Hodgkin’s lymphoma occurs when cancer cells in lymph tissue grow abnormally. The cancer often interferes with the body’s immune system and has the potential to spread to other parts of the body. Since lymph tissue is present throughout the body, Hodgkin’s can affect lymph nodes practically anywhere, including the spleen, liver, and bone marrow.

Every year, Hodgkin’s lymphoma is diagnosed in approximately 8,000 people in the United States. Hodgkin’s affects more men than women and generally happens anywhere between ages 15 and 40. It can also be seen in people older than 50.

There are two types of Hodgkin’s lymphoma -- classic and nodular lymphocyte-predominant. Both are considered malignant, meaning they are cancerous and can spread to other tissues. Classic Hodgkin’s represents a great majority of Hodgkin’s disease cases. Within classic Hodgkin’s, there are subsets.

• Nodular sclerosis Hodgkin’s disease: Nodular sclerosis represents up to 80 percent of Hodgkin’s lymphoma patients. It starts in the neck or chest and when viewed under a microscope, criss-crossing fibrous bands can be seen around the affected lymph node.

• Mixed cellularity Hodgkin’s disease: Mixed cellularity Hodgkin’s can begin in any lymph node and is commonly seen in older men and women. It is the second most common type of Hodgkin’s lymphoma.

• Lymphocyte-rich Hodgkin’s disease: This type of Hodgkin’s can be found in the upper half of the body, affecting only a few lymph nodes.

• Lymphocyte-depleted Hodgkin’s disease: This is a very rare type of Hodgkin’s, only seen in one percent of all patients. Lymph nodes in the abdomen, spleen, liver, and bone marrow can be affected.

Nodular lymphocyte-predominant Hodgkin’s disease is the second type of Hodgkin’s lymphoma. It is found in men more often than women, but ultimately accounts for only five percent of all Hodgkin’s disease cases. Nodular lymphocyte-predominant Hodgkin’s is found in lymph nodes in the neck, chest, and armpits. The lymph nodes are enlarged and often visible under the skin.

 

The cause of Hodgkin’s lymphoma is unknown. What is known is that lymphoma affects the lymphatic system. The lymphatic system works with the immune system to fight illnesses. It acts like a filtering system, using excess fluid between the body’s tissues as a means of carrying harmful substances through lymph vessels and lymph nodes. Lymph nodes are found in clusters in the underarms, pelvis, neck, abdomen, and groin. These lymph nodes contain lymphocytes, white blood cells that fight infection. They flush bacteria from the fluid and prevent bacteria from spreading. Once the process is finished, the fluid drains into the bloodstream.

B lymphocytes are crucial to the development of Hodgkin’s lymphoma. B lymphocytes fight invading bacteria by creating antibodies. When Hodgkin’s is present, B lymphocytes become abnormal and enlarged. These are known as Reed-Sternberg cells. In people with Hodgkin’s, only a small amount of Reed-Sternberg cells need to be present in lymph nodes compared to normal cells. 

 

Hodgkin’s Vs. Non-Hodgkin’s

The existence of abnormal and enlarged B lymphocytes known as Reed-Sternberg cells is one indicator of Hodgkin’s lymphoma. Unlike normal cells, the Reed-Sternberg cells do not die; instead they multiply and attract other immune cells. This clustering causes the lymph nodes to enlarge.

During an examination, if a doctor identifies Reed-Sternberg cells under a microscope, the cancer is considered Hodgkin’s. They can be identified by their large size, plentiful pale cytoplasm, and multiple nuclei. If proliferation of lymphoid tissue has occurred but no Reed-Sternberg cells are spotted, the cancer is classified as non-Hodgkin’s.

Hodgkin’s and non-Hodgkin’s lymphoma symptoms also manifest themselves differently on the body. In Hodgkin’s lymphoma, the enlargement of lymph nodes typically occurs in one region while nodes found in non-Hodgkin’s lymphoma are present in numerous parts of the body.

Additionally, the survival rates for Hodgkin’s and non-Hodgkin’s differ. Whereas Hodgkin’s bases its survival rates on stages, non-Hodgkin’s uses a scale known as the Follicular Lymphoma International Prognostic Index (FLIPI) to determine survival rates. Five factors are considered.

 

• Being over 60

 

• Poor health prior to non-Hodgkin’s

 

• High levels of lactate dehydrogenase in the blood

 

• Stage 3 or 4 non-Hodgkin’s

 

• Non-Hodgkin’s spreads outside the lymphatic system

 

When a person possesses 0 to 1 of these traits, the five-year survival rate of non-Hodgkin’s lymphoma is 70 percent. Possessing 2 to 3 traits lowers the five-year rate to 50 percent, and 4 to 5 traits puts the survival rate at 40 percent. Compared to the survival rates of Hodgkin’s, non-Hodgkin’s has generally lower survival rates.

