Hodgkin’s lymphoma

Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites.

Causes
The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Past infection with the Epstein-Barr virus (EBV) is thought to contribute to some cases. Patients with HIV infection are more at risk than the general population.

Symptoms
Fatigue
Fever and chills that come and go
Itching all over the body that cannot be explained
Loss of appetite
Soaking night sweats
Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
Weight loss that cannot be explained
Other symptoms that may occur with this disease:

Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
Excessive sweating
Pain or feeling of fullness below the ribs due to swollen spleen or liver
Pain in lymph nodes after drinking alcohol
Skin blushing or flushing
Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms.

Exams and Tests
The first sign of Hodgkin's lymphoma is often a swollen lymph node, which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.

The disease may be diagnosed after:

Biopsy of suspected tissue, usually a lymph node biopsy
Bone marrow biopsy
If tests reveal that you do have Hodgkin's lymphoma, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide treatment and follow-up, and gives you some idea of what to expect in the future.

The following procedures will usually be done:

Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level
Bone marrow biopsy
CT scans of the chest, abdomen, and pelvis
Complete blood count (CBC) to check for anemia and white blood count
PET scan
Some people may need abdominal surgery to take out a piece of the liver and remove the spleen. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually not needed.

Treatment
Treatment depends on the following:

The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
The stage (where the disease has spread)
Whether the tumor is more than 4 inches (10 cm) wide
Your age and other medical issues
Other factors, including weight loss, night sweats, and fever
Tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Staging is needed to determine your treatment plan. Stages of Hodgkin's lymphoma range from I to IV. The higher the staging number, the more advanced the cancer.

Treatment depends on your age and stage of the cancer.

Stages I and II (limited disease) can be treated with radiation therapy, chemotherapy, or both.
Stage III is treated with chemotherapy alone, or a combination of radiation therapy and chemotherapy.
Stage IV (extensive disease) is most often treated with chemotherapy alone.
People with Hodgkin's lymphoma that returns after treatment or does not respond to the first treatment may receive high-dose chemotherapy. That is followed by an autologous stem cell transplant (using stem cells from yourself).

What other treatments you have depend on your symptoms, but may include:

Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia
Antibiotics to fight infection, especially if a fever occurs
Support Groups
You can often ease the stress of illness by joining a support group of people who share common experiences and problems. See: Cancer - support group

Outlook (Prognosis)
Hodgkin's disease is considered one of the most curable forms of cancer, especially if it is diagnosed and treated early. Unlike other cancers, Hodgkin's disease is often very curable, even in its late stages.

With the right treatment, more than 90% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment may be more intense. However, 90% of people with advanced disease survive for at least 5 years.

Patients who survive 15 years after treatment are more likely to later die from other causes, including complications of the treatment, rather than from Hodgkin's disease.

People with Hodgkin's lymphoma whose disease returns within a year after treatment or who do not respond to the first treatment have a poorer outlook.

You will need to have regular exams and imaging tests for years after your treatment. This helps your doctor check for signs of the cancer returning, and for any long-term treatment effects.

Possible Complications
Treatments for Hodgkin's lymphoma can have complications. Long-term complications of chemotherapy or radiation therapy include:

Bone marrow diseases (such as leukemia)
Heart disease
Inability to have children (infertility)
Lung problems
Other cancers
Thyroid problems
Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To reduce bleeding, apply ice and pressure. Use a soft toothbrush and electric razor for personal hygiene.

Always take an infection seriously during cancer treatments. Contact your doctor right away if you develop fever or other signs of infection, especially if your white blood cell counts are low due to treatment. Planning rest periods during your daily activities may help prevent fatigue due to anemia.

When to Contact a Medical Professional
Call your health care provider if:

You have symptoms of Hodgkin's lymphoma
You have Hodgkin's lymphoma and you have side effects from the treatment
Alternative Names
Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma

References
Eichenauer DA, Engert A, Dreyling M. ESMO Guidelines Working Group: Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatmetn and follow-up. Ann Oncol. 2011 Sep 22 Suppl 6:vi55-58.

Horning SJ. Hodgkin's lymphoma. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 111.

Armitage JO. Early-stage Hodgkin's lymphoma. N Engl J Med. 2010 Aug 12;363(7):653-62.

Update Date: 2/7/2012
Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Inc.