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Hodgkin's Lymphoma: Types, Symptoms, Causes, Risk Factors, Diagnosis, Stages, And Treatment

Hodgkin's lymphoma, formerly termed as Hodgkin's disease (HD) is a type of lymphoma or cancer which affects the lymphatic system. A type of blood cancer, it begins in the lymphatic system, which aids the immune system in the process of fighting off infections and removing waste.

Hodgkin's lymphoma can affect anyone but is commonly reported in people aged between 20 and 40, and over the age of 55. The cells in the lymphatic system grow abnormally and can spread to other parts too [1] .

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Photo Credit: AIDSMAP

One of the two common types of cancers of the lymphatic system, Hodgkin's lymphoma originates in white blood cells and makes it difficult for your body to fight infections.

Types Of Hodgkin's Lymphoma

Hodgkin's lymphoma can be either classic Hodgkin's disease or nodular lymphocytic predominant Hodgkin's lymphoma (NLPHL), and the type of the condition depends on the types of cells involved the condition [2] .

Classical Hodgkin's lymphoma: It is the more common type and people diagnosed with the condition large, abnormal cells called Reed-Sternberg cells in their lymph nodes. Classical Hodgkin's lymphoma has subtypes and they are as follows [3] :

  • Nodular sclerosis Hodgkin's lymphoma
  • Mixed cellularity Hodgkin's lymphoma
  • Lymphocyte-depleted Hodgkin's lymphoma
  • Lymphocyte-rich Hodgkin's lymphoma

Nodular lymphocyte-predominant Hodgkin's lymphoma: This is rare in nature and involves large, abnormal cells that are sometimes called popcorn cells because of their appearance. People with this type of Hodgkin's lymphoma may have a better chance of a cure when the disease is diagnosed at an early stage [4] [4] .

Non-Hodgkin's Lymphoma: Types, Symptoms, Causes, Treatment, Hodgkin's Vs Non-Hodgkin's Lymphoma

Symptoms Of Hodgkin's Lymphoma

The most common sign of the condition is swelling of the lymph nodes. It usually develops on the side of the neck, in the armpit and around the groin [5] .

The other symptoms of Hodgkin's lymphoma are as follows [6] :

  • Enlarged spleen
  • Itchy skin
  • Fever
  • Weight loss
  • Persistent cough
  • Trouble breathing
  • Chest pain
  • Pain in the lymph nodes after consuming alcohol
  • Fatigue
  • Night sweats

Causes Of Hodgkin's Lymphoma

There is a lack of clarity as to what causes the condition. Hodgkin's lymphoma develops when an infection-fighting cell called a lymphocyte develops a genetic mutation, which in turn causes the cells to multiply and increase.

The mutation causes a large number of oversized, abnormal lymphocytes to accumulate in the lymphatic system, overpowering the healthy cells and then causing the signs of the condition to develop [7] .

Risk Factors For Hodgkin's Lymphoma

Factors that can increase your chances of the condition are as follows [8] :

  • Age
  • Family history
  • Sex, males are increasingly prone to developing the condition than women
  • Past Epstein-Barr infection

Diagnosis Of Hodgkin's Lymphoma

The medical examiner, before the examination, will enquire about your personal and family medical history. Then, you may be required to undergo the following tests and procedures for diagnosis [9] .

  • A physical exam, where the doctor will check for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
  • Imaging tests such as X-ray, CT and positron emission tomography to look for signs of Hodgkin's lymphoma in other areas of your body.
  • Blood tests, where a sample of your blood will be examined to measure levels of red blood cells, white blood cells, and platelets.
  • A lymph node biopsy where a piece of lymph node tissue will be tested for the presence of abnormal cells.
  • Bone marrow biopsy, which involves removing and examining marrow inside your bones to check whether cancer has spread or not.
  • Lung function tests to check the functioning of your lungs.
  • An echocardiogram to check the functioning of your heart.

Staging Of Hodgkin's Lymphoma

After your doctor has determined the extent of your Hodgkin's lymphoma through the diagnosis, the lymphoma (cancer) will be assigned a stage, as it helps the doctor determine your prognosis and treatment options [10] . The stages of Hodgkin's lymphoma are as follows:

  • Stage 1 (early stage): The cancer is limited to one lymph node region or a single organ.
  • Stage 2 (locally advanced): In this stage, the cancer is in two lymph node regions or cancer has invaded one organ and the nearby lymph nodes. However, cancer is still limited to a section of the body.
  • Stage 3 (advanced): In this stage, the would have moved to lymph nodes both above and below the diaphragm. It may have also spread to organs near the lymph node groups or in the spleen.
  • Stage 4 (widespread): This is the most advanced stage of Hodgkin's lymphoma, where the cancer cells will have spread to various organs and tissues. By this stage, the cancer cells are not restricted to that of the lymph nodes but also other parts of the body, such as the bones, liver or lungs [11] .

