Hodgkin Lymphoma

What Is Hodgkin Lymphoma?

Hodgkin lymphoma is a type of cancer. It develops in white blood cells in the lymphatic system, which is part of the immune system.

The lymphatic system includes:

• the lymph nodes (glands)
• the thymus (a gland behind the breastbone)
• the spleen
• the tonsils and adenoids
• bone marrow
• channels — the lymphatics or lymph vessels — that connect these parts

Hodgkin lymphoma begins in the lymph nodes of the neck or chest and then spreads from one part of the lymphatic system to another.

In Hodgkin lymphoma, the tumors usually contain unique cells called Reed-Sternberg cells. These large cancer cells are not seen in other lymphomas.

Who Gets Hodgkin Lymphoma?

Hodgkin lymphoma can happen at any age. But it's most common in teens (15 years and older). 

What Are the Signs & Symptoms of Hodgkin Lymphoma?

Some patients have no symptoms. Others may have one or more of these:

• swelling of the lymph nodes (swollen glands) in the neck, underarm, or groin
• unexplained cough and shortness of breath if the cancer involves the lymph nodes in the chest
• tiredness
• poor appetite
• itching
• rash
• nighttime sweating (night sweats)
• weight loss

What Are the Risk Factors for Hodgkin Lymphoma?

Hodgkin lymphoma is caused by a mutation (a change in a gene) in the DNA of growing white blood cells called B lymphocytes. These mutations are not inherited. 

Having a sibling who has had Hodgkin lymphoma increases the risk of someone getting this type of cancer.

The risk also is higher for people who:

• have severe immune deficiencies, such as severe combined immunodeficiency (SCID), an inherited immune system problem that makes a child unable to fight infections
• have HIV
• are treated with immunosuppressive drugs after organ transplants
• have had Epstein-Barr viral infection (mononucleosis)

How Is Hodgkin Lymphoma Diagnosed?

When Hodgkin disease is suspected, doctors will order a number of tests.

A biopsy (removal of tissue for testing) of the lymph node is usually the first test. The two types of biopsies are:

1. Core biopsy: The doctor numbs part of the body with local anesthesia and uses a hollow needle to remove a small amount of tissue from the lymph node.
2. Incisional biopsy or excisional biopsy: An anesthesiologist gives general anesthesia so the patient is asleep for the procedure and doesn't feel pain. Then, a surgeon opens the skin to remove part of the enlarged lymph node (an incisional biopsy) or all of it (an excisional biopsy).

If the biopsy confirms Hodgkin lymphoma, more tests might be done to see if the cancer has spread. These include:

• blood tests
• a chest X-ray
• a computed tomography (CT or CAT) scan, a type of X-ray that rotates around the patient and creates a picture of the inside of the body from different angles
• a bone marrow biopsy to check for cancer there
• a positron emission tomography (PET) scan, which can tell the difference between normal and abnormal cells

How Is Hodgkin Lymphoma Treated?

Treatment for Hodgkin lymphoma may include:

Chemotherapy (chemo): This treatment uses medicines to kill cancer cells and stop their growth.

Immunotherapy: Sometimes called biologic therapy, this treatment helps a person's immune system fight cancer. 

Stem cell transplant (bone marrow transplant): This treatment takes a patient's (or a donor's) cells from their bone marrow or blood and transplants them to the patient after chemo.

Radiation therapy: This treatment uses high-energy X-rays to shrink tumors and prevent them from growing. Also called X-ray therapy.

Clinical trials: These are ways to test new cancer treatments or compare them with existing treatments. These trials may include all the other types of therapy, and are often aimed at decreasing overall side effects.

Treatment for Hodgkin lymphoma is successful for most kids and teens. The treatment used is based on staging. Staging is a way to describe how much cancer is in the body and where it is at the time of diagnosis. The stage at diagnosis can help the cancer team choose the best therapy and predict how someone with lymphoma will do in the long term.

What Are the Side Effects of Treatment of Hodgkin Lymphoma?

Treatment for Hodgkin lymphoma destroys good cells along with bad ones. This can cause side effects.

Intensive lymphoma treatment affects the bone marrow, causing anemia, easy bleeding, and increasing the risk for serious infections.

Chemotherapy treatments have side effects, such as:

• short-term side effects: hair loss, increased risk of infection, nausea and vomiting
• long-term side effects: heart, thyroid, and kidney damage; fertility problems; the development of another cancer later in life

Looking Ahead

Most kids and teens with Hodgkin lymphoma are cured, meaning they will have long-term cancer-free survival.

After treatment, anyone who has had Hodgkin lymphoma should have regular checkups throughout their life to make sure the lymphoma hasn't come back.

Having a child being treated for cancer can feel overwhelming for any family. But you're not alone. To find support, talk to your child's doctor or a hospital social worker. Many resources are available to help you get through this difficult time.

You also can find information and support online at:

• American Cancer Society
• National Cancer Institute
• Leukemia and Lymphoma Society