An Overview of Hodgkin Lymphoma

Lymphoma is a cancer that develops in a group of white blood cells called lymphocytes. Your body relies on several different kinds of lymphocytes to do various jobs in the immune system. These lymphocytes are cells that grow up in stages, sort of like tadpoles becoming frogs. And, since a cancer can develop in different kinds of lymphocytes and at various stages of their development, many different types of lymphoma are possible.

Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are the two main categories of lymphoma. HL is also called Hodgkin’s disease, and the two names describe only one disease—there is no such thing as a Hodgkin’s disease that is not a lymphoma. A doctor named Thomas Hodgkin first discovered HL in the 1800s, and the lymphoma bears his name to this day.

Hodgkin Lymphoma: A Cancer of the Lymph Nodes

HL typically begins in the lymph nodes, as do most lymphomas.

Each of us has hundreds of lymph nodes, which are small, bean-shaped organs that help keep watch over a bodily fluid called lymph.

What is lymph? Well, if you imagine putting your blood through a microscopic strainer, the blood cells and big proteins would stay in the strainer while the liquid would pass through. That liquid is similar to lymph. The cells in the lymph are a different story. The body’s white blood cells flock to the lymphatic system to do jobs for the immune system. White cells are circulating in the lymph, and many of them reside in the lymph nodes.

Lymph nodes sit strategically along a network of lymph-fluid filled channels, serving as immune outposts, or checkpoints.

Each lymph node filters the fluid it receives from lymph vessels that drain a particular territory of the body.

Sometimes people become aware of lymph nodes as bumps under the skin, or the so-called swollen glands that may result from an infection. Most of the time, healthy or non-responding lymph nodes go unnoticed. Additionally, some lymph nodes are located deep inside the body, near the heart, between the lungs, or deep within the abdomen, draining and filtering lymph fluid from internal organs and tissues. In these locations, they might not be noticed for some time, even if swollen or developing into a mass.

Node swelling from Hodgkin lymphoma is more likely to arise in the upper portion of the body, in lymph nodes of the neck, underarms, or within the chest.

What Causes Hodgkin Lymphoma?

Scientists do not know what specifically causes Hodgkin lymphoma. There are some known risk factors, but the presence of a risk factor does not in any way ensure that HL will develop, nor is a risk factor necessarily the cause when HL does develop.

Such risk factors include the virus that causes mono, or mononucleosis, which is called the Epstein-Bar virus. Family history is also a risk factor, but it’s not known how or why; that is, there may be shared genes that make family members more susceptible to HL, or perhaps people in the same family had similar childhood diseases that put them at risk for HL. Having a weakened immune system also increases the risk of HL. Such impaired immunity may come from HIV/AIDS, various other illnesses, or from medications used to suppress the immune response.

Who Gets Hodgkin Lymphoma?

Hodgkin lymphoma is less common than NHL overall, accounting for only about 10 percent of all lymphoma cases. It can occur in both children and adults, and there are two peak age groups:

  • Adolescents and young adults ages 15 to 40 years
  • Older adults over the age of 55

So, even though HL is relatively rare, if it may seem as though people in their 20s get diagnosed more often, and that’s probably due to the first peak age group.

How Is it Different from Non-Hodgkin Lymphoma?  

Each person with HL is likely to have his or her own story to tell. In general, however, Hodgkin lymphoma is a much smaller, less diverse group of lymphomas than NHL. HL arises in the B cells, or B-lymphocytes, as do many types of NHL. However, unlike NHL, HL has only five traditionally recognized subtypes (more on this below); NHL has scores of them.

HL and NHL also differ in how they emerge and spread through various lymph nodes. HL is much more likely to begin and spread in a stepwise, orderly way—from lymph node to lymph node. Only rarely and late in the disease does HL invade the bloodstream and become more widespread. In many cases of NHL, it’s assumed from the get-go that multiple nodes in different parts of the body may be involved, until proven otherwise.

Symptoms of Hodgkin Lymphoma

People with HL may develop different symptoms, but the most common scenario at diagnosis is enlarged lymph node(s) and nothing else.

Lymph nodes may be enlarged in the neck, armpits, or groin, causing a painless lump, or within the chest.

 Less commonly, those with HL may have weight loss, fever, itching, or drenching sweats at night, collectively called B symptoms.

A very rare but characteristic symptom of HL is pain associated with the consumption of alcoholic beverages. Scientists do not know precisely why this occurs, but it may be due to expanding of the vessels within involved lymph nodes in response to the alcohol.

Diagnosis of Hodgkin Lymphoma

An enlarged lymph node that doesn’t go away should never be ignored. However, the causes of lymph node enlargement are numerous, and many of them are not cancerous. If a suspect lymph node is relatively new, there is often a waiting period to make sure it is not swollen for some other reason. Lymph nodes are much more likely to be swollen from infections and other causes than from lymphoma.

Lymph Node Biopsy

When HL is suspected, lymph nodes may be biopsied. A biopsy is a procedure in which a sample of tissue is taken from a lymph node or other parts of the body and sent to the laboratory for testing and evaluation. Depending on the location of the lymph node, the procedure may be very simple or slightly more involved, but in either case it is generally considered a minor surgery. Cases may be done in an outpatient surgical center or in a hospital operating room.

In an excisional biopsy, you are given an injection of local anesthetic so that you don't feel pain during the procedure. The skin above the suspicious lymph node(s) is opened with a small incision, and a single lymph node or a few of them are taken out. The cut is then stitched closed. The biopsy takes about 30 to 45 minutes, and you can return home soon after the procedure.

Alternatively, when the lymph nodes or other suspicious sites are deep inside the body, the biopsy procedure may involve scans of the body and imaging to guide a needle to the exact area of suspect tissue. The physician can than use the needle to access a sample, which is taken and sent to the pathologist for testing.

