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Hodgkin's lymphoma

Hodgkin's lymphoma is a type of cancer in your lymphatic system. It’s also known as Hodgkin’s disease. Like all cancers, it’s caused by an abnormal and uncontrolled growth of cells.

The lymphatic system

Your lymphatic system includes your bone marrow, spleen, thymus and lymph glands (nodes). Your lymph glands make and store cells ready to fight any infections you might get. These cells are white blood cells called lymphocytes. Your lymphatic system also includes lymph vessels, which carry and recycle fluid (known as lymph fluid) in your body.

The diagram shows where the main glands, organs and vessels of your lymphatic system are. There are groups of lymph glands in your neck, armpit and groin. They appear in other areas too. You may be able to feel these as soft, round lumps (like a bean) under your skin.

What is Hodgkin's lymphoma?

There are many different types of cancer (malignant tumour) that can occur in the lymphatic system. These are called lymphomas. Hodgkin’s lymphoma is one type of these cancers. It can occur in a group of lymph glands in one area of your body. Sometimes, the cancer cells can spread through your lymph vessels to lymph glands in other parts of your body. The cancer cells may also spread further in your body to your spleen, liver, lungs or bone marrow.

In the UK, around 1,850 people are diagnosed with Hodgkin's lymphoma every year. Although it’s rare, it’s one of the most common cancers in children, teenagers and young adults.

Hodgkin's lymphoma isn’t the same as non-Hodgkin's lymphoma, which is a different type of lymphoma. These two types of lymphoma can be told apart by looking at the cells under a microscope. They are also treated differently.

Types of Hodgkin's lymphoma

Hodgkin's lymphomas are separated into two main groups according to how the cells look under a microscope.

  • Most people with Hodgkin’s lymphoma have the classical type.
  • More rarely, people can have a type called nodular lymphocyte predominant Hodgkin’s lymphoma.
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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the lymphatic system

Details

  • Symptoms Symptoms of Hodgkin's lymphoma

    The most common first symptom of Hodgkin's lymphoma is a swelling, often in your neck, upper chest, armpit or groin. This is a swollen lymph gland which is usually painless. It will feel firm rather than hard. These lumps may appear slowly over time. Other symptoms that some people may have include:

    • sweating at night
    • having a high temperature
    • unexplained weight loss
    • an itchy feeling all over your body
    • feeling tired
    • pain after drinking alcohol
    • a cough
    • shortness of breath

    These symptoms aren't always caused by Hodgkin's lymphoma, but if you have them, see your GP.

  • Diagnosis Diagnosis of Hodgkin's lymphoma

    To diagnose Hodgkin’s lymphoma, first your GP will ask about your symptoms and examine you. They will also review your medical history and may take a blood sample.

    Then, if your GP suspects you may have Hodgkin's lymphoma, they will refer you to a specialist at a hospital for further tests. These may include the following.

    • You may have blood tests to check your general health.
    • You may have a chest X-ray to look for swollen lymph glands inside your chest.
    • Your doctor may take a biopsy of your lymph gland. They may remove a whole gland or part of it to check in a laboratory. This may be done under local or general anaesthetic, depending on how deep underneath your skin the affected lymph gland is.
    • You may have a CT scan and/or PET (positron emission tomography) scan to look for signs of the disease in other parts of your body.
    • Your doctor may take a biopsy of your bone marrow. They may remove a sample of your bone marrow to check in a laboratory. This is usually done under a local anaesthetic and uses a needle to take a sample from your bone.

    If you’re diagnosed with Hodgkin’s lymphoma, these tests will also look at whether the cancer has spread and how big it is. This is described by the ‘stage’ of the disease; from stage 1 (no spread) to stage 4 (extensive spread).

  • Treatment Treatment of Hodgkin's lymphoma

    Your treatment will depend on the type of Hodgkin's lymphoma you have, whether it has spread and your general health. Most people have chemotherapy, and some will have radiotherapy too.

    A team of professionals, called a multidisciplinary team (MDT), will guide you through your treatment. This team may include:

    • a haematologist (a doctor who specialises in treating conditions affecting the blood)
    • an oncologist (a doctor who specialises in cancer care)
    • a radiologist (a doctor who specialises in using X-rays to diagnose conditions)
    • a radiation oncologist (or clinical oncologist) who uses X-rays to treat conditions
    • a nurse specialist
    • a counsellor

    They can explain your treatment options and help you make choices.