Risks for Hodgkin’s

Even though the cause for Hodgkin’s is unclear, there are factors that can elevate the risk for developing the cancer.

 

• Age: Hodgkin’s most often strikes between the ages of 15 and 40, and in people over 50.

 

• Gender: Males are at a higher risk for Hodgkin’s lymphoma than females.

 

• Other diseases: It has been found that people who have experienced Epstein-Barr infections such as mono, are at a higher risk of Hodgkin’s. In addition, those with HIV often have compromised immune systems, which makes it easier for Hodgkin’s to develop.

 

• Family history: Family history, while rare, can still contribute to Hodgkin’s. People with a brother or sister with the disease are at risk.

 

• Geography: Hodgkin’s lymphoma can be found most commonly in North America and northern Europe.

 

Since Hodgkin’s affects the lymph nodes, one of the trademark symptoms is often lymph nodes that have become enlarged for no apparent reason. This swelling can usually be seen in the neck, armpits, or groin. The enlarged lymph nodes usually do not come with pain, but may cause discomfort if a person drinks alcohol.  Other symptoms can accompany the swelling, such as fever, fatigue, soaking night sweats, itching, and unreasonable weight loss.

Certain symptoms can be related to action of the lymphoma cells. When lymphoma cells invade the bone marrow, a person will experience fatigue, bleeding, and possible bone pain. Muscle weakness and hoarseness occurs when the lymph nodes swell big enough to compress nerves in the spinal cord or vocal cords. When lymphoma cells block the flow of bile from the liver, jaundice is a recognized symptom. A shortness of breath and coughing can signal that the lymphoma is entering the lungs.

Complications

The main complication with Hodgkin’s is the disease’s ability to spread to other parts of the body. As with any cancer, the severity of Hodgkin’s increases as it spreads.

The other complications associated with Hodgkin’s are actually related to the disease’s treatment. Chemotherapy and radiation can affect the body in a number of ways, including bone marrow disease, sterility, cardiovascular disease, lung problems, a second cancer invading the lungs, breast, or digestive system, and thyroid problems.

Following a physical exam and medical history, a doctor will perform a biopsy to determine whether or not a person has Hodgkin’s lymphoma. A biopsy is when a doctor removes a piece of the affected lymph node for examination under a microscope. This can be done in one of several ways. An excisional biopsy is performed by cutting into the skin and removing a piece of the lymph node. If the lymph node is close to the skin, a fine needle aspiration can be performed. This is when a thin needle is inserted into the lymph node and a piece of the node is taken out.

However, to make the diagnosis, doctors must perform a biopsy of an affected lymph node to see if it is abnormal and if Reed-Sternberg cells are present. Reed-Sternberg cells are large cancerous cells that have more than one nucleus. Their distinctive appearance can be seen when a biopsy specimen of lymph node tissue is examined under a microscope. Once the doctor has a sample, it will be examined for signs of cancer. In the case of Hodgkin’s, the doctor will specifically attempt to identify the trademark Reed-Sternberg cell.

If cancer cells are discovered, the patient may be referred to an oncologist for further testing. This testing determines what stage the cancer has reached, and is crucial for deciding the course of treatment. Staging tests include a blood test to determine the amount of red blood cells, white blood cells, hemoglobin, and platelets present in the body. An X-ray and CT scan will check lymph nodes in the chest and abdomen. Bone marrow biopsies may be performed to make sure cancer has not spread to the bone marrow. Immunophenotyping can determine whether cancer originated in B lymphocytes or T lymphocytes.

Stages

There are four stages to Hodgkin’s lymphoma. The stages are determined by the severity of the cancer.

Stage I

Stage I Hodgkin’s means the cancer is only in one lymph node.

Stage II

This is when two or more lymph nodes are affected on the same side above or below the diaphragm. Meaning, a person can have affected lymph nodes in the neck and the armpit.

Stage III

Stage III occurs when cancer is present in lymph nodes above and below the diaphragm. It is possible for Stage III to have also spread to a nearby organ or the spleen.

Stage IV

Stage IV Hodgkin’s lymphoma indicates that the cancer has spread beyond the lymph nodes to other organs such as the liver or lung.

It is also possible to assign a letter “A” or “B” to the stage. In order to assign a “B” to the stage, a person must have lost over 10 percent of their body fat in six months, experienced a fever of at least 101.5 degrees F, or have night sweats. If any of these symptoms are present, the cancer is considered advanced and may require more aggressive treatment.

Prognosis per Stage

According to the National Cancer Institute, the following survival rates for those who receive treatment for Hodgkin’s lymphoma are projected for each stage of the disease:

Stage	5-year Survival Rate
I	About 90%
II	About 90%
III	About 80%
IV	About 65%