Hodgkin’s Disease

Hodgkin’s disease, also known as Hodgkin lymphoma, is a type of cancer that affects the lymphatic system, a vital part of the body’s immune system. Despite being a serious condition, it is considered one of the most curable cancers, with treatment often eliminating all signs and symptoms.

Hodgkin lymphoma, Hodgkin disease, classical Hodgkin lymphoma

Table of contents

• What is Hodgkin’s Disease?
• Types of Hodgkin’s Disease
• Parts of the Body Affected
• Signs and Symptoms
• Who is More Likely to Develop It
• How It is Diagnosed
• Treatment Options
• Outlook and Recovery
• Living with and After Hodgkin’s Disease

What is Hodgkin’s Disease?

Hodgkin’s disease is a type of cancer that develops in the lymphatic system, which is a network of organs, vessels, and tissues that work together to protect your body from infection and disease^[1]. The lymphatic system includes lymph nodes, bone marrow, spleen, thymus, tonsils, and other structures throughout the body^[3].

This cancer begins when certain white blood cells called B lymphocytes (or B cells) change and start to grow out of control^[2]. These abnormal cells are called Reed-Sternberg cells, and their presence is one of the key features that doctors look for when diagnosing Hodgkin’s disease^[4]. These cancer cells are usually surrounded by normal white blood cells called T lymphocytes^[4].

What makes Hodgkin’s disease different from other cancers of the lymphatic system is that it commonly starts in the lymph nodes of the neck or chest, and it tends to spread in a more predictable pattern from one group of lymph nodes to nearby groups^[1][2].

Types of Hodgkin’s Disease

Hodgkin’s disease is divided into two main categories: classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Classical Hodgkin lymphoma accounts for about 95% of all cases^[4].

There are four subtypes of classical Hodgkin lymphoma^[1][2]:

• Nodular sclerosis Hodgkin lymphoma is the most common subtype. It often affects young adults, especially women, and typically develops in lymph nodes in the central part of the chest^[2].
• Mixed cellularity Hodgkin lymphoma typically affects people in their 60s and sometimes develops in the belly area^[2].
• Lymphocyte-rich classic Hodgkin lymphoma affects about 6% of people with Hodgkin’s disease and is more common in men^[2].
• Lymphocyte-depleted Hodgkin lymphoma affects only about 1% of people with this disease. It is most common in people older than 60 and in those who have HIV/AIDS^[2].

Parts of the Body Affected

• Lymph nodes (especially in the neck, chest, underarms, and groin)
• Spleen
• Thymus
• Bone marrow
• Tonsils
• Liver
• Lungs

Hodgkin’s disease most commonly begins in the lymph nodes of the neck, chest area, or underarms^[2][8]. As the disease progresses, it can spread to other groups of lymph nodes and may eventually affect organs such as the spleen, liver, lungs, or bone marrow^[1][2].

Signs and Symptoms

The most common first sign of Hodgkin’s disease is painless swelling of lymph nodes in the neck, underarm, or groin area^[2][3]. These swollen lymph nodes may feel like lumps under the skin and do not shrink or disappear as you would expect with normal swelling from an infection^[6].

Other symptoms that may occur include^[2][3]:

• Persistent fatigue – feeling much more tired than usual for at least several days
• Unexplained fever – a high fever that comes and goes without an obvious cause
• Drenching night sweats – sweating so intense during sleep that it soaks your sheets and clothes
• Unexplained weight loss – losing 10% or more of your body weight over six months without trying
• Itchy skin, which may become worse after drinking alcohol or taking a bath^[2][3]
• Chest pain or trouble breathing if the disease affects lymph nodes in the chest^[2]
• Belly pain or swelling^[2]

Doctors use a special term for three specific symptoms: fever, unexplained weight loss, and drenching night sweats. Together, these are called “B symptoms” and they are important in determining the stage and severity of the disease^[2].

