Hodgkin's lymphoma (Hodgkin's disease)
Hodgkin's lymphoma is a type of cancer that affects the lymphatic system, which is part of the body's germ-fighting immune system. In Hodgkin's lymphoma, white blood cells called lymphocytes grow out of control, causing swollen lymph nodes and growths throughout the body. Hodgkin's lymphoma, which used to be called Hodgkin's disease, is one of two general categories of lymphoma. The other is non-Hodgkin's lymphoma.
Signs and symptoms of Hodgkin's lymphoma may include:
- Painless swelling of lymph nodes in your neck, armpits or groin;
- Persistent fatigue;
- Fever;
- Night sweats;
- Losing weight without trying;
- Severe itching;
- Pain in your lymph nodes after drinking alcohol.
When to see a doctor
Be sure to see your doctor if you have any above persistent signs or symptoms.
Causes
The exact cause of Hodgkin's lymphoma is unknown, but it is known that it begins when infection-fighting white blood cells - lymphocytes – develop changes in their DNA. A cell's DNA contains the instructions that tell it what to do.
The DNA changes cause the cells to multiply rapidly and to continue living when other cells would naturally die. The lymphoma cells attract many healthy immune system cells to protect them and help them grow. The extra cells crowd up in the lymph nodes, causing swelling and other signs and symptoms of Hodgkin’s lymphoma.
There are many types of Hodgkin’s lymphoma. Your type is based on the characteristics of the cells involved in the disease and their behavior. The type of lymphoma determines your treatment options.
Classical Hodgkin’s lymphoma
Classical Hodgkin’s lymphoma is the most common type of this disease. People diagnosed with this type have large lymphoid cells called Reed-Sternberg cells in their lymph nodes.
Subtypes of classical Hodgkin's lymphoma include:
- 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 much rarer type of Hodgkin's lymphoma involves lymphoma cells that are sometimes called popcorn cells because of their appearance. Nodular lymphocyte-predominant Hodgkin's lymphoma is usually diagnosed at an early stage and may require less intensive treatment than the classical type of the disease.
Risk factors
Factors that increase the risk of developing Hodgkin's lymphoma include:
- Age. Hodgkin lymphoma is most often diagnosed in people in their 20s and 30s and those over age 55.
- A family history of lymphoma. Having a blood relative with Hodgkin’s lymphoma increases your risk of developing Hodgkin’s lymphoma.
- Being male. Men are more likely to develop Hodgkin's lymphoma than women.
- Past Epstein-Barr infection. People who have had diseases caused by the Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin's lymphoma than those who have not had an Epstein-Barr infection.
- HIV infection. People who are infected with HIV have an increased risk of developing Hodgkin's lymphoma.
Treatment
The goal of Hodgkin’s lymphoma treatment is to destroy as many of the lymphoma cells as possible and bring the disease into remission. The treatment depends on the type and stage of cancer, overall health, and preference.
Chemotherapy is a drug treatment in which chemicals destroy lymphoma cells. Chemotherapy drugs travel through the bloodstream and can reach almost all areas of the body. Chemotherapy drugs can be taken in pills or intravenously, and in some cases, both methods are used.
Treatment for classic Hodgkin's lymphoma usually begins with chemotherapy.
For nodular lymphocyte-predominant Hodgkin's lymphoma, chemotherapy is often combined with drugs that target the cancer cells (targeted therapy) and radiation therapy.
The side effects of chemotherapy depend on the drug. Common side effects include nausea and hair loss. Serious long-term complications such as heart disease, lung damage, fertility problems, and other cancers can also occur.
Radiation therapy
Radiation therapy uses high-energy beams such as X-rays and protons to destroy cancer cells.
For treatment of Hodgkin's lymphoma, radiation can be aimed at the affected lymph nodes and nearby areas where the disease might spread. It is usually used in combination with chemotherapy. For people with early-stage lymphocyte-predominant Hodgkin's lymphoma, radiation therapy may be the only treatment needed.
Side effects of radiation therapy include fatigue and skin redness in the area targeted by the radiation. Other side effects depend on the location of the radiation. For example, radiation to the neck can cause dry mouth and thyroid problems such as underactive thyroid (hypothyroidism). Radiation to the chest can cause heart and lung problems.
Bone marrow transplant
Bone marrow transplant, also known as stem cell transplant, is a treatment to replace diseased bone marrow with healthy stem cells. A bone marrow transplant may be used if Hodgkin's lymphoma returns or does not respond to other treatments.
During a bone marrow transplant, blood stem cells are removed, frozen and stored for later use. Next, you receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally, your stem cells are thawed and put back in your body where they help build healthy bone marrow.
Side effects of a bone marrow transplant include the side effects that might be caused by the chemotherapy or radiation before transplant.
Drug therapy
Drugs used to treat Hodgkin's lymphoma include:
- Targeted therapy. Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted therapy is often combined with chemotherapy for treating nodular lymphocyte-predominant Hodgkin's lymphoma. For classical Hodgkin's lymphoma, it might be an option in certain situations.
- Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system, may not attack the cancer because cancer cells produce proteins that help them hide from the immune system cells. For Hodgkin's lymphoma, immunotherapy might only be considered if the disease does not respond to other treatments.
