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Hodgkin Lymphoma

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Lymphoma comprises more than 67 subtypes of two related cancers that affect the lymphatic system, Hodgkin lymphoma (formerly referred to as Hodgkin's lymphoma) and non-Hodgkin lymphoma (NHL) (formerly referred to as non-Hodgkin's lymphoma). There are six types of Hodgkin lymphoma and at least 61 types of non-Hodgkin lymphoma. Non-Hodgkin lymphomas are different from Hodgkin lymphomas in the way they develop, spread and are treated. Lymphoma is the most common blood cancer and the third most common cancer among children.

Overview

Hodgkin lymphoma, also known as Hodgkin disease, is a less common form of lymphoma. Researchers know it is a cancer which arises from an abnormal lymphocyte (white blood cell). According to the American Cancer Society, approximately 8,500 new cases of Hodgkin lymphoma are projected each year. Although the cancer can occur in both children and adults, it is most commonly diagnosed in young adults between the ages of 15 and 35 and in older adults over age 50.

Development

Hodgkin lymphoma develops when a lymphocyte (usually a B-cell) becomes abnormal (cancerous). These abnormal cells are called Reed-Sternberg (R-S) cells. Most people with Hodgkin lymphoma have R-S cells, although other abnormal cell types may be present. Reed-Sternberg cells continually divide, making more and more abnormal cells, which do not die when they should. As these abnormal cells build up, they can form a mass of tissue called a tumor.

Hodgkin lymphoma usually starts in the lymph nodes. Since lymph tissues are connected, cancerous lymphocytes circulate throughout the lymphatic vessels. Hodgkin lymphoma often spreads from one lymph node to another and can also spread to organs outside the lymph system. 

Signs and Symptoms

Common signs and symptoms include swelling of the lymph nodes (which is often but not always painless), fever, night sweats, unexplained weight loss, and lack of energy. While most people who have these complaints will not have Hodgkin lymphoma, anyone with persistent symptoms should be seen by a doctor to make sure that lymphoma is not present.

Risk Factors

The causes of Hodgkin lymphoma remain unknown, but immune system impairment and exposure to environmental carcinogens, pesticides, herbicides, viruses, and bacteria may play a role. There may be a higher risk for getting HL in individuals:

  • Infected with the Epstein-Barr virus (which causes mononucleosis)
  • Infected with HIV
  • With a weakened immune system caused by either an inherited condition or the use of immunosuppressants to prevent organ transplant rejection
  • With a family history of Hodgkin lymphoma (though no hereditary pattern has been well established)

Treatment

Most patients live long and healthy lives following successful treatment for Hodgkin lymphoma. Many people treated will receive some form of chemotherapy, radiation therapy or a combination of the two. Bone marrow or stem cell transplantation may sometimes be used under special circumstances.

Current Research

The Lymphoma Research Foundation funds some of the most innovative research to find a cure for lymphoma.

Common Types of Hodgkin Lymphoma - Classical Hodgkin Lymphoma (CHL)

Diffuse Lymphocyte Predominant
Lymphocyte Depletion
Lymphocyte-Rich
Mixed Cellularity
Nodular Lymphocyte Predominant
Nodular Sclerosis

Diffuse Lymphocyte Predominant
This type of Hodgkin lymphoma is extremely rare. The existence of this entity has been questioned. Most cases are in fact nodular lymphocyte predominant Hodgkin lymphoma with an ill-defined nodular pattern. Unlike nodular lymphocyte predominant Hodgkin lymphoma, fewer small benign B-cells are found. The lymphatic tissue is dominated instead by reactive, non-malignant T-cells. Disease recurrence is common in this subtype of Hodgkin lymphoma.

Lymphocyte-Depleted CHL
Lymphocyte-Depleted CHL is rarely diagnosed. Abundant RS cells and few normal lymphocytes are present in the lymph nodes of patients with this subtype, which is aggressive and usually not diagnosed until it is widespread throughout the body..

Lymphocyte-Rich CHL
Lymphocyte-Rich CHL accounts for less than five percent of HL cases. The disease may be diffuse (spread out) or nodular in form and is characterized by the presence of numerous normal- appearing lymphocytes and classic RS cells. This subtype of HL is usually diagnosed at an early stage in adults and has a low relapse (disease returns after treatment) rate..

Mixed Cellularity CHL
Mixed Cellularity CHL accounts for about 15 to 30 percent of all HL cases. The disease is found more commonly in men than in women, and it primarily affects older adults. With this type of CHL, the lymph nodes contain many RS cells in addition to several other cell types. More advanced disease is usually present by the time this subtype is diagnosed..

Nodular Lymphocyte Predominant
Nodular Lymphocyte Predominant HL accounts for five to 10 percent of all HL cases. It affects men more often than women and is usually diagnosed before the age of 35. In nodular lymphocyte predominant HL, most of the lymphocytes found in the lymph nodes are normal (not cancerous). Typical RS cells are usually not found in this subtype, but large, abnormal B cells (sometimes referred to as popcorn cells) can be seen as well as small B cells, which may be distributed in a nodular pattern within the tissues. This subtype is usually diagnosed at an early stage and is not very aggressive. In many ways, this form of HL resembles indolent (slow-growing) B-cell NHL with late recurrences..

Nodular Sclerosis CHL
Nodular Sclerosis CHL is the most common subtype of HL, accounting for 60 to 80 percent of all HL cases. In nodular (knot-like) sclerosis CHL, the involved lymph nodes contain RS cells mixed with normal white blood cells. The lymph nodes often contain a lot of scar tissue, which is where the name nodular sclerosis (scarring) originates. The disease is more common in women than in men, and it usually affects adolescents and adults under the age of 50. The majority of patients are cured with current treatments..

Resources

To learn about educational opportunities, please visit the Patient Education Programs section of our website.

For more information, call 1-800-500-9976, e-mail helpline@lymphoma.org, or continue to visit www.lymphoma.org.