Hodgkin's lymphoma, also known as Hodgkin lymphoma or Hodgkin cancer, occurs when lymphocytes, a type of white blood cells, divide uncontrollably and form a mass. The commonly observed symptoms of this condition include enlarged lymph nodes, night sweats, persistent fatigue, and fever. Due to the availability of advanced diagnostic and treatment techniques in recent decades, the survival rates of Hodgkin’s cancer have improved, and the prognoses have been far more promising.
The lymphatic system is an integral part of our immune system and comprises T lymphocytes, B-lymphocytes, and natural killer cells. They play a pivotal role in destroying germs and infections. When the B lymphocytes or T lymphocytes divide uncontrollably and form a mass, it is referred to as lymphoma.
As for Hodgkin lymphoma meaning, it is a condition where the B-cells, a type of WBC, undergo uncontrolled division due to DNA mutations and form a mass. Lymphoid tissues are present in various body areas, including lymph vessels, lymph nodes, bone marrow, thymus, spleen, adenoids, and tonsils. Hodgkin disease most commonly occurs in the lymphoid tissues of upper body parts, such as the neck, chest, or under the arms.
Although Hodgkin's lymphoma is a rare disease, it is one of the most common cancers found in individuals between 15 and 19 years of age. Globally, Hodgkin's lymphoma comprises 0.4% of all cancer cases and 0.2% of all cancer-related deaths. The incidence rate of Hodgkin’s lymphoma is 0.98 per 100,000, and mortality is 0.26 per 100,000. Being a male, a history of Epstein-Barr virus infection, HIV infection, exposure to pollution, family history, cigarette smoking, and autoimmune diseases are risk factors for Hodgkin’s lymphoma. In recent times, there has been an increasing incidence of Hodgkin's lymphoma in females, in Asian countries, and in the younger population.
There are several differences between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, and the predominant ones include the following:
Reed-Sternberg cells, abnormal cells in the lymph nodes, are present in Hodgkin's lymphoma but not in non-Hodgkin’s lymphoma.
Hodgkin’s lymphoma usually initiates in a single lymph node and then spreads to the nearby nodes. In contrast, non-Hodgkin’s lymphoma occurs in multiple lymph nodes and may affect organs and tissues outside the lymphatic system.
Hodgkin’s lymphoma usually spreads predictably and is thus diagnosed at early stages. On the other hand, non-Hodgkin’s lymphoma is highly unpredictable in spread and is thus diagnosed at different stages.
The prognosis of Hodgkin’s lymphoma is generally favorable, even in patients with advanced disease. The prognosis of non-Hodgkin’s lymphoma depends on the subtypes. Some subtypes are aggressive, while others are slow-growing.
Following are the different types of Hodgkin lymphoma:
Classical Hodgkin’s lymphoma accounts for almost 90% of all Hodgkin’s disease cases. This type is characterized by Reed-Sternberg cells (abnormal B-lymphocytes). Classical Hodgkin’s lymphoma is further divided into subtypes based on the appearance of Reed-Sternberg cells and other features.
This type of Hodgkin’s lymphoma usually initiates in the neck and chest and is one of the most common types of Hodgkin’s lymphoma in developed countries. It accounts for almost 70% of cases. Although it may occur at any age, teens and young adults are at high risk for this subtype.
It accounts for almost 35 to 40% of Hodgkin’s lymphoma cases. In this type, the Reed-Sternberg cells are usually surrounded by histiocytes, plasma cells, and eosinophils.
Relatively fewer Reed-Sternberg cells are present in the tumor. The tumor has abundant lymphocytes that give it a unique appearance under the microscope. It mostly affects individuals between 30 and 40 years of age.
Unlike lymphocyte-rich Hodgkin’s lymphoma, lymphocyte-depleted Hodgkin’s lymphoma is characterized by significantly fewer lymphocytes. It is usually diagnosed in individuals over 55 years of age and is relatively less common in young people.
