Hodgkin's lymphoma (patient information)
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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, MD
Overview
Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites.
What are the symptoms of Hodgkin's lymphoma?
- Fatigue
- Fever and chills that come and go
- Itching all over the body that cannot be explained
- Loss of appetite
- Soaking night sweats
- Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
- Weight loss that cannot be explained
Other symptoms that may occur with this disease:
- Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
- Excessive sweating
- Pain or feeling of fullness below the ribs due to swollen spleen or liver
- Pain in lymph nodes after drinking alcohol
- Skin blushing or flushing
Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms.
Who is at highest risk?
Clinical data has suggested that the development of Hodgkin's lymphoma is related to several factors.
- Epstein-Barr Virus (EBV) infection/Mononucleosis: The role of EBV in the development of Hodgkin lymphoma is not very clear. As we know, mononucleosis is an infection caused by the Epstein-Barr virus (EBV). Clinical data show that mononuclesis has a close relationship with Hodgkin's lymphoma.
- Family history: The reason why family history may increase risk of developing Hodgkin's lymphoma is not clear. Some researchers proclaimed they had found certain changes in the genes responsible for immunity in patients with Hodgkin's lymphoma.
- Socioeconomic status: Clinical survey shows patients with Hodgkin's lymphoma posses higher socioeconomic background. The reason is not clear.
- Geography: Epidemiological data demonstrates that Hodgkin's lymphoma is most common in western countries such as the United States, Canada and northern Europe, and is least common in Asian countries.
- Age: Epidemiological survey suggests that Hodgkin's lymphoma is most common in early adulthood (ages 15 to 40, especially in a person's 20s) and in late adulthood (after age 55).
- Gender: Hodgkin's lymphoma occurs slightly more often in men than in women.
When to seek urgent medical care?
Call your health care provider if symptoms of Hodgkin's lymphoma develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
- Hyperpyrexia and severe chills
- Severe infection
Diagnosis
The first sign of Hodgkin's lymphoma is often a swollen lymph node, which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.
The disease may be diagnosed after:
- Biopsy of suspected tissue, usually a lymph node biopsy
- Bone marrow biopsy
- If tests reveal that you do have Hodgkin's lymphoma, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide treatment and follow-up, and gives you some idea of what to expect in the future.
The following procedures will usually be done:
- Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level
- Bone marrow biopsy
- CT scans of the chest, abdomen, and pelvis
- Complete blood count (CBC) to check for anemia and white blood count
- PET scan
- Some people may need abdominal surgery to take out a piece of the liver and remove the spleen. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually not needed.
Treatment options
Treatment depends on the following:
- The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
- The stage (where the disease has spread)
- Whether the tumor is more than 4 inches (10 cm) wide
- Your age and other medical issues
- Other factors, including weight loss, night sweats, and fever
- Tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Staging is needed to determine your treatment plan. Stages of Hodgkin's lymphoma range from I to IV. The higher the staging number, the more advanced the cancer.
Treatment depends on your age and stage of the cancer.
- Stages I and II (limited disease) can be treated with radiation therapy, chemotherapy, or both.
- Stage III is treated with chemotherapy alone, or a combination of radiation therapy and chemotherapy.
- Stage IV (extensive disease) is most often treated with chemotherapy alone.
- People with Hodgkin's lymphoma that returns after treatment or does not respond to the first treatment may receive high-dose chemotherapy. That is followed by an autologous stem cell transplant (using stem cells from yourself).
What other treatments you have depend on your symptoms, but may include:
Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia Antibiotics to fight infection, especially if a fever occurs
Diseases with similar symptoms
Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed in the following:
- Lymph nodes reactive hyperplasia
Where to find medical care for Hodgkin's lymphoma?
Directions to Hospitals Treating Hodgkin's disease
Prevention
Hodgkin's lymphoma is not related with life style, so there is no known risk factors for people to change at present. But more researches are needed to verify.
What to expect (Outook/Prognosis)?
Hodgkin's disease is considered one of the most curable forms of cancer, especially if it is diagnosed and treated early. Unlike other cancers, Hodgkin's disease is often very curable, even in its late stages.
With the right treatment, more than 90% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment may be more intense. However, 90% of people with advanced disease survive for at least 5 years.
Patients who survive 15 years after treatment are more likely to later die from other causes, including complications of the treatment, rather than from Hodgkin's disease.
People with Hodgkin's lymphoma whose disease returns within a year after treatment or who do not respond to the first treatment have a poorer outlook.
You will need to have regular exams and imaging tests for years after your treatment. This helps your doctor check for signs of the cancer returning, and for any long-term treatment effects.
Possible complications
Treatments for Hodgkin's lymphoma can have complications. Long-term complications of chemotherapy or radiation therapy include:
- Bone marrow diseases (such as leukemia)
- Heart disease
- Inability to have children (infertility)
- Lung problems
- Other cancers
- Thyroid problems
- Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To reduce bleeding, apply ice and pressure. Use a soft toothbrush and electric razor for personal hygiene.
Always take an infection seriously during cancer treatments. Contact your doctor right away if you develop fever or other signs of infection, especially if your white blood cell counts are low due to treatment. Planning rest periods during your daily activities may help prevent fatigue due to anemia.