Hodgkin's Lymphoma

Adults

Description

Hodgkin’s lymphoma is typically characterized by the presence of abnormal cells called Reed-Sternberg cells. However, the presence of these cells alone does not mean that an individual has Hodgkin’s lymphoma. To confirm a diagnosis, the lymphatic tissue sample that contains Reed-Sternberg cells must also be surrounded by a background of other cells and features that are characteristic of Hodgkin’s lymphoma.

Hodgkin’s lymphoma is not contagious and the patient does not pose a risk to others in any way. Many sources point out that the diagnosis and treatment of Hodgkin’s has improved remarkably in recent years. Hodgkin’s now has a high survival rate.

Development

Hodgkin’s lymphoma starts in the lymph nodes. Lymph tissues are connected throughout the body, providing a route for cancerous lymphocytes to travel. As a result, Hodgkin’s lymphoma often spreads from one lymph node to another throughout the body. Unlike other lymphomas, Hodgkin’s will more often spread from one lymph node to the next in sequence, rarely skipping areas (which is more common in non-Hodgkin’s lymphoma [NHL]). Hodgkin’s lymphoma can also spread to other areas and organs outside the lymph system.

Diagnosis

Symptoms of Hodgkin’s lymphoma are not specific. Often a lymph node swells, or a person notices a significant lack of energy. At times serious symptoms occur, which may include weight loss, fever, and severe night sweats. Frequently however, a diagnosis is made during standard physical examinations.

To confirm diagnosis, a biopsy is taken of tissue and examined to look for Reed-Sternberg cells. A needle biopsy is sometimes used but a surgical biopsy, which removes the whole node, is preferred by most physicians to obtain sufficient tissue to confirm diagnosis.

Click here to see a picture of a Reed-Sternberg cells

Other tests your medical team may perform include:

• A complete physical exam (including lymph nodes)
• Complete medical history including symptoms
• A blood work-up including complete blood cell count (numbers of white and red blood cells), blood chemistry, and abnormal erythrocyte sedimentation rate (ESR)
• A chest x-ray
• A computerized tomography (CT or CAT) scan or magnetic resonance imaging (MRI) scan of the chest, pelvis, and abdomen to determine possible spread of the disease
• A positron emission tomography (PET) scan to find areas of increased cellular activity.
  Click here to view PET scan images.
• A combined PET/CT scan, which allows physicians to view the cancer more precisely
• A gallium scan to check for radioactive intake of gallium in the lymph system, which may indicate disease
• A bone marrow aspiration and biopsy to determine if the bone marrow has been affected by Hodgkin’s lymphoma (the hip is numbed and a needle is inserted into the bone; liquid bone marrow and a bone chip are extracted and examined under a microscope).

Certain medical centres may perform additional tests, including exploratory surgery to determine the extent of the disease, or a lymphangiogram, a procedure during which a radio-opaque liquid is injected into the lymph system through the feet; the fluid travels throughout the lymph system and remains visible for up to six months on x-rays.

Occurrence

The risk factors that relate to other cancers such as diet, smoking and unprotected sun or pesticide exposure are not related to Hodgkin’s lymphoma. There are, in fact, very few risk factors directly connected to the development of Hodgkin’s lymphoma.

It has been noted, however, that the disease occurs more often in males in the primary age categories, early adulthood (15 to 40 years) and late adulthood (after 55 years). Brothers and sisters of Hodgkin’s lymphoma patients have an above-average chance of developing this cancer but the significance of the family relationship as the primary cause is not known.

The Epstein-Barr virus (EBV), which causes mononucleosis, may be linked to an increase in the risk of developing Hodgkin’s. EBV is a virus that infects B-lymphocytes, causing them to grow and live longer. If the body’s T-cell production is compromised, then the B-cells continue to accumulate, increasing the chance for the disease to develop. However, more than half of all Hodgkin’s patients have no evidence of a previous EBV infection so a definitive relationship is still unclear.

Stages

Hodgkin’s lymphoma can be described according to stages, as follows:

• Stage I involves one lymph node region.
• Stage II involves two or more lymph node regions on the same side of the diaphragm.
• Stage III involves lymph nodes on both sides of the diaphragm.
• Stage IV involves other organs beside or other than the lymph system.

Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

Staging is also dependent on whether the patient has had a group of symptoms including night sweats, fever, or weight loss. Patients who have had one or more of these are grade "B" while patients who have none are classed grade “A.”

Treatment

Cancer cells tend to reproduce and grow rapidly. Therefore, even though the cancer appears to be contained to one tumour or swollen gland, the disease has almost always spread beyond its origin. In order to kill all the lymphoma cells present throughout the body, a systemic treatment plan of chemotherapy is the preferred method.

Radiation

Radiation is used in localized areas to destroy cancer cells so they will not continue to spread. Radiation treatment is frequently used in addition to surgery or chemotherapy, and is usually applied in lymphoma through external high-energy ray beam or radioactive isotopes. Not all types of lymphoma respond to radiation treatment, therefore it will be up to your healthcare professional to determine if radiation is appropriate in your situation.

External radiation treatment is painless (similar to having an x-ray). The actual treatment lasts for a few minutes and causes no discomfort. A complete course of treatment typically is five days a week for four to five weeks in an outpatient setting depending on the cancer size, type and location.

As with all treatments, side effects vary from patient to patient and depend upon the part of the body treated and the amount of radiation used.

Chemotherapy

Chemotherapy is the use of powerful anticancer drugs that are carried through the body in the bloodstream. Chemotherapy may be taken by mouth or injected into a vein, and is often chosen when cancer is present in different parts of the body. Often, a combination of drugs is prescribed to improve the chances for success. After a round of chemotherapy drugs are administered, the patient will undergo a recovery period. This cycle allows the body to rest. Then another round of drugs is administered. The total course of chemotherapy may range from three to nine months. Depending on the type of cancer, chemotherapy may be effective after surgery in preventing the cancer from returning. Depending on the type of cancer and its stage, as well as the patient’s age and overall wellness, chemotherapy may be used as a cure, to prevent spreading, slow growth, kill cancerous cells that may have spread to other parts of the body, or relieve symptoms.

As with all treatments, side effects vary from patient to patient and depend upon the degree and duration of treatment.

Web Links

Note: The LFC is not responsible for verifying the accuracy of all information that is contained on these sites.

Hodgkin’s Lymphoma Information: www.hodgkinsdisease.org
UK Cancer Information: www.cancerbackup.org.uk/info/hodgkins.htm
National Cancer Institute (US): www.cancer.gov/cancertopics/types/hodgkin
Lymphoma Information Network: www.lymphomainfo.net/hodgkins
Lymphoma Research Foundation: www.lymphoma.org

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