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Hodgkin’s lymphoma

Definition

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

Alternative Names

Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma

Causes

The first sign of this cancer is often an enlarged 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 cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Infection with the Epstein-Barr virus (EBV) is thought to contribute to most cases.

Symptoms

• Fatigue
• Fever and chills
• Itching
• Loss of appetite
• Night sweats
• Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
• Weight loss

Other symptoms that may occur with this disease:

• Clubbing of the fingers or toes
• Excessive sweating
• Flank pain
• Hair loss
• Neck pain
• Pain in the affected areas after drinking alcohol
• Skin blushing or flushing
• Splenomegaly

Exams and Tests

The disease may be diagnosed after:

• Biopsy of suspected tissue
• Bone marrow biopsy
• Lymph node biopsy
• Detection of Reed-Sternberg (Hodgkin's lymphoma) cells by biopsy from any site

A staging evaluation (tumor staging) may be done to determine how far the disease has spread. The following procedures may be done:

• Blood chemistry tests
• Bone marrow biopsy
• CT scans of the chest, abdomen, and pelvis
• PET scan
• Physical examination

In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary.

Hodgkin's lymphoma may change the results of the following tests:

• Angiotensin converting enzyme (ACE) levels
• Blood differential
• Bone marrow aspiration
• Cryoglobulins
• Ferritin
• Gallium scan
• Lymphocyte count

Treatment

Treatment primarily depends on the following:

• The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
• The stage (where the disease is found)
• Whether the tumor is more than 4 inches (10 cm) wide
• The patient's age and other medical issues
• Other factors, including weight loss, night sweats, and fever

A staging evaluation is necessary to determine the treatment plan.

• Stage I indicates one lymph node region is involved (for example, the right neck).
• Stage II indicates involvement of two lymph node areas on the same side of the diaphragm (for example, both sides of the neck).
• Stage III indicates lymph node involvement on both sides of the diaphragm (for example, groin and armpit).
• Stage IV involves the spread of cancer outside the lymph nodes (for example, to bone marrow, lungs, or liver).

Treatment varies with the stage of the disease. The best treatment for an individual patient depends on many factors, and should be discussed with a doctor who has experience treating this disease.

• Stages I and II (limited disease) can be treated with local radiation therapy, chemotherapy, or a combination of both.
• Stages III and IV (extensive disease) are treated with chemotherapy alone or a combination of radiation therapy and chemotherapy.

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)

With the right treatment, more than 80% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment is more intense and the 5-year survival rate is about 60%.

Possible Complications

• Inability to have children (infertility)
• Liver failure
• Lung problems
• Other cancers
• Side effects of radiation and chemotherapy

Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. Use a soft toothbrush and electric razor for personal hygiene.

Infection should always be taken seriously during cancer treatment. Contact your doctor immediately if you develop fever or other signs of infection. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia.

When to Contact a Medical Professional

Call your health care provider if:

• You have symptoms of Hodgkin's lymphoma
• You are being treated for Hodgkin's lymphoma and you experience side effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding

References

Connors JM. Hodgkin's lymphoma. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 197.

National Cancer Institute. Adult Hodgkin lymphoma treatment (PDQ). 2009. Accessed February 25, 2009.

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