    After treatment, you will have an assessment to check if there are any remaining signs of your cancer. If there are, you’ll need more treatment. Then, you will have regular check-ups with your doctor to check for any signs of the cancer returning. You will have check-ups every three months or so to begin with and gradually they will become less frequent.

    About eight or nine out of every 10 people with Hodgkin’s lymphoma go into remission after their treatment and it goes away for good. Remission means the signs and symptoms of cancer have decreased or disappeared. Your cancer can be in complete or partial remission. Complete means there are no signs of your cancer. Partial means some but not all signs have disappeared.

    Chemotherapy

    Chemotherapy uses medicines to destroy cancer cells. These medicines are usually given through a drip into a vein in your arm. You may be given a few different medicines over a few months. You won’t receive the medicines everyday – you will have breaks to allow your body to recover from the side-effects of the medicines.

    Side-effects are the unwanted effects of chemotherapy. They can include losing your hair, feeling sick, tired and having diarrhoea.

    Sometimes you may be given steroid medicines (e.g. prednisolone) alongside your chemotherapy. These are to help the chemotherapy to work and are taken as tablets.

    Radiotherapy

    Radiotherapy uses X-rays to destroy cancer cells. A radiotherapy treatment only takes a few minutes. A beam of radiation is targeted to the cancer to shrink it. Depending on the type of Hodgkin’s lymphoma you have and its stage, you might have radiotherapy after your chemotherapy. You’ll need to go to the hospital for radiotherapy treatment, usually from Monday to Friday, and then have a rest over the weekend. How long your course of treatment lasts will depend on the area you’re having it on. Your doctor will be able to explain how long they expect you will need treatment for.

    Monoclonal antibodies

    Monoclonal antibodies are medicines that can recognise and target cancer cells. They aren’t used very often for people with Hodgkin's lymphoma. You may be given a monoclonal antibody medicine called rituximab if you have the nodular lymphocyte predominant type.

    Stem cell transplant

    If you still have Hodgkin’s lymphoma after your chemotherapy, or it comes back, you may need very high doses of chemotherapy. This could kill off special cells in your body, known as stem cells. Your body needs stem cells to make blood cells. To stop you becoming unwell, you will have a stem cell transplant. This is an injection of stem cells into your body to replace the ones you lost. See our FAQs for more information about this treatment option.

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  • Causes Causes of Hodgkin's lymphoma

    The exact reasons why you may develop Hodgkin’s lymphoma aren't fully understood. There are certain things that increase your chance of getting it, including:

    • a weakened immune system (for example, if you have HIV/AIDS, or you’re taking medicines that suppress your immune system)
    • having the Epstein-Barr viral infection (the virus that causes glandular fever)
    • previously having had non-Hodgkin’s lymphoma
    • gender – Hodgkin's lymphoma is slightly more common in men than women
    • age – although it can affect people of all ages, Hodgkin’s lymphoma is more common in people aged 15 to 30 and over 55 years
    • smoking
  • FAQs FAQs

    Where do the cells for a stem cell transplant for Hodgkin’s lymphoma come from?

    Answer

    The cells are usually taken from you before you have high-dose chemotherapy, but sometimes they come from another person (usually a close relative).

    Explanation

    If your first chemotherapy for classical Hodgkin’s lymphoma hasn’t worked well, you may need a higher dose of chemotherapy and a stem cell transplant. Your body can use the stem cells to make new blood cells to replace the ones the high-dose chemotherapy destroys.

    The stem cells are usually taken from your own blood or bone marrow before you begin high-dose chemotherapy. If the stem cells are collected from your blood, you’ll be given injections of a substance called ‘growth factor’ first. This will increase the number of stem cells in your blood. The stem cells are collected through a needle and drip (usually in your arm).

    If the stem cells are collected from your bone marrow, a doctor will use a needle to take bone marrow from your pelvic bone. You will have a general anaesthetic, which means you will be asleep during the procedure. Your stem cells will be put back in your body through a drip after you have finished your high-dose chemotherapy. This is known as an autologous stem cell transplant or autologous bone marrow transplant.

    Sometimes, you may need a stem cell or bone marrow transplant from another person. This is called an allogeneic transplant. It will usually be from a close family member because their cells are most likely to match your own. You may need to have this type of transplant if Hodgkin's lymphoma is affecting your bone marrow. Another reason you may need an allogeneic transplant is if your cancer has returned after a previous stem cell transplant of your own cells.