Who is More Likely to Develop It

While Hodgkin’s disease is rare, affecting about 3 in 100,000 people each year, certain factors can increase the likelihood of developing it^[2].

Hodgkin’s disease is most common in two age groups: young adults between 20 and 39 years old, and adults older than 65^[3][8]. It is actually one of the most common cancers in teenagers and young adults^[2].

Other factors that increase risk include^[3][4][6]:

• Being male – men are slightly more likely to develop Hodgkin’s disease than women
• Past infection with Epstein-Barr virus (EBV) – having this virus, which causes infectious mononucleosis (also called “mono”), especially as a teenager, increases the risk. About half of all cases of Hodgkin’s disease are linked to EBV^[8]
• Having a weakened immune system, such as from HIV/AIDS infection or taking medicines that suppress the immune system^[3][6]
• Family history – having a parent or sibling with Hodgkin’s disease increases your risk^[3]
• Autoimmune diseases such as rheumatoid arthritis, lupus, or celiac disease^[6]

It’s important to know that having these risk factors does not mean you will definitely develop Hodgkin’s disease. Many people with risk factors never get the disease, and some people without any known risk factors do develop it^[4].

How It is Diagnosed

If your doctor suspects Hodgkin’s disease based on your symptoms, several tests will be needed to confirm the diagnosis and determine how far the disease has spread^[3][10].

The diagnostic process typically includes^[3][10]:

Physical examination – Your doctor will check for swollen lymph nodes in your neck, underarms, and groin, and will also check if your spleen or liver is enlarged^[10].

Blood tests – These can help show whether there are signs of disease in your body. Tests may include a complete blood count, blood chemistry studies, and tests for viruses like HIV and Epstein-Barr virus^[3][10].

Imaging tests – These create pictures of the inside of your body to show where the disease is located. Common tests include CT scans (computed tomography) and PET scans (positron emission tomography)^[3][10].

Lymph node biopsy – This is the most important test for diagnosing Hodgkin’s disease. A doctor removes all or part of a swollen lymph node, and the tissue is examined in a laboratory to look for Reed-Sternberg cells, which are the abnormal cells that indicate Hodgkin’s disease^[3][10].

Bone marrow biopsy – In some cases, a sample of bone marrow may be taken to check if the disease has spread there^[10].

After diagnosis, doctors determine the stage of the disease, which describes how far it has spread in the body. Staging helps doctors plan the best treatment^[3].

Treatment Options

The good news is that Hodgkin’s disease is highly treatable, and most people can be cured^[1][2][3]. Treatment choices depend on several factors, including the type and stage of the disease, your age, and your overall health^[3].

The main treatments for Hodgkin’s disease are^[1][3][12]:

Chemotherapy uses powerful medicines to kill cancer cells. You will likely receive several different chemotherapy drugs together, often along with steroid medicines. Chemotherapy is given in cycles, with treatment periods followed by rest periods to allow your body to recover^[12][13].

Radiation therapy uses high-energy rays to destroy cancer cells in specific areas of the body. It may be used alone for early-stage disease, or combined with chemotherapy for more advanced cases^[1][12][13].

Targeted therapy and immunotherapy are newer treatments that work in specific ways to attack cancer cells. Targeted medicines attack particular features of cancer cells, while immunotherapy helps your own immune system recognize and destroy cancer cells. These treatments may be used if the disease comes back after initial treatment or if first-line treatments don’t work well^[12][13].

Stem cell transplant (also called bone marrow transplant) may be recommended if the cancer returns after treatment. This procedure replaces damaged blood-forming cells with healthy ones^[1][3][12].

For some people with slow-growing disease, especially a type called nodular lymphocyte-predominant Hodgkin lymphoma, doctors may recommend “watch and wait” instead of immediate treatment. This means having regular check-ups and tests to monitor the disease, and starting treatment only when needed^[12].

Your treatment team will include specialists such as oncologists (cancer doctors), radiation oncologists, and nurses who specialize in cancer care. They will work with you to create a treatment plan that best suits your situation^[12].