Apart from classical Hodgkin’s lymphoma, the other types of Hodgkin’s lymphoma include:
This type of Hodgkin’s lymphoma is characterized by lymphocyte-predominant (LP) cells. These are large, atypical cells. The nodular lymphocyte-predominant Hodgkin’s lymphoma does not have Reed-Sternberg cells. It is a slow-growing tumor with a favorable prognosis.
It is an aggressive form of lymphoma that arises from B-cells and results in various symptoms. Reed-Sternberg cells are absent in diffuse large B-cell lymphomas. The risk of diffuse large B-cell lymphoma increases with age. It is not usually found in children.
Diffuse large T-cell lymphoma originates from mature T-cells. It is relatively less common than diffuse large B-cell lymphoma. It is aggressive and involves rapid, diffused growth of abnormal T-cells.
Following are the different Hodgkin’s lymphoma stages:
In Hodgkin’s lymphoma stage 1, the tumor is present only in one lymph node, OR only one extra lymphatic organ is invaded by cancer.
Stage 2 Hodgkin lymphoma is characterized by the presence of cancer in two or more lymph node regions on the same side (below or above) of the diaphragm.
In this Hodgkin’s lymphoma stage, the disease may be present in a single organ and its lymph nodes, with or without the invasion of the tumor to regions of other lymph nodes on the same side of the diaphragm.
Hodgkin’s lymphoma stage 2B is similar to stage 2 or stage 2E, along with a mass present in the chest.
The tumor has invaded the lymph node regions above and below the diaphragm.
It involves at least one organ beyond the lymph nodes, such as the bone marrow, liver, or lungs.
Commonly observed symptoms of Hodgkin’s lymphoma include fever, fatigue, weight loss, and weakness. However, these symptoms overlap with those of other health conditions, and this makes the diagnosis of Hodgkin’s lymphoma challenging. Therefore, it is important not to ignore persistent symptoms. The exact causes of Hodgkin’s lymphoma disease are unknown. However, certain factors contribute to the development of the disease.
Some of the common Hodgkin’s lymphoma symptoms are:
Fatigue is one of the most common Hodgkin’s lymphoma symptoms and significantly affects the patient’s quality of life. Fatigue in patients with Hodgkin’s lymphoma may be due to various reasons, some related to the disease and some from treatment. In some patients, Hodgkin’s lymphoma may cause a reduction in red blood cell levels, leading to fatigue. In some patients, widespread inflammatory processes because of the body's response to fighting cancer cells may lead to fatigue. Treatment-related factors contributing to fatigue include radiation therapy, chemotherapy, and stem cell transplantation.
Like fatigue, high fever is also one of Hodgkin’s lymphoma symptoms related to the disease. A few specific treatments used to treat this condition may also lead to fever. Certain chemicals released by cancer cells trigger an immune response, resulting in the secretion of inflammatory mediators. It results in a high fever. Additionally, treatments, such as chemotherapy, weaken the immune system, leading to an increased risk of infection. Infections may also lead to a high fever.
Night sweats could also be a Hodgkin’s lymphoma cancer symptom. Night sweats and drenching to the extent that the clothes and bedsheets get soaked are a cause for concern and require immediate medical attention. Night sweats observed in patients with Hodgkin lymphoma disease may be due to an inflammatory response and the release of cytokines as an immune response against Hodgkin’s lymphoma cells.
Hodgkin’s lymphoma may also disrupt the levels of certain hormones, leading to night sweats.
Along with night sweats, weight loss is also a Hodgkin’s lymphoma B symptom used for staging the disease. If patients with Hodgkin’s lymphoma have unexplained significant weight loss, it indicates the possibility of a more aggressive type of Hodgkin’s lymphoma. Weight loss may be an early sign of Hodgkin’s lymphoma due to metabolic changes, loss of appetite, and increased energy requirements. As the disease advances, patients may experience cachexia that results in muscle wasting, significant weight loss, and weakness.