    How will a stem cell transplant for Hodgkin’s lymphoma affect me?

    Answer

    The side-effects usually come from the high-dose chemotherapy you have before the transplant, not the transplant itself. This treatment affects everyone differently and the length of time it takes to recover varies.

    Explanation

    Your immune system won't be very strong after high-dose chemotherapy and you’ll be more susceptible to infections. Although your stem cell transplant will help your body get stronger, this can take several weeks. You’ll need to stay in hospital for this time and will probably be nursed in a private room to stop you getting infections.

    Most side-effects come from the high-dose chemotherapy rather than the transplant. You’ll feel very tired. You may also lose your appetite, get a sore mouth and have sickness and diarrhoea.

    Your doctor might give you antibiotics and mouthwashes to help prevent you getting an infection and you’ll probably need to have blood transfusions. Once recovered, you will need to have new immunisations against diseases, as you will have lost any immunity you previously had.

    Some people need to have a stem cell or bone marrow transplant from another person. This is called an allogeneic transplant. If you have this type of transplant, there’s a chance you could develop a condition called ‘graft versus host disease’. This happens when white blood cells donated from the other person attack tissues in your body because they don’t recognise them. This causes symptoms such as diarrhoea, weight loss and rashes. You will be given medicines to prevent this.

    Will I be able to have children after treatment for Hodgkin's lymphoma?

    Answer

    Chemotherapy and radiotherapy can reduce your chances of having children or cause infertility. Sometimes this is only temporary. You may be able to have your sperm or eggs frozen before starting treatment, so you can use them to try to have children in the future.

    Explanation

    Hodgkin's lymphoma is commonly treated with chemotherapy. Some chemotherapy medicines can cause infertility, particularly if you have very high doses. Radiotherapy may also affect your fertility if used in your pelvic or abdominal area. Ask your doctor about your treatment and whether it can affect your chances of having children.

    It's sometimes possible for a clinic to freeze your eggs (if you’re a woman) or sperm (if you’re a man) before you start treatment. This is so you can use them with infertility treatment to have children in the future.

    Sometimes, it’s not possible to freeze and store sperm or eggs before starting chemotherapy. Be aware that, unfortunately, infertility treatments don’t always work.

    Your doctor will be able to give you more information about your options and let you know about sources of further information and support.

  • Resources Resources

    Further information

    Sources

    • Connors JM. Clinical manifestations and natural history of Hodgkin's lymphoma. Cancer J 2009; 15(2):124–8. doi:10.1097/PPO.0b013e3181a282d8
    • Campbell NA. Biology. 4th ed. Menlo Park, California: The Benjamin/Cummings Publishing Company, Inc.; 1996
    • Map of Medicine. Lymphoma. International View. London: Map of Medicine; 2013 (Issue 4). www.mapofmedicine.com 
    • Hodgkin lymphoma. Cancer Research UK. www.cancerresearchuk.org, reviewed 29 September 2014
    • Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program 2009; 523–31. doi:10.1182/asheducation-2009.1.523
    • Hodgkin lymphoma cancer statistics. Cancer Research UK. www.cancerresearchuk.org, reviewed 16 April 2014
    • Childhood cancer incidence statistics. Cancer Research UK. www.cancerresearchuk.org, reviewed 5 June 2014
    • Teenage and young adult cancer incidence statistics. Cancer Research UK. www.cancerresearchuk.org, reviewed 25 March 2013
    • Eichenauer DA, Engert A, Dreyling M, et al. Hodgkin’s lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22(Suppl 6): vi55–8. doi:10.1093/annonc/mdr378
    • Stem cell transplants. Cancer Research UK. www.cancerresearchuk.org, reviewed 15 July 2013.
    • Bone marrow transplants. Cancer Research UK. www.cancerresearchuk.org, reviewed 12 July 2013
    • Side effects of bone marrow and stem cell transplants. Cancer Research UK. www.cancerresearchuk.org, reviewed 12 July 2013
    • Royal College of Physicians. The effects of cancer treatment on reproductive functions: Guidance on management. www.rcr.ac.uk, published 2007
    • Hodgkin’s lymphoma. Patient Plus. www.patient.co.uk/patientplus.asp, published 14 May 2014
    • Dictionary of cancer terms. National Cancer Institute. www.cancer.gov, accessed 25 November 2014
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