Hodgkin lymphoma is a type of cancer that affects the lymphatic system, including the lymph nodes. In people with this condition, the cancer typically spreads from one lymph node to a neighboring one.
Unlike people with non-Hodgkin lymphoma, those with Hodgkin lymphoma have Reed-Sternberg cells. These are abnormally large B lymphocytes that often have more than one nucleus. Doctors can find these cells quite easily in lymph fluid using a microscope.
With treatment, Hodgkin lymphoma has a high cure and survival rate.
In this article, we discuss Hodgkin lymphoma, including its symptoms, causes, treatment options, and outlook.
Hodgkin lymphoma usually begins in B lymphocytes, a type of white blood cells that produce antibodies to help the immune system mount a response to infection.
Not all people with Hodgkin lymphoma have symptoms. However, some people may experience signs that could point to this condition.
Swollen lymph nodes
The most common symptom of Hodgkin lymphoma is a swollen lymph node under the skin. This often appears as a lump in the neck, armpit, or groin.
The lump may not hurt all the time, but it might hurt more after a person has drunk alcohol.
However, a swollen lymph node does not necessarily mean a person has cancer, since lymph nodes often swell when the body is tackling infection.
If the swollen lymph node hurts when a person touches it, it could be due to an infection. It will go down when the infection has healed.
However, when a lymph node swells for no apparent reason, and the swelling remains, it could be indicative of cancer.
Still other symptoms some people may experience include:
Anyone can develop Hodgkin lymphoma, which occurs when healthy cells divide and grow uncontrollably.
However, some factors can increase the risk of this condition, including:
- Age: Young adults and people over the age of 55 may be more vulnerable to Hodgkin lymphoma.
- Sex: Hodgkin lymphoma is slightly more common in males than in females.
- Immune system factors: People with diseases that weaken their immune systems, such as HIV, may be more likely to develop Hodgkin lymphoma.
- Genetics: People with a family history of the condition are more vulnerable to this type of cancer.
- Epstein-Barr virus (EBV): People who have had the EBV, which causes mononucleosis, may be more likely to develop Hodgkin lymphoma. About one in four people with classic Hodgkin lymphoma (CHL) have this virus in their Reed-Sternberg cells.
There is no known effective strategy for preventing Hodgkin lymphoma or the EBV, which increases the likelihood of developing this type of cancer.
Infection with HIV can increase a person’s risk of Hodgkin lymphoma. Ways to lower the risk of HIV include limiting intravenous drug use and avoiding unprotected sex.
There are several factors doctors look at when staging Hodgkin lymphoma:
- Stage 1: This is the most localized form of the cancer. This means that cancer is present only in one lymph node or lymph organ or that it is present in an organ after spreading there from a lymph node.
- Stage 2: During this stage, the cancer has spread slightly, affecting two or more lymph nodes or lymph organs. It may have also spread to a nearby organ. The cancer must only be present on one side of the diaphragm, the primary muscle that controls breathing. In other words, it could be above or below the diaphragm, not in both locations at the same time.
- Stage 3: Stage 3 Hodgkin lymphoma is present on both sides of the diaphragm or has spread to the spleen.
- Stage 4: In this stage, the cancer has spread more widely, to at least one organ outside of the lymphatic system. It does not just involve one organ near a cancerous lymph node.
People with bulky disease have stage 2 or higher cancer. They have tumors that are larger than 4 inches anywhere in the body, or a tumor that is at least one-third as wide as the chest.
Doctors usually add an “X” to the stage to indicate bulky disease.
In lymphoma, bulky disease may mean a person requires more treatment.
A vs. B
In addition to a number, stages of cancer may also appear written with an “A” or “B.”
A person may have B stage cancer if they experience:
- drenching night sweats
- unexplained loss of more than 10% of body weight
- a temperature consistently higher than 100.4°F (38°C)
If these symptoms are not present, the person has an A stage cancer.
A person may hear a doctor use the following terms when discussing Hodgkin lymphoma:
- Resistant or progressive: This means the lymphoma is not going away or is growing during treatment.
- Recurrent or relapsed: This means that the lymphoma went away with treatment before but has now returned. It might have returned to the same place as before, or it could be in another part of the body.
There are two major types of Hodgkin lymphoma:
At least 90% of Hodgkin lymphoma cases are CHL. This type of cancer occurs when B lymphocytes develop into a type of cancer called Reed-Sternberg cells.
- Nodular sclerosis Hodgkin lymphoma: This is the most common type of this cancer. It usually appears in young adults and teenagers. Symptoms typically begin in the lymph nodes of the chest or neck.
- Lymphocyte-rich Hodgkin lymphoma: This uncommon form of lymphoma affects lymph nodes in the upper portion of the body.
- Lymphocyte-depleted Hodgkin lymphoma: Affecting just 1% of people with CHL, this form is more common among people with weakened immune systems, such as older adults and those with HIV. It is a more aggressive form of cancer with a higher death rate, and it tends to affect lymph nodes in the stomach, liver, or spleen.
- Mixed cellularity Hodgkin lymphoma: This form of lymphoma, which affects about 25% of people with CHL, is more common among older adults, children, and people with HIV. It usually begins in lymph nodes near the top of the body, such as in the armpits.
Nodular lymphocyte predominant Hodgkin lymphoma
About 5% of Hodgkin lymphoma cases are nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). This type of the condition causes a form of Reed-Sternberg cells called “popcorn” cells.
This slow-growing cancer often begins in the armpit and neck.
People of all ages can develop NLPHL. It is, however, more common in males than in females.
Both Hodgkin and non-Hodgkin lymphoma affect the lymphatic system.
The main difference between these two types of cancer is that people with non-Hodgkin lymphoma do not have Reed-Sternberg cells.
Non-Hodgkin lymphoma is also more common than Hodgkin lymphoma.
The 5-year survival rate for all stages of Hodgkin lymphoma is 87%.
Most people who have survived 5 years with Hodgkin lymphoma will go on to recover.
However, many factors can affect a person’s prognosis and the intensity of the treatment they need, including:
- being older than 45 years
- being male
- having the B type disease
- having high levels of inflammatory markers, including erythrocyte sedimentation rate and lactate dehydrogenase
- having anemia
- having a high white blood cell count
Access to quality, evidence-based treatment could also have an impact on a person’s outlook.
Moreover, some people relapse after going into remission or do not respond to initial treatment. Data suggest about
A doctor may suspect lymphoma when a person has unexplained swollen lymph nodes.
A biopsy of the lymph node can test for cancer cells.
In most cases, a doctor will cut out the entire lymph node for testing. They may also insert a needle into the lymph node and remove some fluid.
If a person gets a lymphoma diagnosis, a doctor may recommend a bone marrow biopsy. This procedure involves inserting a needle into the bone to see whether the cancer has spread to the bone marrow.
Hodgkin lymphoma can spread quickly throughout the body. However, it is one of the most treatable types of cancer.
In general, treatment options include:
- Chemotherapy and radiation: This is the first treatment option for most people, especially those with early stage and low risk cancers.
- Stem cell transplant: This can help people who do not respond to chemotherapy or radiation, or those whose cancer returns.
- Immunotherapy: This type of treatment involves using drugs that help the immune system fight the cancer.
Hodgkin lymphoma is a type of cancer that affects the lymphatic system. It has a high remission rate, and most people with this condition survive.
Survival rates are best in people who receive an early diagnosis. Therefore, it is important to contact a doctor as soon as possible for any unexplained changes in a lymph node, or other symptoms of infection or illness.