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«What is Hodgkin disease? Hodgkin disease (Hodgkin lymphoma) is a type of lymphoma, a cancer that starts in white blood cells called lymphocytes. ...»

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Hodgkin Disease Overview

This overview is based on the more detailed information in our document Hodgkin


What is Hodgkin disease?

Hodgkin disease (Hodgkin lymphoma) is a type of lymphoma, a cancer that starts in

white blood cells called lymphocytes. Lymphocytes are part of the immune system.

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part

of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

Types of lymphoma

There are 2 kinds of lymphoma:

• Hodgkin disease (named after Dr. Thomas Hodgkin, who first described it)

• Non-Hodgkin lymphoma These types of lymphomas differ in how they behave, spread, and respond to treatment, so it’s important to tell them apart. Doctors can most often tell the difference between them by looking at the cancer cells under a microscope. Sometimes, lab tests might be needed to do this.

Both children and adults can get Hodgkin disease. This document covers treatment in both groups.

To learn about non-Hodgkin lymphoma, see Non-Hodgkin Lymphoma.

The lymph system and lymphoid tissue To understand Hodgkin disease, it helps to know about the body’s lymph system. The lymph system is part of the immune system, which helps fight infections. The lymph system is made up of lymphoid tissue, lymph vessels, and a clear fluid called lymph.

Lymphoid tissue includes the lymph nodes and other organs that are part of the body’s immune and blood-forming systems. Lymph nodes are bean-size collections of lymphoid tissue in many places throughout the body. Other parts of the lymph system include the spleen, the bone marrow (soft inner part of some bones), the tonsils, and the thymus.

Lymphoid tissue can also be found in other organs, such as the stomach and intestines.

Lymphoid tissue is made up mainly of lymphocytes, which are special white blood cells

that fight infection. There are 2 types of lymphocytes:

• B lymphocytes (or B cells)

• T lymphocytes (or T cells) Almost all cases of Hodgkin disease start in B lymphocytes.

Start and spread of Hodgkin disease Lymphoid tissue is found in many parts of the body, so Hodgkin disease can start almost anywhere. Most often it starts in lymph nodes in the upper part of the body (in the chest, neck, or under the arms).

Hodgkin disease can spread through the lymph vessels in a stepwise fashion from lymph node to lymph node. Rarely, and late in the disease, the cancer can get into the blood vessels and then spread to almost any other place in the body.

Types of Hodgkin disease

The main types of Hodgkin disease are:

• Classic Hodgkin disease (which has 4 subtypes), which accounts for about 95% of cases

• Nodular lymphocyte predominant Hodgkin disease (NLPHD), which makes up about 5% of cases These types differ in the way the cancer cells look under a microscope. The types are important because they grow and spread in different ways. Often they are treated in different ways. You can ask your doctor about the exact type of Hodgkin disease you (or your loved one) has.

All types of Hodgkin disease are cancer because as they grow they can invade (grow into) nearby normal tissues and spread to other parts of the body.

What are the risk factors for Hodgkin disease?

We do not yet know exactly what causes Hodgkin disease, but we do know that certain risk factors are linked to the disease. A risk factor is something that affects a person’s chance of getting a disease such as cancer. Different cancers have different risk factors.

Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

Scientists have found a few risk factors that may make a person more likely to get Hodgkin disease, although it’s not always clear why these factors increase risk. But having a risk factor, or even several, doesn’t mean that a person will get the disease.

Likewise, having few or no risk factors doesn’t mean a person won’t get the disease.

Epstein-Barr virus (EBV) infection/mononucleosis: People who have had “mono” (infectious mononucleosis), caused by the Epstein-Barr virus, have a higher risk of Hodgkin disease. The overall risk is still very small. Many people are infected with EBV, but very few get Hodgkin disease.

Age: Hodgkin disease is most common in early adulthood (age 15 to 40, especially in a person’s 20s) and in late adulthood (after age 55). But it can occur at any age.

