Hodgkin's lymphoma

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who have Hodgkin's lymphoma, or who would like information about it.

Hodgkin's lymphoma, also known as Hodgkin's disease, is an abnormal and uncontrolled growth of cells in the lymphatic system.

How cancer develops

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About Hodgkin's lymphoma

The lymphatic system

Your lymphatic system is the tissues and organs, including your bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. These tissues and organs are connected by lymph vessels, which transport lymph fluid. Lymph fluid contains body fluid, fat and white blood cells called lymphocytes, which fight infection.

There are two main types of lymphocyte: B cells (that produce antibodies - proteins that fight against bacteria and viruses) and T cells (that interact more directly with other cells and sometimes kill them, for example cells that are infected with a virus).

What is Hodgkin's lymphoma?

Hodgkin's lymphoma is a type of cancer that affects your lymphatic system. It may affect groups of lymph nodes in just one area of your body. However, the cancerous cells can sometimes spread through your lymphatic system to lymph nodes in other parts of your body, where they may form secondary tumours. The cancerous cells may also spread to other parts of your body through your blood and may form secondary tumours in other organs.

In the UK, around 1,600 people are diagnosed with Hodgkin's lymphoma every year. It's one of the most common cancers in teenagers.

Hodgkin's lymphoma 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.

Types of Hodgkin's lymphoma

There are a number of types of Hodgkin's lymphoma. They are separated into two groups - classical (most Hodgkin's lymphomas are classical) and nodular lymphocyte predominant.

The four main classical types are:

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

A certain type of cell called a Reed-Sternberg cell is found in the classical types of Hodgkin's lymphoma when lymph node cells are examined under a microscope. The presence of these cells confirms that you have classical Hodgkin's lymphoma.

The nodular lymphocyte predominant type of Hodgkin's lymphoma contains very few Reed-Sternberg cells but has abnormal 'popcorn'-like cells.

Symptoms of Hodgkin's lymphoma

The most common first symptom of Hodgkin's lymphoma is swelling, often in your neck, armpit or groin. It's usually painless but can ache.

Other symptoms can include:

• excessive sweating - particularly at night
• recurrent high temperatures
• unexplained weight loss
• a cough or difficulty breathing
• an itchy feeling all over your body
• occasionally, pains in your abdomen (tummy) after drinking alcohol

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

Causes of Hodgkin's lymphoma

The causes of Hodgkin's lymphoma aren't fully understood at present. But there are certain factors that increase your likelihood of getting it, including the following.

• A weakened immune system - such as if you have HIV/AIDS, or are taking medicines that suppress your immune system.
• Epstein-Barr viral infection (glandular fever) - this may slightly increase your risk of developing Hodgkin's lymphoma.
• Gender - Hodgkin's lymphoma is slightly more common in men than in women.
• Age - Hodgkin's lymphoma can occur in people of all ages but it's more common in people aged between 15 and 29 and over 50.

Diagnosis of Hodgkin's lymphoma

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may take a blood sample.

If your GP thinks you have Hodgkin's lymphoma, he or she will refer you to a specialist at a hospital for further tests that may include the following.

• A biopsy - this is a small sample of tissue, which is taken from your lymph node. The sample will be sent to a laboratory for examination under a microscope.
• A CT scan, to see whether Hodgkin's lymphoma has spread.
• A bone marrow biopsy, to check whether Hodgkin's lymphoma has spread to your bone marrow.

Treatment of Hodgkin's lymphoma

Treatment will depend on the type of Hodgkin's lymphoma you have and whether it has spread. You will usually have chemotherapy, and sometimes radiotherapy.

Hodgkin's lymphoma is one of the most curable cancers, particularly if it's only found in one area.

A team of professionals will help you through your treatment. This team may include a nurse specialist, a haematologist (a doctor who specialises in treating conditions affecting the blood), an oncologist (a doctor who specialises in the treatment of cancer), a radiotherapist (a doctor who specialises in treating conditions using radiation) and a counsellor.

After treatment, you will have regular check-ups with your doctor to see if there are any signs of the cancer returning. You will have check-ups every three months or so to begin with and they will gradually become less frequent.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. These medicines will usually be injected into a vein in your arm, but you may need to take tablets or capsules instead. You may be given a combination of medicines over a number of days. This is often followed by a break in treatment for a few weeks. The treatment cycle will then be restarted. The breaks between treatments will allow your body to recover from the side-effects of the medicines.

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

Sometimes you may be given steroid medicines (eg prednisolone) with chemotherapy.

If standard chemotherapy hasn't been successful or Hodgkin's lymphoma has come back, you may need to have very high doses of chemotherapy. If this happens, you may need to have a stem cell transplant to help you produce healthy blood cells after the high dose treatment. Stem cells are the most basic type of cells, from which all other types of cells in your body develop.

Radiotherapy

Radiotherapy uses X-rays to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the cancer.

Monoclonal antibodies

Monoclonal antibodies are medicines designed to recognise and target markers that are commonly carried by cancer cells. They are not used very often for people with Hodgkin's lymphoma, but you may be given a monoclonal antibody medicine called rituximab if you have the nodular lymphocyte predominant type of the disease.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.