Hodgkin’s Lymphoma: Symptoms, Diagnosis and Treatment

Hodgkin’s disease, also known as Hodgkin’s lymphoma, is a rare type of lymphoma affecting the lymphatic system. Cancer is the uncontrollable growth of cells that can spread to other parts of the body.

Lymphoma is a type of cancer that starts in the white blood cells called lymphocytes. Based on specific characteristics, lymphoma is of two main types, Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma. Here we will discuss in detail Hodgkin’s lymphoma.

What is Hodgkin’s Lymphoma?

Hodgkin’s lymphoma is a form of blood cancer that affects the lymphatic system. It was named after Thomas Hodgkin, a prominent pathologist who was the first to describe the disease.

The lymph system is a part of the immune system of a network of nodes connected by lymphatic vessels that spread throughout the body. It contains a clear fluid called lymph which helps drain fluid and waste products from the body.

The lymphatic system produces white blood cells, called lymphocytes, essential to protect against various infections and straining foreign organisms. The lymphatic system is also involved in producing other immune cells.

Some nodes and tissues may swell and become tender when the lymphatic system fights against the infection or foreign organism. This is a normal reaction of the body against the invasion.

pexels tima miroshnichenko 6010862
Photo by Tima Miroshnichenko from Pexels

Lymphoma occurs when the lymph nodes or the lymphocytes multiply abnormally and collect in certain parts of the lymphatic system. Hodgkin’s lymphoma usually starts with the uncontrolled multiplication of B-lymphocytes, a white blood cell vital for immunity. The affected parts of the lymphatic system lose their ability to fight infections, making you vulnerable and producing malignant cells that may spread to other parts of the body.

According to National Cancer Institute, Hodgkin’s disease is more common in two age groups: young adults aged 15 to 35 years and older adults aged over 50 years. It is more common in males than in females and Caucasian people.

Common Symptoms

The most common symptom of Hodgkin lymphoma is swelling in the neck, armpit, or groin area. The swelling may be painless, but some may feel aches. Other signs and symptoms of Hodgkin’s lymphoma include:

  • Chronic Fatigue
  • Unintentional weight loss
  • Persistent fever
  • Itching all over the body
  • Nausea
  • Night sweats

Other symptoms may depend on the location of the lymph node swelling. For example, if an affected lymph node near the abdomen, the person may experience abdominal pain or indigestion.

Upon diagnosis, there may be a presence of abnormal cells in the bone marrow. This may lead to symptoms like excessive bleeding, blood spots under the skin, and even an increased risk of infections.

According to cancer research, some people with Hodgkin lymphoma may also experience pain in their lymph glands when they drink alcohol.

What causes Hodgkin’s Lymphoma?

Cancer is caused by mutation or a change of DNA in affected cells. In Hodgkin lymphoma, there is a change in the DNA of B-lymphocytes. The reason for this change is not known.

The abnormal lymphoma cells are usually present in the lymphatic system, vessels, and lymph node regions. The lymph node is generally found in the neck, armpits, and groin area. Over time, these cancerous cells may spread to other parts of the body like bone marrow, spleen, liver, skin, or lungs. The risk factors for developing cancer cells and this type of cancer include:

  • having any condition that may lower your immunity, like HIV infection
  • taking immunosuppressant medication, for example, in case of organ transplant
  • previously exposed to the Epstein-Barr virus, a type of infectious mononucleosis which causes glandular fever
  • Being overweight – this is a risk factor in women than men
  • previously have had non-Hodgkin lymphoma, possibly due to chemotherapy or radiation

You may also be at risk of developing Hodgkin’s lymphoma if a first-degree relative has had the condition; it may be due to genetic fault or lifestyle factors.

How to diagnose Hodgkin’s Lymphoma?

