Hodgkin's Lymphoma Facts

Lymphoma is cancer that begins in the lymph system—a network of tubes that slowly carries fluid, called lymph, from your tissues to be recycled back into your blood.

Along this network are lymph nodes—small, bean-shaped organs that are located throughout your body in your neck, underarms, groin, and behind your knees. They are also deeper inside your body in your chest, abdomen, and pelvis. The nodes filter lymph and store cells called lymphocytes that mature into cells of the immune system to defend against infections caused by bacteria, viruses, and parasites.

Cancer is caused when something goes wrong inside the lymphocytes so they don’t mature to completion and don’t die off like they are supposed to, but instead collect and accumulate in the lymph nodes, causing the disease lymphoma.

There are several kinds of lymphocytes:

B lymphocytes, or B cells: These make antibodies. Antibodies attach to bacteria and to cells infected with a virus so that other immune cells recognize them and know to destroy them.
T lymphocytes, or T cells: There are many kinds of T cells. They are involved in destroying invaders or tumor cells or in attracting or stimulating other immune cells to do this.
Natural killer cells: These scout for cells that do not look normal and destroy them.

The lymphatic system includes other parts of your body, too, like the:

Bone marrow, which makes lymphocytes and where B cells mature
Spleen, an organ near your stomach that filters and stores blood, destroys old red blood cells, and fights infection
Thymus, a gland in your neck where T cells mature

Lymphoma occurs when something goes wrong inside lymphocytes, making them divide and multiply out of control. These abnormal cells don’t die when they should according to the normal lymphocyte lifecycle. Instead, they build up in the body. They don’t carry out their normal immune functions.

Hodgkin’s lymphoma is named for the doctor that first recognized it, Dr. Thomas Hodgkin’s. In Hodgkin’s lymphoma, the cancer cells are a particular kind of abnormal B cells called Reed-Sternberg cells. There are several types and subtypes of Hodgkin’s lymphoma. Doctors classify them based on the way the cancer cells look under a microscope.

The type and subtype matter because they sometimes help doctors decide which treatments are most likely to be effective.

Most often Hodgkin’s lymphoma starts in the lymph nodes in the upper part of the body, in the neck, chest, or under the arms. It can spread through the lymphatic vessels to other nearby lymph nodes. If the disease progresses further, it can spread outside the lymph nodes to the bone marrow, lungs, or liver.

Most Hodgkin’s lymphomas—about 95 percent—are the type called classic Hodgkin’s lymphoma. There are four subtypes of classic Hodgkin’s lymphoma: nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted. All of them involve Reed-Sternberg cells. The names of the four subtypes have to do with two factors:

What’s happening to the lymph nodes. Nodules, or bumps, and fibrous bands form in the lymph nodes in the nodular sclerosis type.
The kinds of cells are involved along with Reed-Sternberg cells. Other kinds of immune system cells can be present to greater or lesser degrees.

About 5 percent of Hodgkin’s lymphomas are the type called nodular lymphocyte predominant. This type involves a variation of Reed-Sternberg cells. They are sometimes called popcorn cells because of the way they look. This type also involves nodules made up of lymphocytes.

Hodgkin’s lymphoma can be cured or controlled for many years in most people who have the disease. The five-year relative survival rate for Hodgkin’s lymphoma is about 85 percent, according to the National Cancer Institute.

Symptoms

The symptoms of Hodgkin’s lymphoma can be caused by other non-cancer conditions. So it's important to see a doctor if you have symptoms that concern you, such as:

Painless swollen lymph nodes in the neck, underarm, groin, chest or abdomen
Unexplained fever, weight loss or night sweats—sometimes called “B symptoms”
Ongoing fatigue
Itchy skin
Swelling in the face, neck or upper chest, caused by lymphoma pressing on the major vein that drains blood from these areas
Feeling of fullness in the abdomen from an enlarged liver, spleen or lymph nodes
Abdominal problems, such as nausea, vomiting and indigestion
Sensitivity to alcohol or pain in the lymph nodes after having alcohol
Coughing, trouble breathing or chest pain

For Hodgkin’s lymphoma, there is usually a longer, slower onset of lymph node symptoms, compared to non-Hodgkin’s lymphoma. For instance, a person may have some swelling for as long as a year before diagnosis.

Diagnosis

Your doctor will do a physical exam first to look for signs of lymphoma. The doctor will also ask about your health history.

If the doctor thinks that you may have lymphoma, the doctor will probably perform a biopsy next to confirm the diagnosis. To perform a biopsy, a doctor removes a small sample of tissue to examine under a microscope. This may mean removing part or all of a lymph node or some tissue by surgery.

Another method is to take a sample of fluid or tissue using a needle, called needle biopsy or fine needle aspiration. This type of biopsy may be done to check the bone marrow or the fluid around the lungs (pleural fluid) or in the membrane around the abdominal organs (peritoneal fluid).

Your doctor may also want you to have imaging studies, such as a chest X-ray, magnetic resonance imaging (MRI), computed tomography (CT) scan or PET scan, to see pictures of the inside of your body. This allows the doctor to look for enlarged lymph nodes, tumors or areas of cancer activity.

Doctors may do further tests to detect whether the cancer has spread around the lymph system or to other areas. This helps your doctor determine the stage of your cancer, which will be important when it's time to make decisions about your treatment. You may need these or other tests:

Complete blood count, or CBC: to determine how many cells of each type are circulating in the blood stream
Blood chemistry analysis: to look for chemicals in the blood that indicate disease in certain organs or tissues
Lumbar puncture, or spinal tap: to remove cerebrospinal fluid (CFS) from the spinal column and check it for cancer cells; used in non-Hodgkin’s lymphoma only
Bone marrow test: to see if the lymphoma has spread to the bone marrow

Staging

Staging refers to the way doctors classify lymphoma based on where it is in the body. People who have lymphoma are considered to be at one of these stages:

Stage I: This stage applies to those who have lymphoma in only one lymph node area or one organ.
Stage II: This stage applies to those who have lymphoma in two or three lymph node areas near each other, such as all in the neck and chest.
Stage III: This stage applies to those who have lymphoma in several lymph node areas in the neck, chest and abdomen.
Stage IV: This stage applies to those who have widespread lymphoma in their lymph nodes and other organs, such as the bone marrow, lungs, or liver.

Doctors may add a letter after your stage to describe more about your disease. In Hodgkin’s lymphoma, doctors use the letters A and B to describe whether you have symptoms: ?

A (such as “stage IA”) means you do not have symptoms. ?
B (such as “stage IB”) means you have the B symptoms: fever, weight loss or night sweats.

Risk Factors

Doctors do no know what causes Hodgkin’s lymphoma. However, doctors and researchers have found some risk factors that are associated with Hodgkin’s disease.

Keep in mind that most people who get the disease have none of the risk factors. And most people with the risk factors do not develop the disease.

Sex and age are two of the risk factors. The disease is more common in men than in women, and more common in people aged 15 to 35 and over the age of 50.

Also, you may be at higher risk for Hodgkin’s lymphoma if any of these is true:

Your immune system is weakened by an inherited disease, autoimmune disease, human immunodeficiency virus (HIV) or drugs given because you had an organ transplant.
You have been infected with Epstein-Barr virus (which causes mononucleosis).
You have a brother or sister who has had Hodgkin’s disease.