Chest pain is one of the most common Hodgkin’s lymphoma symptoms in cases where the tumor forms in the lymph nodes of the mediastinum. The enlarged lymph nodes compress the surrounding tissues, such as blood vessels, nerves, and the lungs, causing pain and discomfort. Superior vena cava syndrome is a rare Hodgkin’s lymphoma symptom. It occurs when the enlarged lymph nodes compress a major blood vessel, the superior vena cava. It results in facial swelling and chest pain. It is usually a symptom of stage 4 Hodgkin’s lymphoma.
Patients with Hodgkin’s lymphoma have trouble breathing due to several reasons. It includes enlarged lymph nodes in the mediastinum region, superior vena cava syndrome, direct involvement of the lungs (infiltration of the lymphoma cells), and pulmonary infection.
Skin rashes are also a Hodgkin’s lymphoma sign. Hodgkin’s lymphoma increases the risk of paraneoplastic pemphigus, which causes blisters, painful skin rashes, and erosions. Skin infections due to compromised immune systems may also result in skin rashes.
The definite cause of Hodgkin’s lymphoma remains unknown. However, certain factors increase the risk of Hodgkin’s lymphoma. The possible Hodgkin’s lymphoma causes include:
Hodgkin’s lymphoma may occur at any age. However, age is one of the causes of non-modifiable Hodgkin’s lymphoma, and the occurrence of subtypes varies with age. Nodular sclerosis Hodgkin’s lymphoma commonly occurs in individuals between 15 and 35 years of age. The mixed cellularity subtype of Hodgkin's lymphoma more commonly causes symptoms of Hodgkin’s lymphoma in adults. This condition is rare in children.
There is no significant gender bias in individuals affected by Hodgkin's lymphoma. However, some subtle gender differences do exist, especially in the incidence of Hodgkin's lymphoma subtypes. For instance, mixed cellularity Hodgkin lymphoma is more common in males, while nodular sclerosis Hodgkin lymphoma is more common in females.
Most cases of Hodgkin’s lymphoma occur sporadically and do not involve a family history. However, in some instances, Hodgkin’s lymphoma may be related to a family history of Hodgkin’s lymphoma and other cancers.
Organ transplant is also one of the possible Hodgkin’s disease causes. However, those who undergo organ transplants are more likely to develop non-Hodgkin’s disease as compared to Hodgkin’s disease.
Immunity protects the body against various cancers by detecting and destroying abnormal cells. However, a compromised immune system cannot fight against these cancer cells, resulting in their growth, proliferation, and spread.
There is no strong evidence regarding the association between smoking and Hodgkin’s lymphoma. However, excessive smoking of tobacco increases the body’s exposure to carcinogens that enhance the risk of several types of cancer. Additionally, the association between smoking and Hodgkin's lymphoma may vary across these subtypes.
Exposure to certain hazardous chemicals may cause Hodgkin’s lymphoma. These chemicals include benzene, trichloroethylene, and insecticides.
Individuals should not ignore any symptoms that may indicate serious underlying medical conditions. Patients should consult with oncologists if they persistently experience Hodgkin’s lymphoma symptoms, such as high fever, chest pain, problems with breathing, skin rashes, weight loss, night sweats, and fatigue.
Patients should not ignore symptoms that indicate Hodgkin’s lymphoma and should consult a specialist for a proper evaluation. Hodgkin’s lymphoma cancer treatment will often need a comprehensive approach wherein specialists carefully study the case, understand the individual case parameters, and devise an individualized treatment plan.
Doctors recommend multiple tests for Hodgkin’s lymphoma diagnosis. Along with confirming the diagnosis, these tests also help specialists stage the disease and devise treatment plans accordingly. The commonly recommended tests for Hodgkin’s lymphoma diagnosis include:
Patients with Hodgkin’s lymphoma usually have enlarged or swollen lymph nodes in the center of the chest (mediastinum). The X-ray scan assists the clinicians in determining the course of treatment. It also provides information about fluid accumulation in the pleural cavity (pleural effusion). Pleural effusion is a rare symptom of Hodgkin’s lymphoma. Some of the findings on the chest X-ray that indicate Hodgkin’s lymphoma are osteolytic and expandible ribs, involvement of the sternum and mediastinal nodes, and the presence of mass.