Treatment For Hodgkin's Lymphoma

The medical care provided for the condition depends on the stage of the disease, overall health and preferences of the patient. The main treatment for Hodgkin's lymphoma is chemotherapy and radiation [12] , which aims to destroy the cancer cells and manage the condition.

Apart from the aforementioned, bone marrow transplant and drug therapies are also used. Studies have pointed out that the treatments for Hodgkin's lymphoma can have certain long-term side effects, which can increase your risk of developing other serious medical conditions [13] .

The treatment-induced risks are as follows:

  • Lung damage
  • Thyroid problems
  • Infertility
  • Infections
  • Second cancers

Advances in the treatment of the condition over the past few decades have greatly increased the survival rate.

View Article References
  1. [1] Ansell, S. M., Lesokhin, A. M., Borrello, I., Halwani, A., Scott, E. C., Gutierrez, M., ... & Rodig, S. J. (2015). PD-1 blockade with nivolumab in relapsed or refractory Hodgkin's lymphoma. New England Journal of Medicine, 372(4), 311-319.
  2. [2] Johnson, P., Federico, M., Kirkwood, A., Fosså, A., Berkahn, L., Carella, A., ... & Luminari, S. (2016). Adapted treatment guided by interim PET-CT scan in advanced Hodgkin’s lymphoma. New England Journal of Medicine, 374(25), 2419-2429.
  3. [3] Radford, J., Illidge, T., Counsell, N., Hancock, B., Pettengell, R., Johnson, P., ... & McMillan, A. (2015). Results of a trial of PET-directed therapy for early-stage Hodgkin’s lymphoma. New England Journal of Medicine, 372(17), 1598-1607.
  4. [4] Connors, J. M., Jurczak, W., Straus, D. J., Ansell, S. M., Kim, W. S., Gallamini, A., ... & Lech-Maranda, E. (2018). Brentuximab vedotin with chemotherapy for stage III or IV Hodgkin’s lymphoma. New England Journal of Medicine, 378(4), 331-344.
  5. [5] Schaapveld, M., Aleman, B. M., van Eggermond, A. M., Janus, C. P., Krol, A. D., van der Maazen, R. W., ... & van Imhoff, G. W. (2015). Second cancer risk up to 40 years after treatment for Hodgkin’s lymphoma. New England Journal of Medicine, 373(26), 2499-2511.
  6. [6] Turtle, C. J., Hanafi, L. A., Berger, C., Hudecek, M., Pender, B., Robinson, E., ... & Soma, L. (2016). Immunotherapy of non-Hodgkin’s lymphoma with a defined ratio of CD8+ and CD4+ CD19-specific chimeric antigen receptor–modified T cells. Science translational medicine, 8(355), 355ra116-355ra116.
  7. [7] Ansell, S. M. (2015, November). Hodgkin lymphoma: diagnosis and treatment. In Mayo Clinic Proceedings (Vol. 90, No. 11, pp. 1574-1583). Elsevier.
  8. [8] Kasamon, Y. L., de Claro, R. A., Wang, Y., Shen, Y. L., Farrell, A. T., & Pazdur, R. (2017). FDA approval summary: nivolumab for the treatment of relapsed or progressive classical Hodgkin lymphoma. The oncologist, 22(5), 585-591.
  9. [9] Ansell, S. M. (2017). Nivolumab in the treatment of Hodgkin lymphoma. Clinical Cancer Research, 23(7), 1623-1626.
  10. [10] Rosolen, A., Perkins, S. L., Pinkerton, C. R., Guillerman, R. P., Sandlund, J. T., Patte, C., ... & Cairo, M. S. (2015). Revised international pediatric non-Hodgkin lymphoma staging system. Journal of Clinical Oncology, 33(18), 2112.
  11. [11] Glimelius, I., & Diepstra, A. (2017). Novel treatment concepts in Hodgkin lymphoma. Journal of internal medicine, 281(3), 247-260.
  12. [12] Hoppe, R. T., Advani, R. H., Ai, W. Z., Ambinder, R. F., Aoun, P., Bello, C. M., ... & Chen, R. (2017). Hodgkin lymphoma version 1.2017, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 15(5), 608-638.
  13. [13] Kreissl, S., Mueller, H., Goergen, H., Mayer, A., Brillant, C., Behringer, K., ... & Rueffer, J. U. (2016). Cancer-related fatigue in patients with and survivors of Hodgkin's lymphoma: a longitudinal study of the German Hodgkin Study Group. The Lancet Oncology, 17(10), 1453-1462.

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