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Hodgkin's lymphoma

In the UK, Hodgkin's lymphoma accounts for less than one in every 100 cancers diagnosed. It's one of the most common cancers in teenagers, but it can occur at any age.

Around 1,500 people are diagnosed with Hodgkin's lymphoma every year. Around twice as many men as women get Hodgkin's lymphoma.

Hodgkin's lymphoma may also be referred to as Hodgkin lymphoma or Hodgkin's disease. It can be confused with non-Hodgkin's lymphoma, which is a separate condition and is more common. For information on non-Hodgkin's lymphoma, see Related topics.

About Hodgkin's lymphoma

The lymphatic system

Your lymphatic system consists of a network of organs which includes the liver, spleen, thymus and lymph glands (nodes) connected by lymph vessels. These vessels transport lymph fluid which contains body fluid, fat and white blood cells called lymphocytes which fight infection. You have two main types of lymphocyte cell - B cells (which produce antibodies) and T cells (which kill virus-infected cells). These cells develop from stem cells.

What is Hodgkin's lymphoma?

Hodgkin's lymphoma occurs when there is an abnormal and uncontrolled growth of certain cells in the lymph organs.

The tumour can grow through your lymph organs and cells can spread in the lymph system where they may grow and form secondary tumours. The cells may also spread to other parts of your body through your bloodstream and may grow and form secondary tumours in other organs of your body. This spread of cancer is called metastasis.

Types of Hodgkin's lymphoma

There are a number of types of Hodgkin's lymphoma. The types are separated into two groups - classical types and the nodular lymphocyte predominant type. The four main classical types are:

  • nodular sclerosing - the most common
  • mixed cellularity
  • lymphocyte rich
  • lymphocyte depleted - this is rare

A certain type of cell called the Reed-Sternberg cell is found in the classical types of Hodgkin's lymphoma when lymph node cells are seen under a microscope.

The other main group called nodular lymphocyte predominant type contain few or no Reed-Sternberg cells but have abnormal "popcorn" like cells. This type of Hodgkin's lymphoma is usually found in one area.

Symptoms

The initial symptom of Hodgkin's lymphoma is swelling, often found in the neck, armpit or groin. It's usually painless but can ache in some people.

Other symptoms can include:

  • excessive sweating - particularly at night
  • a high temperature which comes and goes
  • unexplained weight loss
  • tiredness
  • coughing or finding it hard to breathe
  • itchy feeling all over the body
  • getting more infections than usual
  • excessive bleeding when injured, if your nose bleeds or if you have a period
  • bone, nerve or abdominal pain

Although not usually a sign of Hodgkin's lymphoma, if you experience these symptoms, you should seek medical advice.

Causes

The cause of Hodgkin's lymphoma isn't understood at present. But there are certain factors that may make Hodgkin's lymphoma more likely, including the following.

  • Lowered immunity - such as if you have HIV, are taking medicines after a transplant operation or you have a rare medical condition which affects your immunity.
  • Epstein-Barr viral infection (glandular fever) - slightly increases your risk of developing Hodgkin's lymphoma.

Diagnosis

Your doctor will ask you about your symptoms and will examine you. He or she may take a blood test. Your doctor may refer you to a hospital specialist for more blood tests and further tests including the following.

  • A biopsy is when a small sample of your lymph node tissue or the lymph node itself is taken. Your doctor may use an ultrasound or CT scan to guide a needle to the lymph node to take a biopsy. This will be sent to a laboratory for testing.
  • A bone marrow sample may be taken to see if it contains lymphoma cells. A sample of the bone and bone marrow is often taken from the hip bone (pelvis). You will be given a local anaesthetic and may have a sedative.
  • You may need a chest X-ray. This creates an image so your doctor can see if any of the lymph nodes in the chest are enlarged.
  • A CT (computerised tomography) scan uses X-rays to build up a three-dimensional picture of the body. You may be given a drink or an injection before the scan which contains a dye to help see if there are any areas of cancer.
  • An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the inside of the body which can help your doctor see if the cancer has spread. You may be given an injection before the scan to help see if there are any areas of cancer.
  • A new type of scan called a PET (positron emission tomography) scan may be used but this is not widely available. For this you will be given an injection of a weak radioactive sugar a few hours before the scan. This is usually into your arm. The radioactive substance will show any areas where there may be cancer.
  • Other tests may be needed such as a bone scan to see if the lymphoma has spread to the bones, or a urogram which looks at your urinary system (including your bladder) to see if it has been affected.

Ask your doctor to explain the tests you will have.

For more information, see Related topics.

Treatment

The treatment for Hodgkin's lymphoma depends on the type of cancer you have and the stage and grade of the cancer. The treatment usually consists of chemotherapy with or without radiotherapy.

Chemotherapy medicines

Medicines to attack cancer cells are usually given as an injection into your arm, but you may need to take tablets or capsules. A combination of medicines may be given over a number of days, this is often followed by a break in the treatment for a few weeks. The treatment cycle is then restarted. The breaks between the treatments allow your body to recover from the side-effects of the medicines.

The most commonly used treatment is called ABVD, which includes the medicines adriamycin (doxorubicin), bleomycin, vinblastine and dacarbazine.

There are several other combinations that might be used, or may be offered as part of a clinical trial. Ask the doctor who is treating you for advice.

Steroids

Some chemotherapy includes steroid medicines (eg prednisone) to treat the cancer and to help reduce side-effects of the chemotherapy. It's best to take steroids early in the day so they don't affect your sleep pattern. For more information on chemotherapy, see Related topics.

Radiotherapy

This uses radiation, rather like strong X-rays, to destroy cancer cells. This will only be used if the cancer is in one or two lymph node areas. It may be given at the same time as chemotherapy. For more information on radiotherapy, see Related topics.

High dose treatment

Very high doses of chemotherapy can be given to some people if standard chemotherapy has not successfully treated Hodgkin's lymphoma or if it has come back. With this treatment you will have a stem cell transplant (also known as a peripheral blood stem cell transplant). A stem cell transplant is needed so healthy blood cells can be replaced after the treatment because high dose chemotherapy may destroy the bone marrow where blood cells are produced. All the cells in the body can develop from stem cells.

Living with Hodgkin's lymphoma

Hodgkin's lymphoma is one of the most curable cancers, particularly if it's only found in one area. After treatment for the cancer you will have regular check ups with your doctor to detect any evidence of the cancer returning. This will be every three months or so to begin with and will gradually become less frequent.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may be support groups so you can meet people who may have similar experiences to you. Ask your doctor for advice.

Further information

Cancerbackup

Sources

  • British National Formulary (BNF) March 2007. Vol. 53: BMJ Publishing Group, 2007
  • Improving outcomes in haemological cancers. National Institute for Health and Clinical Excellence (NICE), 2003. www.nice.org.uk
  • UK Hodgkin's lymphoma incidence statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 24 September 2007
  • Hodgkin's lymphoma. Cancerbackup. www.cancerbackup.org.uk, accessed 24 September 2007
  • Hodgkin's lymphoma. BMJ Clinical Evidence. http://clinicalevidence.bmj.com, accessed 24 September 2007
  • Simon C, Everitt H, Kendrick T, Oxford Handbook of General Practice. Oxford: Oxford University Press. 2005: 534-535
  • Souhami R, TJ, Cancer and its Management. 5th ed. Oxford: Blackwell, 2005
  • Types of Hodgkin's lymphoma. Cancer Research UK. www.cancerhelp.org.uk, accessed 25 September 2007

Related topics

  • Chemotherapy
  • CT scan
  • MRI scan
  • Non-Hodgkin's lymphoma
  • Radiotherapy