MRI is not the preferred imaging method for Hodgkin’s lymphoma diagnosis. However, oncologists may recommend it in certain situations to obtain additional information or detect disease characteristics. It assists clinicians in evaluating soft tissues. It is also recommended when there is suspicion about the involvement of the chest or spinal cord.
CT is a preferred imaging modality for Hodgkin’s lymphoma diagnosis. It assists the clinicians in diagnosing, staging, and monitoring the disease. A CT scan helps detect lymph node involvement and its extent in individuals suspected of Hodgkin’s lymphoma. Along with diagnosing Hodgkin’s lymphoma, a CT scan also determines the size and location of the lymph nodes to determine staging. It also identifies disease-related complications, such as blood vessel blockage, compression of nearby tissues, and fluid accumulation. A CT scan also helps guide the instruments, such as the needle, during the biopsy (CT-guided biopsy).
A PET scan involves using radioactive sugar analogs that allow clinicians to determine areas of high metabolic activity. Like other malignant cells, the cells of Hodgkin’s lymphoma have a higher metabolic rate than normal, healthy cells. A PET-CT scan provides detailed information about the cellular function and anatomy of the lymph nodes. The PET scan also determines the disease stage and assesses the patient’s response to therapy.
A bone scan is not a common imaging technique employed for Hodgkin’s lymphoma diagnosis. Although Hodgkin’s lymphoma commonly affects the lymph nodes, bone involvement may be seen in some cases. If specialists suspect bone involvement, they recommend a bone scan to detect the location and extent of the disease. Bone scans also help evaluate bone health during treatment, as certain therapies, such as chemotherapy, may affect bone mineral density.
Blood tests are not recommended for the diagnosis of Hodgkin’s lymphoma, as they cannot indicate the presence of the disease. However, they are recommended to determine the levels of different blood cells, examine liver and kidney functions, and look for the presence of lymphoma cells or other abnormal cells. Commonly recommended blood tests for Hodgkin’s lymphoma diagnosis include:
A complete blood count (CBC) in patients suspected of Hodgkin’s lymphoma provides valuable information about the individuals' overall health and the disease's impact on blood cells. The blood components analyzed include white blood cells, lymphocytes, platelets, and red blood cells. The abnormal levels of one or more of the blood cells suggest bone marrow involvement in these individuals.
Blood tests may also be recommended to determine the functioning of the body's different organs and to diagnose and monitor Hodgkin’s lymphoma. These tests include kidney function tests, liver function tests, blood urea nitrogen, and a complete metabolic panel including glucose levels and electrolyte concentration, C-reactive protein, lactate dehydrogenase, and levels of albumin and total protein in the blood.
ESR is not specific for Hodgkin’s lymphoma and may be recommended along with various other tests for Hodgkin’s lymphoma diagnosis, such as imaging tests. ESR provides information about the body's inflammatory status and assists in evaluating the progression of the disease. Patients in the active phase of Hodgkin’s lymphoma may have altered levels of ESR.
A biopsy may help in the definitive diagnosis of Hodgkin’s lymphoma. In this method, the clinicians withdraw the sample from the abnormal or suspected site for Hodgkin’s lymphoma and send the sample to the laboratory for a comprehensive evaluation. The presence of malignant cells in the sample confirms the diagnosis of Hodgkin’s lymphoma. There are types of biopsies available for Hodgkin’s lymphoma diagnosis, and they include:
This procedure is recommended when the patient has enlarged lymph nodes. During this procedure, the surgeon cuts the skin and obtains the complete lymph node (excisional biopsy) or a part of the lymph node (incisional biopsy).
During a core needle biopsy, the doctor inserts a needle through the skin into a swollen lymph node to collect the tissue sample. A core needle biopsy is relatively less invasive than an excisional biopsy. However, the sample obtained in a core needle biopsy is comparatively less than that obtained through an excisional biopsy.
These tests are also known as pulmonary function tests. These tests are not the primary tests for Hodgkin’s lymphoma diagnosis. However, the doctor may recommend lung function tests in specific conditions, such as mediastinal involvement, as revealed in the imaging tests, and in cases where patients have serious breathing problems. Lung function tests may include spirometry, evaluation of diffusion capacity, and lung volume tests.