Fine needle aspiration is a procedure that is sometimes done, especially as a first step when there is a concern that a node in the neck could be involved with head and neck cancer. Fine needle aspiration, however, does not provide as good of a sample as an excisional biopsy for the initial diagnosis of HL.

Sometimes other sites such as the bone marrow are biopsied, but this is not usually a part of the routine evaluation for early HL.

Blood Tests

Blood tests such as the complete blood count or CBC involves an automated counter tallying up the blood cells of different types to determine whether your numbers fall in a normal or abnormal range. Findings are not specific to HL. Sometimes other markers from the blood may be used to add information to correlate with a prognosis. And screening for certain viral infections is also a part of the initial lab evaluation.

PET Scans and Imaging

PET scanning over recent years has become vital to the initial staging of Hodgkin lymphoma. PET scans can also help tell the difference between active tumors and fibrous areas that remain in the body after a person with HL has been treated. Guidelines from the National Comprehensive Cancer Network recommend PET/CT for initial staging and final response evaluation in patients with HL.

PET scans and CT scans are two different kinds of imaging that are often done together so that a good picture of the anatomy is rendered via the CT while the power of PET is harnessed to detect areas of disease that light up. A mass in the chest area, or mediastinum, is a very common finding in classical HL on PET/CT.

The role of PET continues to evolve, and there is much interest in interim PET scanning, whereby you can see the response you are getting to a given therapy before that regimen is even completed. In many cases, the jury is still out on the best timing of PET scanning and implications for changes in therapy.

Types of Hodgkin Lymphoma

There are five major types of HL that one can be diagnosed with. Classical Hodgkin lymphoma is an older term used to describe a group of four common types that together comprises more than 95 percent of all cases of HL in developed countries. Of the five main types, only the first four are classical HL:

Nodular Sclerosing Hodgkin Lymphoma (NSHL)

  • The most common type of HL; accounts for 60 percent to 70 percent of all HL cases
  • More common in females and mostly affects younger people
  • Mainly affects nodes in the neck or armpits, or within the chest

Mixed Cellularity Hodgkin Lymphoma (MCHL)

  • Another common type of HL, accounting for 15 percent to 30 percent of diagnoses
  • More common in developing countries
  • Affects people of any age
  • More likely to involve the abdomen than the more common nodular sclerosing variety, and less likely to involve nodes within the chest
  • Aggressive, but highly curable

Lymphocyte Depleted Hodgkin Lymphoma (LDHL)

  • Very rare form of HL that makes up only about 1 percent of cases
  • Seen in older people and is often diagnosed in an advanced stage; also more common in those who are infected with HIV

Lymphocyte-rich Classical Hodgkin Lymphoma (LRCHL)

  • Uncommon subtype; accounts for about 5 percent to 6 percent of diagnoses
  • Affects people most commonly in the 30s or 40s
  • Most are diagnosed in early stages; response to treatment is excellent
  • Rarely found in more than a few lymph nodes; occurs in the upper half of the body.

That leaves just one form of non-classical HL:

Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)

  • Now considered a special type of HL that is distinct from the other types above
  • Accounts for 4 percent to 5 percent of diagnoses
  • Microscopically cells are similar to NHL
  • Clinical disease that is similar to the lymphocyte-rich type of classical HL, with involved lymph nodes typically in the neck and armpits

What’s the Prognosis?

In general, HL is considered one of the more treatable and curable forms of blood cancer when caught in its early stages, and it’s potentially curable even in later stages. However, there are also cases that come back after treatment and/or that are more difficult to treat.

Statistics on HL cure rates and survival rates are not always easy to understand or apply to a single individual; therefore working with a doctor to understand treatment options and prognoses is important.

Treatment of Hodgkin Lymphoma

If you have been diagnosed with HL and are wondering about your treatment options, talk to your doctor about your particular stage and what that means. Chemotherapy or radiation may be recommended, but what is right for you will depend on your specific HL type, case, your age, your overall health, and more.

Learn more about treatment of Hodgkin lymphoma.

If you are undergoing treatment, be sure to see your doctor if you notice anything new related to your condition or are experiencing side effects, some of which may be managed medically. If you have a question about your condition or how it is being managed, never hesitate to talk to your doctor further or seek out a second opinion.

A Word From Verywell

You should consider making an appointment with your doctor if you have any worrisome signs or symptoms. Sometimes a swollen lymph node is just a swollen lymph node, which is important to keep in mind. But ignoring a persistently swollen lymph node can also mean missed opportunities for early detection and prompt treatment.

If you or a loved one has been diagnosed with Hodgkin lymphoma, it is very normal to feel confused and a bit stunned. Making sense of all the lymphoma types and treatments can be a daunting task. When reading up, make sure your sources refer to Hodgkin lymphoma specifically, and not just lymphoma in general.

At Verywell, we aim to explain things based on the best science, but always in plain English. Check back often and at each phase of your cancer journey, and make use of other resources for patients such as the American Cancer Society and the Leukemia & Lymphoma Society.

Sometimes it can be helpful to talk to someone who has been through Hodgkin lymphoma and all that diagnosis and treatment entails. Survivorship workshops, conferences, and even social media are excellent ways to connect with others who may share your struggles or have similar experiences and insights.

Sources:

American Cancer Society. What are the risk factors for Hodgkin disease?

Hutchings M. How does PET/CT help in selecting therapy for patients with Hodgkin lymphoma? Hematology Am Soc Hematol Educ Program. 2012;2012:322-7.

Townsend W, Linch D. Hodgkin's lymphoma in adults. Lancet. 2012;380(9844):836-47.

More from Verywell in Hodgkin's Lymphoma

Learn more about Leukemia & Lymphoma