What is Hodgkin Lymphoma?

Hodgkin lymphoma is a cancer that starts in a white blood cell called a B-lymphocyte. Healthy B-lymphocytes are part of the immune system. They fight infections and illnesses. They are often found in bean-sized lymph nodes or in other lymphoid tissues, such as the spleen. Because B-lymphocytes and other immune cells are present in lymph nodes, it is normal for the lymph nodes to get bigger when the body is fighting an infection.

However, in Hodgkin lymphoma, some of the B-lymphocytes are no longer healthy and do not fight infection. Instead, the abnormal (cancerous) lymphocytes begin to grow out of control, causing the lymph nodes to get bigger. These cancerous lymphocytes can also spread outside the lymph nodes. The cancerous B-lymphocyte of Hodgkin lymphoma is often surrounded by many normal immune cells. When a lymph node is affected by Hodgkin lymphoma, it typically becomes much larger than it would with an infection. As Hodgkin lymphoma advances, it may spread beyond the lymph node to the bone marrow, liver or lungs.

Children and adults can get Hodgkin lymphoma. In the United States, Hodgkin lymphoma is most frequently diagnosed in young adults between 20 and 34 years old. About 10% to 15% of cases occur in children younger than 20 years old.

What causes Hodgkin Lymphoma?

Hodgkin lymphoma develops when something changes the genetic code of a specific white blood cell (B-lymphocyte). DNA is what makes up the genetic code of all cells. This code tells the cells how to work. Changes to DNA (deoxyribonucleic acid) changes the genetic code of the cell. In the case of Hodgkin lymphoma, these changes make it impossible for the B-lymphocyte to fight infection. Instead, the lymphocyte just grows and divides.

In most cases of Hodgkin lymphoma, doctors do not know what causes the DNA to change. Scientists have identified some risk factors that might make a person more likely to get the illness:

• An earlier infection with Epstein-Barr virus (mononucleosis)
• An immune deficiency (including HIV (Human Immunodeficiency Virus) infection)
• Having a parent or sibling with Hodgkin lymphoma

Having a risk factor does not mean a person will get Hodgkin lymphoma. Many people who get Hodgkin lymphoma do not have any risk factors.

What are the signs and symptoms of Hodgkin Lymphoma?

The symptoms of Hodgkin lymphoma depend on where in the body the disease begins, and how far it has spread when it is found. The most common symptom is swelling of the lymph nodes in the neck or armpit. This swelling is not painful.

Lymph nodes in the chest or abdomen can also become enlarged. An enlarged lymph node in the chest or abdomen may not be noticed until it is big enough to cause problems. If lymph nodes in the chest are affected, a person may develop a cough, difficulty breathing, fatigue and shortness of breath.

Some patients with Hodgkin lymphoma also have the following symptoms:

• Fever
• Weight loss without dieting
• Drenching sweating, not while exercising (usually at night, called “night sweats”)
• Itching
• Feeling tired
• Loss of appetite
• Pain in the lymph nodes after drinking alcohol

How is Hodgkin Lymphoma diagnosed?

The diagnosis of Hodgkin lymphoma is made by biopsy, a surgery that removes part or all of the abnormal lymph node. Doctors then examine the lymph node under the microscope. They study thin slices of the lymph node tissue for the presence, type and arrangement of cancer cells that are typical of the disease.

Doctors also perform tests to see if the disease has spread to other parts of the body. These tests usually include blood tests and radiology tests. A chest X-ray is typically done first to see if there are enlarged lymph nodes in the chest. A CT (Computed Tomography) scan is done to check for lymphoma in the chest and belly. A PET (Positron Emission Tomography) scan can see if the disease has spread to the liver, bones, bone marrow or spleen. If doctors are concerned that the lymphoma has spread to the bone marrow, they may take a biopsy.

Staging the Disease

Defining the stage, or the extent of the cancer, can help determine if and how it will progress, and how best to treat it. In general, localized disease (disease that is found in only one place in the body, called Stage I or II) is associated with a better outlook and requires less intensive therapy than disease found in multiple locations in the body (called Stage III or IV) or localized disease that is accompanied by unexplained fever, weight loss or night sweats.

How is Hodgkin Lymphoma treated?

The primary treatment for Hodgkin lymphoma is chemotherapy. When deciding the best treatment option, doctors consider:

• How much the disease has spread
• The patient’s age, medical history and overall health
• How well a patient's body can manage specific medicines, procedures or therapies

Cincinnati Children’s is an international referral center for the treatment of children and young adults with cancer. Our doctors lead national efforts to develop new treatments that may be more effective and may have fewer side effects.

We take part in a variety of clinical studies for patients with cancer. If there is a study that might be helpful for your child, we will discuss that, as well as other treatment options, with you.

Some patients require radiation therapy in addition to chemotherapy. If so, we are one of only a few children’s hospitals in the country that offer proton therapy. This is a type of radiation treatment that uses a highly precise proton beam that treats the tumor but avoids healthy tissue in the body. Proton therapy can help avoid some of the short-term side effects and long-term complications of traditional radiation therapy.

What is the outlook for someone with Hodgkin Lymphoma?

Currently, the survival rate for Hodgkin lymphoma is approximately 85%. Children, adolescents and young adults with localized disease have a better outcome than those with advanced or widespread disease.

Rarely, Hodgkin lymphoma does not respond to chemotherapy or comes back after a period of remission (remission is a time in which a cancer disappears or stops growing). If Hodgkin lymphoma does not respond to treatment or returns after a time of remission, doctors may recommend a more intense course of treatment, which may include stem cell transplant.

As a referral center for high-risk and relapsed cancers in children and young adults, we have many treatment options available. Our physicians lead the way in developing and using the latest chemotherapy treatments, immunological approaches, and stem cell transplant to treat patients with relapsed disease.