In patients diagnosed with Hodgkin’s lymphoma, the doctor may recommend a comprehensive evaluation of heart function, as certain chemotherapy medications may affect heart health. The tests include a multigated acquisition (MUGA) scan and an echocardiogram.
Hodgkin’s lymphoma treatment often demands a multidisciplinary team approach, where specialists from different disciplines carefully go through the patient information and individual case parameters and devise a personalized care plan that meets their health requirements and helps them return to the best state of health possible. The following are the commonly recommended Hodgkin’s lymphoma treatment options:
A stem cell transplant is predominantly recommended for patients with difficult-to-treat Hodgkin’s lymphoma or Hodgkin’s lymphoma that is not responding to conventional treatments, such as chemotherapy or radiation therapy. It is also recommended for patients with disease recurrence. There are two types of stem cell transplants: autologous stem cell transplant and allogeneic stem cell transplant. This treatment approach involves delivering high-dose chemotherapy and radiation therapy before transplanting healthy stem cells. Currently, the stem cells are usually taken from the blood (the other option is from the bone marrow), known as peripheral stem cell transplantation.
Radiation therapy is an effective Hodgkin’s lymphoma treatment option. Radiotherapy for Hodgkin’s lymphoma is usually recommended after chemotherapy. It is commonly recommended for patients with classic Hodgkin’s lymphoma, particularly when the patients have a large tumor. Radiation therapy is also helpful in the management of nodular lymphocyte-predominant Hodgkin’s lymphoma. Although radiation therapy for Hodgkin’s lymphoma is effective, chemotherapy is usually preferred by oncologists due to the long-term side effects of the radiation. Radiation therapy for Hodgkin’s lymphoma is usually delivered in low doses.
Immunotherapy is a systemic therapy wherein the patient’s immune system is re-engineered to identify cancer cells and kill them. Systemic medications are administered as a part of immunotherapy. These include monoclonal antibodies that attack specific targets present on the surface of lymphocytes. Immune checkpoint inhibitors belong to another class of immunotherapy drugs. These drugs work by blocking the proteins that stop the immune system from identifying and attacking cancer cells.
Targeted therapy works by specifically targeting cellular pathways or proteins associated with cancer cells that help them divide, grow, and proliferate. These targets are specific to cancer cells, so the therapy has fewer side effects than conventional chemotherapy. Targeted therapy is recommended in cases where patients have refractory or relapsed Hodgkin’s lymphoma.
Chemotherapy is the preferred Hodgkin’s lymphoma treatment option in most cases. It involves the administration of powerful anti-cancer drugs orally or intravenously. The doctor will prescribe a combination of two or more Hodgkin’s lymphoma medications as part of chemotherapy. These drugs attack different cell cycle phases. For Hodgkin’s, chemotherapy drugs are delivered in multiple cycles with a resting period between the cycles.
Palliative care is usually recommended for severely ill patients. The goal of palliative care is to enhance the patient's quality of life by improving their physical and psychological health. Palliative care is not essentially end-of-life care. It may be used along with life-prolonging or curative treatments.
Hodgkin’s lymphoma should be diagnosed early and appropriately treated for better health outcomes, fewer complications, and enhanced survival. As one of the best cancer hospitals in India, HCG has modern diagnostic and treatment solutions to facilitate the effective management of Hodgkin’s lymphoma. The medical and paramedical staff at HCG are extensively trained and experienced in managing simple to complex cases of Hodgkin’s lymphoma.
Hodgkin’s disease risk factors are those factors that increase one’s chances of developing Hodgkin’s lymphoma. It is through these factors that specialists carry out Hodgkin lymphoma risk stratification. Learning about various risk factors associated with this condition can help one reduce their chances of developing it with appropriate preventive measures.