Gender: Slightly more males than females get Hodgkin disease.

Geography: Hodgkin disease is most common in the United States, Canada, and northern Europe, and least common in Asian countries.

Family history: Brothers and sisters of young people with Hodgkin disease have a higher risk for this disease. The risk is very high for an identical twin of a person with Hodgkin disease. But still, a family link is not common – most people with Hodgkin disease do not have a family history of it.

Socioeconomic status: The risk of Hodgkin disease is greater in people with a higher income and educational background. The reason for this is not clear.

HIV infection: The risk of Hodgkin disease is higher in people who have HIV (the virus that causes AIDS).

Can Hodgkin disease be prevented?

Few of the known risk factors for Hodgkin disease can be changed, so it is not possible to prevent most cases of the disease at this time.

One way to limit your risk would be to stay away from known risk factors for infection with HIV, the virus that causes AIDS (such as IV drug use and unsafe sex with many partners). You can read more about HIV in HIV, AIDS, and Cancer.

How is Hodgkin disease found?

At this time, there are no widely used screening tests for Hodgkin disease. (Screening is testing for cancer in people without any symptoms.) Still, in some cases Hodgkin disease can be found early.

Most people with Hodgkin disease see a doctor because they have felt a lump under the skin that hasn’t gone away or they just don’t feel well and go in for a checkup.

Signs and symptoms of Hodgkin disease You or your child can have Hodgkin disease and feel fine. But Hodgkin disease often causes symptoms.

Lumps under the skin You may notice a lump in the neck, under the arm, or in the groin. The lump may be a swollen lymph node. Usually it doesn’t hurt, although it might after you drink alcohol.

The lump might grow larger, or new lumps could show up near it (or even in other parts of the body).

Enlarged lymph nodes, especially in children, are more often caused by an infection or other illness – not cancer. Still, if you (or your child) have enlarged lymph nodes and no recent infection, it is best to have them checked by the doctor.

General symptoms

Some people with Hodgkin disease have what are known as B symptoms:

• Fever (which can come and go over several days or weeks)

• Drenching night sweats

• Weight loss without trying

Other symptoms can include:

• Itching

• Feeling tired

• Poor appetite Sometimes the only symptom is feeling tired all the time.

Cough, trouble breathing, chest pain If Hodgkin disease affects lymph nodes inside the chest, the swelling of these nodes can press on the windpipe. This can make you cough or even have trouble breathing, especially when lying down. Some people might feel pain behind the breast bone.

Having one or more of the symptoms above does not mean you have Hodgkin disease. In fact, many of these symptoms are more likely to be caused by other things such as an infection. Still, if you or your child has any of these symptoms, have them checked by a doctor so that the cause can be found and treated, if needed.

Medical history and physical exam

If symptoms suggest that you or your child might have Hodgkin disease, the doctor will:

• Ask about the symptoms, your family history, and any other medical issues.

• Examine you (or your child), paying special attention to the lymph nodes (Because infections are the most common cause of enlarged lymph nodes, especially in children, the doctor will look for an infection.)

• Possibly order blood tests to look for signs of infection or other problems.

• Get a biopsy if it is thought that Hodgkin disease might be causing the symptoms.

Biopsies Swollen lymph nodes are more often caused by infections than by Hodgkin disease, so doctors often wait a few weeks to see if they stay swollen. Sometimes they give an antibiotic to see if it helps shrink the nodes. If not, a biopsy will be done.

In a biopsy, a lymph node (or a piece of one) is removed and looked at it under a microscope. This is the only way to know for sure if the swelling is caused by cancer.

There are different kinds of biopsies. The doctor will choose the one best suited for you or your child. The goal is to get enough tissue to be sure of the diagnosis and, if it is Hodgkin disease, to tell what type it is.

Types of biopsies Excisional or incisional biopsy: This is the most common type of biopsy for a swollen lymph node. It is called an excisional biopsy when a cut is made through the skin to take out a whole lymph node. When only a small part of a larger tumor or node is taken out it is called an incisional biopsy.

