rich Hodgkin’s lymphoma. Nodular sclerosis Hodgkin’s lymphoma is rare, grows more slowly than classic Hodgkin’s lymphoma, is characterized by large, abnormal cells called popcorn cells, is treated differently, and has a better chance of cure. Hodgkin’s lymphoma is categorized by the following stages: Stage I – The lymphoma is only in one lymph node region or a single organ. Stage II – The lymphoma is in two lymph node regions or has spread (metastasized) to one organ and its nearly lymph nodes but is limited to either above or below the diaphragm. Stage III – The lymphoma has spread to the lymph nodes both above and below the diaphragm and may have spread (metastasized) to tissue near an organ, lymph nodes, or the spleen. Stage IV – In this advanced stage of lymphoma, the cancer has spread (metastasized) to several areas of one or more organs or tissues and affects the lymph nodes and other areas of the body, such as the lungs, liver, or bone. Hodgkin’s lymphoma is further described as either A (no significant symptoms) or B (significant symptoms, such as chronic fever, unexplained weight loss, and severe night sweats).

Hodgkin’s lymphoma may also be referred to as HL or Hodgkin's disease.

While the causes of Hodgkin’s lymphoma are unknown, the disease begins when cells (lymphocytes) in the lymphatic system undergo a genetic mutation that causes the cells to grow abnormally and multiply in areas of the lymphatic system, such as the lymph nodes, and eventually form tumors. Several risk factors also increase the chances of developing Hodgkin’s lymphoma, including being male, having been infected with the Epstein-Barr virus (EBV), which causes mononucleosis, being infected with the human immunodeficiency virus (HIV), having a weakened immune system, being between the ages of 15 and 40-years-old or over the age of 50, and having a family history of lymphoma.

The most common symptom of early-stage Hodgkin’s lymphoma is the appearance of a painless, swollen lymph node in the neck (most common site), underarm, or groin. Further symptoms of Hodgkin’s lymphoma may include chronic fatigue, unexplained weight loss, cough, severe itching, increased sensitivity to alcohol, including pain in lymph nodes after drinking, fever, difficulty breathing (dyspnea), night sweats, enlargement of the liver (hepatomegaly) or spleen (splenomegaly), abnormalities of the gastrointestinal system and/or kidneys, and rarely, bone pain.

Treatment for Hodgkin’s lymphoma depends on the type and how far it has advanced (stage) and focuses on killing the cancer cells in order to achieve remission. Treatments for Hodgkin’s lymphoma include chemotherapy, radiation therapy, targeted therapy, immunotherapy, and bone marrow transplant (stem cell transplant). Chemotherapy – Chemotherapy uses drugs to kill cancer cells and can be administered orally (pill), intravenously (systemic chemotherapy; IV), or by other methods and is often used in combination with radiation therapy or other drugs, such as corticosteroids, for Hodgkin’s lymphoma. Chemotherapy drugs combined with corticosteroids used for Hodgkin’s lymphoma include the combination regimen of nitrogen mustard, vincristine (Oncovin), procarbazine, and prednisone (MOPP), the combination regimen of doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD), or a combination of MOPP and ABVD every other month, the combination regimen of nitrogen mustard, vincristine (Oncovin), procarbazine, bleomycin, Adriamycin, and prednisone (MOP-BAP), and the combination regimen chlorambucil, vinblastine, procarbazine, and prednisone (ChlVPP). The drug, Leukine, has recently been approved for the treatment of Hodgkin’s lymphoma. Radiation therapy – Radiation therapy uses high-energy radiation, such as X-Rays or protons, to kill cancer cells and is often used in combination with chemotherapy for classical Hodgkin’s lymphoma. Early-stage nodular lymphocyte-predominant Hodgkin’s lymphoma may be treated with radiation therapy alone. Several radiation treatments may be given several times a week over a period of weeks, usually 30 minutes at a time. Targeted therapy – Targeted therapy uses drugs that are designed to attack certain proteins on cancer cells to kill them or stop them from growing and includes drugs that target specific genetic mutations for Hodgkin’s lymphoma, which include the monoclonal antibodies, brentuximab and rituximab. Immunotherapy (Biological therapy) – Immunotherapy for Hodgkin’s disease uses immune checkpoint inhibitor therapy such as the PD-1  inhibitors, nivolumab and pembrolizumab, to treat Hodgkin’s lymphoma that has recurred.  Bone marrow transplant, also known as stem cell transplant, may be used to replace diseased bone marrow with healthy stem cells for Hodgkin’s lymphoma that has recurred after treatment.  For pregnant women with Hodgkin’s lymphoma, treatment may include watchful waiting or steroid therapy. The chemotherapy drug, Vinblastine, may be given in the second or third trimester of pregnancy, if necessary.

There are several online, local, national, and international support groups for Hodgkin’s lymphoma, including the following: CancerCare - https://www.cancercare.org/diagnosis/lymphoma Cancer Support Community - https://www.cancersupportcommunity.org/hodgkin-lymphoma Leukemia and Lymphoma Society - https://www.lls.org/support/support-groups

While the outcomes (prognosis) for Hodgkin’s lymphoma depend on the stage of the cancer, the type of Hodgkin lymphoma, whether the lymphoma has spread (metastasized), or whether the cancer has recurred, and the patient’s overall health, most Hodgkin’s lymphoma can be cured.

Most complications of Hodgkin’s lymphoma are related to the cancer treatment and may include chronic fatigue, infertility, low thyroid (hypothyroidism), severe infection, an increased risk of secondary cancers, a weakened immune system, headaches, diarrhea, aching muscles, painful, blistering rash, lung problems, heart disease, and avascular necrosis of bone (loss of blood flow, usually to the hip bone).

If you experience any symptoms of Hodgkin’s lymphoma, such as persistent fever, fatigue, difficulty breathing or wheezing, lymph node pain after drinking alcohol, severe itching, night sweats, and especially the appearance of a painless, swollen lymph node in the neck, underarm, or groin, make an appointment with your doctor as soon as possible.

There is no known method of prevention for Hodgkin’s lymphoma other than avoiding infection with the human immunodeficiency virus (HIV) by practicing safe sex and not injecting drugs with dirty or unsterilized needles.