Outlook and Recovery

Hodgkin’s disease has one of the best cure rates of any cancer. About 85% of people diagnosed with this disease will survive and be cured^[1][4]. In the United States, 88% of people with Hodgkin’s disease survive for at least five years after diagnosis^[8]. For people under age 20, the survival rate is even higher at 97%^[8].

The outlook is especially good if the disease is found and treated early^[3][8]. Treatment can often eliminate all signs and symptoms of the disease^[2].

Several factors affect how well treatment works^[11]:

• The stage of the disease when it is diagnosed
• The type of Hodgkin’s disease
• Your age and overall health
• Whether you have B symptoms (fever, night sweats, weight loss)
• The size of tumors

However, it’s important to know that Hodgkin’s disease can sometimes come back after treatment. This is called relapse or recurrent disease^[2][13]. Even when the disease returns, additional treatment can often still cure it^[13].

Living with and After Hodgkin’s Disease

After completing treatment for Hodgkin’s disease, you will need regular follow-up care. These appointments help doctors make sure the cancer hasn’t come back and allow them to watch for and manage any long-term effects of treatment^[21].

Follow-up visits are usually scheduled every few months at first, then become less frequent over time. After 2 to 3 years, if you remain well, your care may be handed back to your regular doctor^[21]. Some hospitals use a system called “supported self-management” where you learn what symptoms to watch for and contact your medical team if concerns arise^[21].

Late effects of treatment are health problems that can develop months or years after treatment ends. Because many people with Hodgkin’s disease are young when treated, they have many years ahead in which these late effects might occur^[22].

Possible late effects include^[22][24]:

• Secondary cancers – Treatment for Hodgkin’s disease, especially radiation therapy, can increase the risk of developing other cancers years later, including breast cancer, lung cancer, and thyroid cancer
• Heart and blood vessel problems – Both chemotherapy and radiation to the chest can affect the heart
• Lung problems – Some treatments can cause breathing difficulties
• Thyroid problems – Radiation to the neck can affect thyroid function
• Fertility issues – Some treatments can affect the ability to have children. It’s important to discuss fertility preservation options with your doctor before treatment begins^[12][24]
• Fatigue – Many survivors experience ongoing tiredness^[24]
• Increased risk of infections – Treatment can weaken the immune system^[24]

Because of these potential late effects, it’s crucial to^[19][22]:

• Keep detailed records of your treatment history, including exactly what chemotherapy drugs you received and what areas received radiation
• Attend all follow-up appointments and screening tests
• Find doctors who understand cancer survivorship and late effects
• Have a survivorship care plan that includes a schedule for future tests and screenings
• Women who received radiation to the chest should begin breast cancer screening earlier than usual and may need more frequent mammograms^[21]

Taking care of yourself during and after treatment is important for your overall well-being. While there is no specific diet for people with Hodgkin’s disease, eating a balanced diet with fruits, vegetables, whole grains, and lean proteins helps keep your body strong^[23][24].

Staying active is also beneficial when you’re able. Exercise can help with fatigue, maintain muscle strength, and improve your overall quality of life^[23]. Talk with your healthcare team about what level of activity is safe for you.

Emotional support is equally important. A cancer diagnosis and treatment can be overwhelming and bring up many difficult feelings^[17]. It’s normal to feel scared, angry, sad, or uncertain. Talking with friends, family, a counselor, or other people who have been through similar experiences can help. Many organizations offer support groups and resources specifically for people with lymphoma^[17][19].

Managing practical issues like work, finances, and daily activities during treatment can also be challenging. Social workers and patient navigators at cancer centers can help connect you with resources for financial assistance, transportation, and other support services^[24].

Remember that you don’t have to face Hodgkin’s disease alone. There are thousands of survivors and a caring community ready to support you^[19]. Don’t hesitate to ask your healthcare team questions and seek help when you need it.