Multiple studies have found that certain individuals are more likely to develop Hodgkin’s lymphoma than others. This is because of certain risk factors that can increase one’s chances of developing this condition. The following are the most important Hodgkin’s lymphoma risk factors:
Age is one of the most dominant Hodgkin’s lymphoma risk factors. Although Hodgkin’s lymphoma may occur in people of any age, certain types of Hodgkin’s lymphoma are common among certain age groups. The incidence of Hodgkin’s lymphoma is relatively low in older adults and children. The risk of different subtypes of Hodgkin’s lymphoma varies in different age groups. For instance, nodular sclerosis Hodgkin’s lymphoma is more common in people between the ages of 15 and 35. There are different characteristics of Hodgkin’s lymphoma in young and older adults. Mixed cellularity Hodgkin’s lymphoma is relatively more common in people over the age of 55.
Although there is a difference in the incidence of Hodgkin’s lymphoma between males and females, this gender bias is not significant. Males have a slightly higher risk of developing Hodgkin’s lymphoma compared to females. The occurrence of Hodgkin’s lymphoma subtypes varies among males and females. Males have a higher chance of developing mixed cellularity Hodgkin’s lymphoma, whereas females are more likely to develop nodular sclerosis Hodgkin’s lymphoma.
There is no strong connection between the occurrence of Hodgkin’s lymphoma and hereditary patterns, suggesting that Hodgkin’s lymphoma may not run in families. Most Hodgkin’s lymphoma cases occur spontaneously and have no family history. Family history, if present, may be due to common genetic predispositions and environmental factors.
A compromised immune system is also one of the most important Hodgkin’s lymphoma risk factors. Usually, the abnormal cells in the body are identified, targeted, and killed by various immune cells. However, a weakened immune system cannot kill abnormal cells, and this results in their abnormal division, growth, and spread. Further, Hodgkin’s lymphoma cells may also hide themselves from a weakened immune system, causing them to grow more aggressively.
Human immunodeficiency virus (HIV) attacks the patient's immune system, and this makes HIV infection one of the important Hodgkin lymphoma causes and risk factors. A few studies have reported that HIV-infected people have a higher risk of developing Hodgkin’s lymphoma despite initiating antiretroviral treatment. It has been found that people with HIV have a 5 to 26-fold increased risk of developing Hodgkin’s lymphoma compared to the general population.
There is also an association between the Epstein-Barr virus and the occurrence of Hodgkin’s lymphoma. Individuals with a family history of EBV are at a slightly increased risk of developing Hodgkin’s lymphoma.
There are no known methods to completely prevent the occurrence of Hodgkin’s lymphoma. However, certain measures help prevent Hodgkin’s lymphoma. The commonly recommended Hodgkin’s lymphoma prevention measures include:
Although there is no strong connection reported between smoking and the occurrence of Hodgkin’s lymphoma, quitting smoking reduces exposure to various carcinogens. It reduces the risk of several cancers, including Hodgkin’s lymphoma. Further, smoking also affects the immune system and lowers the body's ability to fight infections and destroy abnormal cells. Quitting smoking preserves the healthy functioning of the immune system.
An increase in weight increases the risk of Hodgkin’s lymphoma. A study reported that an increase in the BMI of 5 kg/m2 increases the risk of Hodgkin’s lymphoma by 10%. Maintaining a healthy weight lowers the chance of Hodgkin’s lymphoma. Exercising regularly and eating a balanced diet support healthy weight management.
Regular exercise is also important for Hodgkin’s lymphoma prevention. Regular exercise supports healthy weight management and helps reduce the risk of Hodgkin’s lymphoma. Further, exercise also enhances the ability of the immune system to kill abnormal cells and fight against viruses, such as EBV and HIV.
A balanced diet also assists Hodgkin’s lymphoma prevention by promoting overall wellness. It maintains the overall weight and improves the immune system.
Hodgkin lymphoma is a tumor growing in the lymphatic system. It usually occurs in the upper part of the body. There are various subtypes of Hodgkin lymphoma, such as classical Hodgkin lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, diffuse large B-cell lymphoma, and diffuse large T-cell lymphoma. The stage of Hodgkin lymphoma ranges from stage 1 to stage 4.
