NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Cancer (Oncology)

Lymphoma: Hodgkin's Lymphoma

Lymphoma is a cancer that affects the lymphatic system. There are two main types of lymphoma: Hodgkin's lymphoma (or Hodgkin's disease, named after Dr. Thomas Hodgkin) and Non-Hodgkin's lymphoma. Both Hodgkin's and Non-Hodgkin's lymphoma start in white blood cells called lymphocytes – which are part of the body's immune system – but they have different behaviors and responses to treatment.

Hodgkin's lymphoma is characterized by the presence of a specific type of abnormal cells called Reed-Sternberg cells, that are larger than normal lymphocytes and not found in Non-Hodgkin's lymphomas.

Almost all cases of Hodgkin's lymphoma start in so-called B lymphocytes (B cells), which mature into antibody-producing plasma cells and protect against germs. A small percentage of cases begin in T lymphocytes (T cells), which destroy certain bacteria or viruses. The most common type of Hodgkin's disease is known as Classic Hodgkin's disease (HD) and accounts for about 95 percent of Hodgkin's disease cases in developed countries. Nodular lymphocyte predominant Hodgkin's disease (NLPHD), accounts for about 5 percent of Hodgkin's disease. Hodgkin's disease can start almost anywhere in the body but is most likely to occur in the lymph nodes, spleen, bone marrow, thymus, and digestive tract.

In general, Hodgkin's is more common in men. It can occur in both children and adults, but is rare in children younger than five years old. It is most common in either early adulthood (in the 20s), or after age 55. Hodgkin's disease is most common in the United States, Canada, and northern Europe, and is least common in Asian countries.

Hodgkin's disease has a relatively high survival rate. Those rates are improving due to advances in treatment.

Risk Factors

The exact cause of Hodgkin disease is not known and it is not possible to prevent most cases of the disease. Having had the Epstein-Barr virus (EBV), which causes infectious mononucleosis, raises the risk of developing Hodgkin's lymphoma. Being infected with Human Immunodeficiency virus (HIV), the virus that causes AIDS, also raises the risk. The risk seems to be greater in people with a higher socioeconomic background. Siblings of people with this disease have a higher risk, but the family link is evident in only around 5 percent of all cases.

Symptoms and Prevention

There are no widely recommended screening tests for Hodgkin's disease and symptoms may not appear early in the disease. When symptoms do appear, the most common is painless enlargement of lymph nodes, particularly on the neck, in the arm pit, or in the groin. Other symptoms can include persistent fever, heavy night sweats, fatigue, unexplained weight loss and loss of appetite, and severe itching. Sometimes Hodgkin's disease affects lymph nodes inside the chest. When those nodes swell, the pressure on the windpipe (trachea) may cause coughing or breathing trouble.

These symptoms are more often a sign of infection (or even another cancer), rather than Hodgkin's disease, but it is important to have such lumps checked by your doctor.

Treatment

Chemotherapy and/or radiation, or a combination, are the primary methods of treating Hodgkin's disease. Surgery is not normally a suitable treatment.