Hodgkin Lymphoma
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:
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Infected with the Epstein-Barr virus (which causes mononucleosis)
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Infected with HIV
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With a weakened immune system caused by either an inherited condition or the use of immunosuppressants to prevent organ transplant rejection
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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
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 Depletion
This is the least common form of Hodgkin lymphoma, accounting for fewer than five percent of all cases. It is characterized by few normal lymphocytes, but abundant R-S cells. Lymphocyte depletion is aggressive and usually not diagnosed until the disease is widespread.
Lymphocyte-Rich
This recently identified form of Hodgkin lymphoma is rare, accounting for less than five percent of all cases. The disease may be diffuse (spread out) or nodular (knot-like) in form and is characterized by the presence of numerous normal lymphocytes and very few abnormal cells and classical R-S cells. It is usually diagnosed at an early stage in adults and has a low relapse rate.
Mixed Cellularity
This type of Hodgkin lymphoma accounts for about 15 percent to 30 percent of all cases of Hodgkin lymphoma and is found more commonly in men than women. The disease is characterized by the involved lymph nodes containing many R-S cells in addition to several other cell types. Scarring is not apparent. The development of mixed cellularity may be associated with HIV and the Epstein-Barr virus. Mixed cellularity primarily affects older adults. More extensive disease is usually present by the time this subtype is diagnosed.
Nodular Lymphocyte Predominant
This type of Hodgkin lymphoma is rare, accounting for five percent to ten percent of all cases. It primarily affects more men than women and is usually diagnosed in people under 35. In nodular lymphocyte predominant lymphoma, most of the lymphocytes found in the lymph nodes are normal (not cancerous). Typical R-S cells are usually not found in this subtype, but large, abnormal B-cells with multi-lobulated nuclei, sometimes referred to as popcorn cells, can be seen, as well as reactive small B-cells, which may be distributed in a nodular patterns within the tissues. This subtype is usually diagnosed at an early stage and is not very aggressive. In many ways, this form of Hodgkin lymphoma resembles low-grade (indolent) B-cell non-Hodgkin lymphoma.
Nodular Sclerosis
This is the most common subtype of Hodgkin lymphoma, accounting for between 6o percent and 80 percent of all cases of Hodgkin lymphoma. In nodular sclerosis, the involved lymph nodes contain areas composed of R-S cells mixed with normal white blood cells. The lymph nodes often contain prominent scar tissue, hence the name nodular sclerosis (scarring). The disease is more common in women than men, and it usually affects adolescents and adults under 50. The great majority of patients are cured with current treatments.
Resources
To learn about educational opportunities, please visit the Patient Education Programs section of our website.
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