Hodgkin's lymphoma

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.
Advances in diagnosis and treatment of Hodgkin's lymphoma have helped give people with this
disease the chance for a full recovery. The prognosis continues to improve for people with
Hodgkin's lymphoma.
Signs and symptoms
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
Causes
Doctors aren't sure what causes Hodgkin's lymphoma. They know that it begins when infection-
fighting white blood cells called lymphocytes develop changes in their DNA. A cell's DNA
contains the instructions that tell a cell what to do.
The DNA changes tell 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 into the lymph nodes and cause swelling and other
Hodgkin's lymphoma signs and symptoms.
There are multiple types of Hodgkin's lymphoma. Your type is based on the characteristics of the
cells involved in your disease and their behavior. The type of lymphoma you have helps
determines treatment options.
Classical Hodgkin's lymphoma
Classical Hodgkin's lymphoma is the more common type of this disease. People diagnosed with
this type have large lymphoma 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 treatments
compared to the classical type of the disease.
Risk factors
Factors that can increase the risk of Hodgkin's lymphoma include:
  Your age. Hodgkin's 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. People who are assigned male at birth are slightly more likely to develop
Hodgkin's lymphoma than are those who are assigned female.
 Past Epstein-Barr infection. People who have had illnesses caused by the Epstein-Barr
virus, such as infectious mononucleosis, are more likely to develop Hodgkin's lymphoma
than are people who haven't had Epstein-Barr infections.
 HIV infection. People who are infected with HIV have an increased risk of Hodgkin's
lymphoma.
Diagnosis
Tests and procedures used to diagnose Hodgkin's lymphoma include:
 A physical exam. Your health care provider may ask about your symptoms and conduct a
physical exam. This might involve checking for swollen lymph nodes, including in your
neck, underarm and groin, as well as a swollen spleen or liver.
 Blood tests. A sample of your blood is examined in a lab to understand your general
health and look for signs of cancer.
 Imaging tests. Imaging tests are used to look for signs of Hodgkin's lymphoma in other
areas of your body. Tests may include X-ray, CT and positron emission tomography
(PET).
 A procedure to remove a lymph node. Your provider may recommend a lymph node
biopsy procedure to remove a lymph node for laboratory testing that looks for signs of
cancer.
 Other lab tests will analyze the lymphoma cells for markers on the surface of the cells
that can tell your health care team exactly what type of Hodgkin's lymphoma you have
and which treatments are best for your particular cancer.
 A procedure to remove a sample of bone marrow. A bone marrow biopsy and aspiration
procedure involves inserting a needle into your hipbone to remove a sample of bone
marrow. The sample is analyzed to look for Hodgkin's lymphoma cells.
 Other tests and procedures may be used depending on your situation.
Hodgkin's lymphoma stages
Hodgkin's lymphoma staging uses the numbers 1 to 4 to indicate the stage. A lower number
indicates an earlier stage cancer that's more likely to be cured. A higher number means the
cancer is more advanced.
Sometimes Hodgkin's lymphoma stages also include the letters A and B. The letter A means that
stage has no worrying symptoms of cancer. The letter B means that the signs and symptoms,
such as a persistent fever, unexplained weight loss and night sweats.
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. Which treatments are right for you depends on the
type and stage of your cancer, your overall health, and your preferences.

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill lymphoma cells. Chemotherapy
drugs travel through your bloodstream and can reach nearly all areas of your body.
Chemotherapy drugs can be taken in pill form or through a vein in your arm, or sometimes both
methods of administration are used.
Classical Hodgkin's lymphoma treatment usually begins with chemotherapy. It may be the only
treatment needed or it may be combined with radiation therapy.
For nodular lymphocyte-predominant Hodgkin's lymphoma, chemotherapy is often combined
with drugs that target the cancer cells (targeted therapy) and radiation therapy.
Side effects of chemotherapy depend on the drugs you're given. Common side effects are nausea
and hair loss. Serious long-term complications can occur, such as heart disease, lung damage,
fertility problems and other cancers.
Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells.
During radiation therapy, you lie on a table and a large machine moves around you, directing the
energy beams to specific points on your body.
For Hodgkin's lymphoma treatment, radiation can be aimed at affected lymph nodes and the
nearby areas where the disease might spread. It's usually used with chemotherapy. For people
with early-stage nodular lymphocyte-predominant Hodgkin's lymphoma, radiation therapy may
be the only treatment needed.
Radiation therapy side effects include fatigue and skin redness at the site where the radiation is
aimed. Other side effects depend on where the radiation is aimed. For instance, radiation to the
neck can cause dry mouth and thyroid problems, such as an 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 your
diseased bone marrow with healthy stem cells that help you grow new bone marrow. A bone
marrow transplant may be an option if Hodgkin's lymphoma returns or doesn't respond to other
treatments.
During a bone marrow transplant, your own 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 you undergo before your transplant. In addition, you may have an
increased risk of infection after your transplant.
Other drug therapy
Other drugs that are sometimes 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 your cancer because the cancer cells produce
proteins that help them hide from the immune system cells. Immunotherapy works by interfering
with that process. For Hodgkin's lymphoma, immunotherapy might be considered in certain
situations, such as if the disease doesn't respond to other treatments.