Hodgkin Disease

With Hodgkin disease malignant (cancer) cells form in the lymph system. The lymph system is part of the body’s immune system. The immune system protects the body from foreign substances, infection, and diseases. The following is all part of the lymph system:

  • Lymph: Colorless, watery fluid that carries lymphocytes (type of white blood cell) through the lymph system. Lymphocytes protect the body against infection.

  • Lymph nodes: Small bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along lymph vessels, found throughout body. Clusters of lymph nodes are found in neck, underarm, abdomen, pelvis and groin.

  • Spleen: An organ located on the left side of the abdomen near the stomach, that filters blood, makes lymphocytes, stores blood cells and destroys old blood cells.

  • Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.

  • Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.

  • Bone marrow: The soft spongy tissue in the center of the large bones. Bone marrow makes white blood cells, red blood cells and platelets. 

Types of Hodgkin Lymphoma

  • Classical Hodgkin lymphoma: Divided into four subtypes, based on how the cancer cell looks under the microscope.
    • Nodular sclerosis Hodgkin lymphoma: This the most common subtype of classical Hodgkin lymphoma, accounting for 45% of all cases in children 8 years of age and younger and 80% of all cases in older children.
    • Mixed cellularity Hodgkin lymphoma: Accounts for 30% of all cases and most commonly seen in children 10 years of age or younger.
    • Lymphocyte-rich classical Hodgkin Lymphoma: This subtype accounts for approximately 5% of all cases.
    • Lymphocyte-depleted Hodgkin lymphoma: Rare subtype, is associated with patients who have human immunodeficiency virus
  • Nodular-lymphocyte predominant Hodgkin Lymphoma: Closely resembles lymphocyte-rich classical Hodgkin lymphoma.

Signs and symptoms

  • Swollen lymph nodes: Painless, near the collarbone, or in the neck, chest, underarm or groin
  • Fevers: Unexplained fevers of 100.4 F or above
  • Night sweats that are drenching
  • Weight loss: Unexplained weight loss of 10% during a 6 month period
  • Fatigue
  • Itchy skin

Tests to help diagnose Hodgkin Lymphoma

  • Physical exam and history: The health care provider checks general signs of health, assesses for any lumps or anything else that seems unusual. They will also get history of past illnesses, health habits and any family history of illness or cancer.

  • CT scan: A computer assisted X-ray that shows detailed pictures inside the body, such as neck, chest, abdomen and pelvis. A dye may be injected into a vein or swallowed to help the organ and tissues show up more clearly.

  • PET scan (positron emission tomography): An X-ray that helps to show where the malignant tumor cells are in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The scanner will then make pictures where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells. The PET scan has three steps:

    • Injection of radioactive glucose

    • A waiting period of 30-60 minutes

    • Scanning by the PET machine

  • Chest X-ray: An X-ray of the organs and bones inside the chest.

  • Blood tests:

    • CBC (complete blood count) checks the number of red blood cells (oxygen carriers), platelets (cells that help the blood clot properly) and white blood cells (infection fighters)

    • Sedimentation rate can help measure how much inflammation is in the body

    • Blood chemistry studies measures amounts of certain substances released into the blood by organs and tissues in the body.

All these tests are usually done at time of diagnosis to rule out other diseases and are also done throughout treatment to monitor response and to monitor for possible side effects of treatment.

  • Lymph node biopsy: Removal of all or part of a lymph node. There are different types of biopsies.

    • Excisional biopsy: Removal of an entire lymph node

    • Incisional biopsy: Removal of part of a lymph node

    • Core biopsy: Removal of tissue from a lymph node using a wide needle

    • Fine needle aspiration biopsy: Removal of tissue from a lymph node using a thin needle

A pathologist will look at the tissue under the microscope to look for cancer cells. Reed - Sternberg cells are common in classical Hodgkin lymphoma.

  • Bone marrow aspiration and biopsy: Sometimes done to help determine if the Hodgkin lymphoma cells are in the bone marrow, the blood producing factory in the body. A special needle is inserted into one of the bones (typically the back of the hip bone) and a small amount of marrow (liquid part) is aspirated into a syringe. The biopsy includes taking a small piece of bone and sending it to lab for review. Since the procedure is uncomfortable most patients are given pain medicine or sedated during procedure.

How is it treated?

Chemotherapy

Medications that are used to help kill cancer cells. Multiple types of chemotherapy medications are used in the treatment of Hodgkin lymphoma. Chemotherapy is given in a specific sequenced combination, mostly given IV. The health care team will explain in detail the treatment plan and possible side effects of the chemotherapy.

Radiation therapy

A special type of X-ray treatment that kills or damages cancer cells. If radiation treatment is necessary the radiation therapy doctor will explain how the radiation is given, possible side effects and how long the radiation treatments will last.