Hodgkin lymphoma starts in the lymph system, usually in a lymph node. The disease may be found because of a swollen lymph node in the neck, chest, or other areas.
The disease begins when a lymphocyte (almost always a B cell) becomes abnormal. The abnormal cell divides to make copies of itself. The copies keep dividing, making more abnormal cells that build up.
When white blood cells collect around the abnormal cells, the lymph node that contains abnormal cells becomes swollen. Abnormal cells may spread through the lymph vessels or blood vessels to other parts of the body.
Although normal cells die when they get old or damaged, abnormal cells don’t die. Also unlike normal cells, abnormal cells can’t help the body fight infections.
What are the types of Hodgkin’s lymphoma?
In 2013, more than 9,000 Americans will be diagnosed with Hodgkin lymphoma. About 4,000 of these people will be children, teens, and adults younger than 35 years old.
Most people diagnosed with Hodgkin lymphoma have the classical type. In 2013, about 8,550 Americans will be diagnosed with this type.
In classical Hodgkin lymphoma, the abnormal cell is called a Reed-Sternberg cell. See photo of the large cell below.
Other abnormal cells may also be found in people with classical Hodgkin lymphoma. These cells are called Hodgkin cells. They are larger than normal lymphocytes but smaller than Reed-Sternberg cells.
In 2013, about 450 Americans will be diagnosed with lymphocyte-predominant Hodgkin lymphoma. In this rare type of Hodgkin lymphoma, the abnormal cell is called a lymphocyte-predominant cell, and the treatment options are different.
Who is affected?
Hodgkin lymphoma can develop at any age, but it mostly affects young adults in their 20s and older adults over the age of 70. Slightly more men than women are affected.
Around 1,900 people are diagnosed with Hodgkin lymphoma in the UK each year.
What causes Hodgkin lymphoma?
The exact cause of Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if you have a medical condition that weakens your immune system, you take immunosuppressant medication, or you have previously been exposed to a common virus called the Epstein-Barr virus, which causes glandular fever.
You also have an increased risk of developing Hodgkin lymphoma if a first-degree relative (parent, sibling or child) has had the condition.
How Hodgkin lymphoma is diagnosed
The only way to confirm a diagnosis of Hodgkin lymphoma is by carrying out a biopsy.
This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory.
How is the staging determined for Hodgkin’s lymphoma?
After you learn that you have Hodgkin lymphoma, you may need other tests to help with making decisions about treatment. Staging tests can show the stage (extent) of disease, such as whether lymphoma cells are found in more than one group of lymph nodes.
Lymphoma cells usually spread from one group of lymph nodes to the next. For example, Hodgkin lymphoma that starts in lymph nodes in the neck may spread first to lymph nodes above the collarbones, and then to lymph nodes under the arms and within the chest.
In time, lymphoma cells can invade blood vessels and spread to almost any other part of the body. For example, they can spread to the liver, lungs, bone, and bone marrow.
Staging tests may include:
CT scan: Your doctor may order a CT scan of your neck, chest, abdomen, and pelvis. An x-ray machine linked to a computer will take a series of detailed pictures of these areas.
You’ll receive contrast material by mouth and by injection into a blood vessel in your arm or hand. The contrast material makes swollen lymph nodes and other abnormal areas easier to see. The pictures can show whether Hodgkin lymphoma has spread.
PET scan: Your doctor may use a PET scan to find Hodgkin lymphoma that has spread. You’ll receive an injection of a small amount of radioactive sugar.
A machine makes computerized pictures of cells in your body that have taken up the radioactive sugar. Because lymphoma cells take up sugar faster than do normal cells, areas with lymphoma cells look brighter on the pictures.
Bone marrow biopsy: To check for lymphoma cells in the bone marrow, your doctor will use a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain.
Other staging tests may include biopsies of lymph nodes or other tissue.
Questions you may want to ask your doctor about testing
- What type of Hodgkin lymphoma do I have?
- How do I get a copy of the report from the pathologist?
- Has the lymphoma spread? Was it found on both sides of the diaphragm?
Treatment and outlook
Hodgkin lymphoma is a relatively aggressive cancer and can quickly spread through the body. Despite this, it is also one of the most easily treated types of cancer.
Your recommended treatment plan will depend on your general health and age, because many of the treatments can put a tremendous strain on the body. How far the cancer has spread is also an important factor in determining the best treatment.
The main treatments used are chemotherapy, followed by radiotherapy or chemotherapy alone. Surgery is not generally used as a treatment for the condition.
Overall, more than 80% of people with Hodgkin lymphoma will live at least five years and most of these will be cured.
However, there is a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future.