If the swollen node is just under the skin, the biopsy is fairly simple and can sometimes be done just with numbing medicine (local anesthesia). But if the node is inside the chest or belly (abdomen), patients are given medicine to make them relaxed and sleepy, or general anesthesia (where they are in a deep sleep).

Needle biopsies: In another type of biopsy, called a fine needle aspiration (FNA), the doctor uses a very thin, hollow needle to take out a small amount of fluid and tiny bits of tissue from the tumor. For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.

A needle biopsy might not get enough of a sample to make a firm diagnosis. Most doctors don’t use needle biopsies to diagnose Hodgkin disease. But they might use it in patients already known to have Hodgkin disease to see whether a swollen lymph node or organ in a different place also contains lymphoma.

Bone marrow aspiration and biopsy: These tests are not used to find Hodgkin disease.

But in some cases they may be done after the disease is found to see if it is in the bone marrow. They are described in more detail in “Staging for Hodgkin disease.” Lab tests of biopsy samples All biopsy samples will be looked at under a microscope. A doctor checks how they look, as well as the size and shape of the cells in the sample. The doctor looks for special cells known as Reed-Sternberg cells, which are found in Hodgkin disease.

Looking at the tissue under the microscope can often tell whether you have Hodgkin disease and what type it is, but sometimes special stains and tests are used on the sample to get more information. Sometimes the first biopsy does not give a clear answer and more biopsies are needed.

Staging for Hodgkin disease Once Hodgkin disease is diagnosed, tests will be done to figure out the stage (extent) of the disease. The treatment and prognosis (outlook) for a person with Hodgkin disease depend somewhat on both the type and the stage of the disease. If you have any questions about the stage of your lymphoma or how it affects your treatment, be sure to ask your doctor.

Hodgkin disease most often starts in one set of lymph nodes. If it spreads, it is usually to a nearby set of lymph nodes. It can sometimes grow into nearby organs, too.

Staging is based on the results from:

• Your medical history (symptoms)

• The physical exam

• Biopsies

• Imaging tests, which often include a chest x-ray, CT scans, and a PET scan

• Blood tests

• Bone marrow aspiration and biopsy (sometimes but not always done) Imaging tests used to stage Hodgkin disease Imaging tests use different methods to make pictures of the inside of the body. One or more of these tests may be used to help look for tumors or enlarged lymph nodes, to learn the extent of the Hodgkin disease, to find out how well treatment is working, or to see if the cancer has come back after treatment.

Chest x-ray Hodgkin disease often causes swelling of lymph nodes in the chest, which can often be seen on a plain chest x-ray.

Computed tomography (CT) scan The CT scan uses x-rays to make detailed pictures inside the body. This test gives your doctor a better look at lymph nodes in the chest, belly (abdomen), and pelvis, as well as other organs.

A CT scanner has been described as a large donut, with a narrow table that slides in the middle “hole.” You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken. Doctors give some children medicine to help keep them calm or even asleep during the test.

Before the test, you or your child might be asked to drink a liquid or get an injection of a kind of dye to help better outline places in the body. Some people are allergic to the dye and get hives or a flushed feeling or—rarely—have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you or your child has any allergies has ever had a reaction to any contrast used for x-rays.

CT-guided needle biopsy: In some cases, a CT can be used to guide a biopsy needle into an area of concern. You lie on the CT scanning table while a doctor moves a biopsy needle through the skin and toward the area. A biopsy sample is then removed to be looked at in the lab.

Magnetic resonance imaging (MRI) scan This test is rarely used for Hodgkin disease, but if your doctor is concerned about spread to the spinal cord or brain, MRI is very useful for looking at these places.

MRI scans use radio waves and strong magnets instead of x-rays to make detailed pictures. A substance is often injected into a vein before the scan to better show details. It does not usually cause allergic reactions.

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