Cancer - Hodgkin’s lymphoma

Alternative names
Lymphoma - Hodgkin’s; Hodgkin’s disease; Hodgkin’s lymphoma

Definition
Hodgkin’s lymphoma is a malignancy (cancer) of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow.

Causes, incidence, and risk factors

The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to adjacent lymph nodes and later may spread outside the lymph nodes to the lungs, liver, or bone marrow.

The cause is not known. The incidence is 2 in 10,000 people. Hodgkin’s lymphoma is most common among people 15 to 35 and 50 to 70 years old.

Symptoms

     
  • Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)  
  • Fatigue  
  • Fever and chills  
  • Night sweats  
  • Weight loss  
  • Loss of appetite  
  • Generalized itching

Additional symptoms that may be associated with this disease:

     
  • Excessive sweating  
  • Skin blushing or flushing  
  • Neck pain  
  • Hair loss  
  • Flank pain  
  • Clubbing of the fingers or toes  
  • Splenomegaly

Signs and tests
The disease may be diagnosed after:

     
  • A lymph node biopsy  
  • A bone marrow biopsy  
  • A biopsy of suspected tissue  
  • Detection of Reed-Sternberg (Hodgkin’s lymphoma) cells by biopsy

A staging evaluation (tumor staging) to determine extent of disease includes:

     
  • A physical examination  
  • CT scans of the chest, abdomen, and pelvis  
  • A bone marrow biopsy  
  • Blood chemistry tests  
  • A PET scan (a nuclear medicine test that looks for tumor cells throughout the body)  
  • Abdominal surgery to biopsy the liver and take out the spleen to see if it is affected by the lymphoma. However, because the other tests are now so good at detecting the spread of Hodgkin’s lymphoma, this surgery is usually unnecessary.

This disease may change the results of the following tests:

     
  • T-lymphocyte count  
  • Small bowel biopsy  
  • Schirmer’s test  
  • Peritoneal fluid analysis  
  • Mediastinoscopy with biopsy  
  • Gallium scan  
  • Ferritin  
  • Cytology exam of pleural fluid  
  • Cryoglobulins  
  • Bone marrow aspiration  
  • Blood differential  
  • ACE levels

Treatment
A staging evaluation is necessary to determine the treatment plan.

     
  • Stage I indicates one lymph node region is involved (for example, the right neck).  
  • Stage II indicates involvement of 2 lymph nodes on the same side of the diaphragm (for example, both sides of the neck).  
  • Stage III indicates lymph node involvement on both sides of the diaphragm (for example, groin and armpit).  
  • Stage IV involves the spread of cancer outside the lymph nodes (for example, to bone marrow, lungs, or liver).

Treatment varies with the stage of the disease. Stages I and II (limited disease) can be treated with localized radiation therapy, with chemotherapy or with a combination of both. Stages III and IV (extensive disease) are treated with a combination of radiation therapy and chemotherapy. The best treatment for an individual patient depends on many factors, and should be discussed in detail with a doctor who has experience treating this disease.

Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. A soft toothbrush and electric razor should be used for personal hygiene.

Infection should always be taken seriously during cancer treatment, so contact your doctor immediately if fever or other signs of infection develop. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia.

Support Groups
The stress of illness can often be eased by joining a support group of people sharing common experiences and problems. See cancer - support group.

Expectations (prognosis)
With appropriate treatment, more than 80% of people with stage I or II Hodgkin’s survive for at least 10 years. With widespread disease, the treatment is more intense and the 5-year survival rate is about 60%.

Complications

     
  • Possible acute non-lymphocytic leukemia (ANLL) as a result of treatment  
  • Possible non-Hodgkin’s lymphoma  
  • Liver failure  
  • Adverse effects of radiation and chemotherapy

Calling your health care provider
Call your health care provider if you have symptoms suggestive of Hodgkin’s lymphoma.

Call your health care provider if you are being treated for Hodgkin’s lymphoma and experience adverse effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.