To diagnose Hodgkin lymphoma, the doctor will perform a physical exam and ask about your medical history. The doctor will also conduct several tests to make the correct diagnosis. The following tests may be performed to diagnose Hodgkin’s lymphoma:

tests for Hodgkin's lymphoma
Photo by Louis Reed on Unsplash
  • Blood tests: a sample of the blood is taken to perform tests like a complete blood count (CBC) to measure the levels of B-cells and T-cells for indications of cancer
  • Imaging tests: these tests include an X-ray, CT scan, or PET scan in the affected areas
  • Biopsy: collecting a part of the tissue from swollen lymph nodes or taking a sample of bone marrow to test the presence of abnormal cells
  • Immunophenotyping: this is performed on blood, bone marrow, or other samples to detect the specific type of lymphoma
  • Echocardiogram: to determine the efficiency of heart function

Staging

Once the diagnosis is confirmed, the cancer is assigned a stage to describe the extent and severity of the disease. This will help in determining treatment options and outlook.

There are four stages of Hodgkin disease:

  • Stage 1: early-stage cancer with the disease in one lymph node region or cancer in one area of a single organ
  • Stage 2: advanced cancer involving one lymph node and a nearby organ or two lymph node regions on one side of the diaphragm
  • Stage 3: an advanced stage where cancer is found in lymph nodes both above and below the diaphragm or cancer in one lymph node and one organ on the opposite side
  • Stage 4: the cancer is widespread and occurs outside the lymph nodes, such as in the bone marrow, liver, or lungs

Furthermore, the doctor may use the letters A and B to indicate other symptoms of Hodgkin’s lymphoma:

  • A: this signifies that you don’t have any other symptoms as a result of cancer
  • B: indicates the presence of significant signs and symptoms, such as persistent fever, weight loss, and night sweats

There are many types of Hodgkin’s lymphoma, including rare forms that are difficult to identify. Accurate diagnosis and staging are required for proper treatment. Cancer research has shown that inexperienced pathologists may misdiagnose biopsy reports. Get a second opinion from a specialist in clinical oncology if needed.

Types of Hodgkin Disease

Classical Hodgkin’s Lymphoma

It is a more common type of disease. People diagnosed with classical Hodgkin lymphoma have abnormally large Reed-Sternberg cells (RS cells) in the lymph nodes. There are four sub-type for classical Hodgkin’s Lymphoma:

  1. Nodular sclerosis Hodgkin’s lymphoma
  2. Lymphocyte-depleted Hodgkin’s lymphoma
  3. Lymphocyte-rich Hodgkin’s lymphoma
  4. Mixed cellularity Hodgkin’s lymphoma

Nodular lymphocyte-predominant Hodgkin’s lymphoma

This is a rare type of Hodgkin’s disease. It involves large and abnormal cells called popcorn cells due to their appearance. People with this type of disease may have a better chance of being cured when diagnosed early.

The tumor cells affected by the disease are termed Hodgkin cells, Reed Sternberg cells, and lymphocyte-predominant cells, based on the type of Hodgkin’s lymphoma. Each of these types is treated differently according to their symptoms and the person’s overall health.

Types of Treatment for Hodgkin Lymphoma

Treatment for Hodgkin’s lymphoma depends on diagnosis and staging of the disease and the patient’s overall health. The diagnosis and treatment also depend on the personal preference of the patient. The goal of the treatment is to destroy the cancer cells and remit the disease.

Chemotherapy

Chemotherapy drugs use chemicals to attack and kill the cells involved in the disease. This drug treatment is often combined with radiation therapy in people with classical Hodgkin’s lymphoma in the early stage. In the advanced stages, chemotherapy may be used alone or in combination with radiation therapy.

Chemotherapy drugs can be taken as pills or through a vein in the arm, and sometimes both methods may be used. Several combinations of drugs may be used to treat the disease.

The chemotherapy regimen can lead to side effects, including nausea, hair loss, and long-term complications like heart damage, fertility problems, and other cancers, such as leukemia.

Radiation Therapy

Radiation therapy is often used combined with chemotherapy to treat classical Hodgkin’s lymphoma. In the case of nodular lymphocyte-predominant Hodgkin’s Lymphoma in the early stages, only radiation therapy may be used.

During radiation therapy, the patient may be asked to lie on a table, and a large machine moves around you, directing high-energy beams, such as X-rays and protons, to specific points on the body. The radiation may be directed toward the lymphoid tissue and nearby areas where the disease might progress.

