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Maurie Markman, MD, President, Medicine & Science
This page was updated on May 26, 2022.
Named after the doctor who identified it in 1832 (Dr. Thomas Hodgkin), Hodgkin lymphoma is distinguished from the other lymphomas by the way it looks under a microscope, and by the way it grows and spreads. Most often, Hodgkin lymphoma starts in the lymph nodes in the upper part of the body (the chest, neck, or under the arms). The disease causes the lymphatic tissue to become enlarged and press on nearby structures. Since lymph tissues are all connected, lymphoma can spread from one lymph node to another throughout the body.
What is Hodgkin lymphoma?
Hodgkin lymphoma is a rare cancer that develops in the lymphatic system, which circulates through the spleen, lymph nodes and other organs, filtering out impurities and infections. Hodgkin lymphoma develops in lymphocytes, immune cells that are found in blood and lymph fluid. When these cells mutate, they grow out of control and may overtake the lymph system and spread to other parts of the body. The disease is named for Dr. Thomas Hodgkin, a British physician who first recognized its symptoms in 1832. It was formerly called Hodgkin's disease.
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What's the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?
The primary difference between Hodgkin and non-Hodgkin lymphoma is whether Reed-Sternberg cells are found in a lymph node biopsy. Reed-Sternberg cells are found in patients diagnosed with Hodgkin lymphoma. These mutated B lymphocytes are very large compared to other cells. The various shapes of Reed-Sternberg cells often help pathologists determine the specific type of Hodgkin lymphoma. A common variety of these cells has at least two nuclei, giving them the appearance of owls' eyes. Reed-Sternberg cells are named for the two scientists who first identified them under a microscope. Non-Hodgkin lymphoma is one of the most common cancers in the United States, with almost 80,620 cases diagnosed each year. Hodgkin lymphoma is rare by comparison, with about 8,600 cases diagnosed annually.
What are the signs and symptoms of Hodgkin lymphoma?
A common symptom of Hodgkin lymphoma is a lump in the neck, groin or armpit. The lump may be painful, especially after drinking alcohol. Over time, the lump may grow, or more lumps may appear.
Some symptoms of Hodgkin lymphoma, such as fever and swollen lymph nodes, may be mistaken for symptoms of the flu or an infection. But in lymphoma patients, these symptoms may not go away. If these symptoms persist for more than two weeks, see your doctor.
Other common symptoms of Hodgkin lymphoma are known as B symptoms. They include:
Some of these symptoms may also affect patients with non-Hodgkin lymphoma or leukemia.
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What are the different types of Hodgkin lymphoma?
There are two types of Hodgkin lymphoma. About 95 percent of all cases are classical (or classic) Hodgkin lymphoma. This form of the disease is divided into four subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted. A less common type is nodular lymphocyte-predominant Hodgkin lymphoma.
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What's the difference between leukemia and lymphoma?
Leukemia and lymphoma share many common symptoms and characteristics. Both diseases are considered blood cancers, or liquid cancers, and originate in lymphocytes, which are the white blood cells that help the body fight off disease. In patients with leukemia and lymphoma, white blood cells grow out of control and crowd out healthy cells. When the mutated cells are found in the blood, the disease is diagnosed as leukemia. When the cells are found in the lymph nodes, the cancer is considered lymphoma.
Leukemic cells are more likely to remain in the blood and circulate throughout the body. Lymphoma cells may also circulate, but they are more likely than leukemic cells to develop into solid tumors in the lymph system, such as in lymph nodes or the spleen.
Despite the similarities, the diseases are often diagnosed and treated in different ways. The diseases are also distinguished in other ways. For instance, lymphoma is characterized by two types, Hodgkin lymphoma and non-Hodgkin lymphoma, and each disease has multiple varieties, as does leukemia.
What kinds of tests will I need to determine if I have lymphoma?
Patients may undergo a variety of tests to determine whether they have lymphoma or leukemia and, if so, to diagnose the stage or progression of the disease. In most cases, a biopsy is performed, retrieving a tissue sample from a lymph node. The sample is then examined under a microscope by a pathologist. A blood test may also be performed to rule out infection or other diseases.
Other tests used to diagnose the type or stage of the lymphoma include flow cytometry (used to look for abnormal DNA), blood tests and imaging tests, such as a CT scan.
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Can a liquid cancer like Hodgkin lymphoma form solid tumors?
Yes. Cancerous lymphocytes can accumulate in the organs and glands of the lymph system, especially in lymph nodes. Cancerous cells may also accumulate in the tonsils, thymus spleen and bones. These tumors may form lumps, become painful and interfere with breathing, circulation and other functions. They may require surgery to be removed.
What types of treatments are used for Hodgkin lymphoma?
The primary treatments for Hodgkin lymphoma are immunotherapy, chemotherapy, stem-cell transplant and/or radiation therapy. These therapies may be used alone or in combination with one another.
The U.S. Food and Drug administration has approved the immunotherapy drug pembrolizumab (Keytruda®) to treat some patients with classical Hodgkin lymphoma whose previous treatment did not work or who have relapsed after receiving three or more types of treatment. Pembrolizumab is a checkpoint inhibitor drug that works by blocking signals that cancer cells use to hide from the immune system.
Radiation therapy may be used to kill cancer cells that accumulate in the lymph nodes, spleen or related organs and cause pain and swelling.
Before a stem cell transplant, a patient will receive high-dose chemotherapy, to destroy as many cancer cells as possible. Then stem cells are given intravenously (similar to a blood transfusion). Stem cells then travel to the bone marrow and produce healthy new blood cells in a process known as engraftment.
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What are the common side effects of Hodgkin lymphoma or its treatment?
Because lymphoma affects the lymphatic system, treatment for the disease may lead to a condition called lymphedema, which is swelling caused by a buildup of lymphatic fluid.
Other common side effects include:
Can Hodgkin lymphoma be prevented?
The cause of Hodgkin lymphoma is unknown, but known risk factors include:
Age: The median age of a patient diagnosed with Hodgkin lymphoma is 39, according to the National Cancer Institute. Most cases—57 percent—are diagnosed in patients younger than 44.
Demographics: Hodgkin lymphoma is more common in North America and northern Europe and in higher socioeconomic circles. Family history is a risk factor in about 5 percent of cases, according to the American Cancer Society.
Gender: Hodgkin lymphoma is diagnosed more often in men.
Health: Patients whose immune system has become compromised after an organ transplant or who have HIV/AIDS or Epstein-Barr virus may be at higher risk.
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