What is Hodgkin lymphoma?
Hodgkin Lymphoma (HL) is cancer of the lymphatic system, part of the immune system, and mainly affects the lymphocytes. Hodgkin lymphoma differs from non-Hodgkin lymphoma in that it is characterised by the presence of a particular cancer cell, known as the Reed-Sternberg cell.
Hodgkin lymphoma is a relatively rare condition, with approximately 120 people in New Zealand being diagnosed each year. It is seen in all age groups but is more common in people aged 15-30 years old and 55-70 years old. HL is more common in males than in females.
Signs and symptoms
The symptoms of Hodgkin lymphoma vary from person to person and can be difficult to diagnose.
In HL, the normal blood cells in the bone marrow, blood and lymph glands can be crowded out by large numbers of lymphoma cells. This can result in symptoms such as anaemia, bleeding, bruising and infections.
Anaemia (low haemoglobin)
- Lack of energy (lethargy)
- Feeling tired all the time (fatigue)
- Shortness of breath, especially when exercising
- Dizziness
- Pale skin
Bleeding and bruising (low number of platelets)
- Bruising easily
- Minor cuts or injuries that take a long time to stop bleeding
- Frequent or severe nosebleeds or bleeding gums
- Red or purple pinhead-sized spots on the skin called petechiae
- Heavier or more frequent menstrual periods
Infections
- Fever (high temperature)
- Shivering
- Coughing up yellow or green phlegm
- Fatigue or extreme tiredness
Swollen lymph glands (lumps)
People with HL commonly have firm, usually painless, swelling of a lymph node. The most common sites are the neck, under the arms or in the groin. Sometimes HL starts in lymph nodes in deeper parts of the body like the stomach (causing bloating or fullness after eating) or the chest (causing coughing, pain or difficulty breathing).
B symptoms
Drenching night sweats, unexplained weight loss and fevers are sometimes called B symptoms.
Other symptoms
- Generalised itching
- Rash
- Loss of appetite
- Blood clots.
Causes
Like other cancers, HL is thought to develop after DNA is damaged, causing genetic mutations. HL is not contagious and in most cases, people diagnosed with HL have no family history of it.
Certain factors may put some people at a higher risk of developing HL. These include:
- Immunosuppression – A small percentage of lymphomas occur in people whose immune system has been weakened (immunosuppressed) either by a viral infection such as human immunodeficiency virus (HIV) or because of drugs which affect the function of the immune system (immunosuppressants).
- Infection – In some cases, particularly in people who are immunosuppressed, viral infections such as Epstein-Barr virus (EBV) or human T-lymphotropic virus (HTLV-1) or bacteria such as H. pylori, may damage developing lymphocytes and increase the risk of lymphoma.
- Chemicals – Exposure to high concentrations of agricultural chemicals, such as pesticides and fertilisers may increase the risk of developing lymphoma.
- Radiation – Exposure to significant or long-term radiation (including people who have previously been treated for cancer using ionising radiation) may be at an increased risk of developing lymphoma.
Diagnosis
Your doctor will diagnose HL by talking with you about how you’re feeling, looking at a sample of your blood and taking a biopsy of a lump or lymph node.
Blood samples are taken from a vein in your arm and sent to the laboratory to be examined. They will likely check your full blood count (FBC), your blood chemistry and may do specialised tests to identify any abnormalities with the chromosomes, genes or DNA.
A lymph node biopsy is a procedure where all or part of a lymph node is removed and sent to be examined in the laboratory.
Information from a lymph node biopsy can confirm what type of lymphoma you have and is used to decide the best type of treatment.
You may need additional tests, which may include:
- More blood tests
- A lumbar puncture: where fluid is taken from the spine to test whether the lymphoma involves the brain or spine.
- A bone marrow biopsy: where a sample is taken from the hip bone to determine if there are cancer cells in the bone marrow.
- A CT scan: a radiology procedure that uses a combination of X-rays and computer technology to produce images of any part of the body. A special liquid may be given before the test to help outline the abdomen and occasionally injections are given into a vein to outline different organs. People usually lie on their back for about ten minutes during the scan.
- An MRI Scan: uses magnetic and radio waves to produce a detailed 3D image of part of your body
- A PET scan: a specialised CT scan that uses a radioactive tracer and special cameras to detect areas in the body affected by lymphoma.
Treatment
Treatment for HL may be different from person to person. It will depend on your age, general health, what stage and type of HL you have. There are 2 main types of HL:
- Classical Hodgkin lymphoma
- Nodular lymphocyte-predominant Hodgkin lymphoma
Around 95% of HL are classical Hodgkin lymphoma and are further divided into 4 subtypes: nodular sclerosing, mixed cellularity, lymphocyte-rich and lymphocyte depleted.
The stage of lymphoma you have depends on how much it has spread in your body. There are 4 stages of HL (see figure below).
Common types of treatment for HL include:
- Chemotherapy
- Steroid therapy
- Radiotherapy
- Immunotherapy and targeted treatments
- Stem cell transplant.