Radiation therapy Hodgkin's lymphoma
Photo by National Cancer Institute on Unsplash

The duration of radiation therapy varies depending on the stage of the disease. Each radiation therapy session lasts 30-minutes, and the treatment plan may include a visit to the hospital five days a week for several weeks.

Radiation therapy can cause specific side effects like skin redness, hair loss at the radiation site, and fatigue during the therapy. It may also cause more serious risks like heart disease, infertility, thyroid problems, and other cancers, such as breast cancer.

Bone marrow transplant

Bone marrow transplant is stem cell transplantation used to replace affected bone marrow with healthy stem cells that help grow a new bone marrow. This treatment is used when Hodgkin’s lymphoma returns despite treatment.

The treatment starts with removing the patient’s stem cells which are frozen and stored for future use. Next, high-dose chemotherapy and radiation therapy are administered to destroy cancerous cells. Finally, the stem cells are injected into the body through the veins. These stem cells help build new healthy cells.

A bone marrow transplant may result in an increased risk of infections.

Other drug therapy

Treatment for Hodgkin’s lymphoma may include certain targeted medicines which focus on specific vulnerabilities of the cancer cells and immunotherapy, which activates the body’s immune system to work against the disease.

When other treatments haven’t worked or if the disease returns, the lymphoma cells are analyzed in various laboratory tests to check for genetic mutations. The doctor may advise a different treatment specially targeted towards the mutated lymphoma cells.

According to Mayo Clinic, targeted therapy is an active part of cancer research. Many clinical trials are being conducted to study the working of new targeted therapy drugs.

Alternative Medicine

There are no alternative medicines for Hodgkin’s lymphoma treatment. But alternative medicine can help with coping and management of stress during cancer diagnosis and treatment. It may also help with improving quality of life. Alternative medicine may also help in managing the side effects of cancer treatment.

Certain alternative therapy options include art therapy, exercise, music therapy, yoga, and spirituality.

Coping with Cancer

A diagnosis of Hodgkin’s lymphoma is challenging physically and mentally. The following methods and resources can be used to deal with cancer and its impact.

  • Learn about the disease

Learn about cancer to understand and make appropriate decisions for the treatment and care. The doctor may provide medical advice, and you may also look for information on the internet and a library.

Resources for information on Hodgkin lymphoma can be found at Lymphoma Research Foundation and Leukemia & Lymphoma Society. The American cancer society, National Cancer Institute, and Mayo Foundation are also good resources. You may also follow cancer news for the latest information on the disease and any possible new treatment options.

  • Create a support system

Maintaining a positive attitude is the critical aspect of the treatment. Family and friends can be the best support to help with the journey. But sometimes, even they may struggle to accept the diagnosis. In such situations, a formal support group or other people who have cancer may help in coping.

  • Set reasonable expectations

The patient may be told as an encouragement that they can go back to work immediately and work a 40-hour week as usual. But it is needed to understand that there may be days they may not be fit enough to work. So, set reasonable expectations, which can give you a sense of purpose and help you feel in control.

  • Self-care

Eat well, relax, and stay active with light exercise. It is essential to stay active and get enough rest to combat the fatigue of cancer therapy—plan for downtimes when you can rest well. If you feel well enough, do what you can to stay active.

Outlook

Hodgkin’s lymphoma is aggressive cancer that can spread to other body parts quickly. But, it is also one of the most easily treated diseases.

Based on the diagnosis, the treatment is decided by considering your age, overall health, and preference for treatment. The types of treatment include chemotherapy, radiation, bone marrow transplant and a few alternative treatment methods.

Hodgkin’s lymphoma has a recovery rate of 85% of the cases living up to 5 years, most of them being cured. There may be certain long-term complications of the treatment, like infertility or the development of a new type of cancer.

Any information found on the site does not constitute legal or medical advice. Should you face health issues, please visit your doctor to get yourself diagnosed. Icy Health offers expert opinions and advice for informational purposes only. This is not a substitute for professional medical advice.

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