Hodgkin lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma is a cancer of your lymphatic system. Your lymphatic system is a network of vessels and glands which carries a clear liquid called lymph throughout your body. Your lymphatic system plays an important role in your immune system and carries white blood cells, called lymphocytes, that fight infections.

Hodgkin lymphoma occurs when your lymphocytes become abnormal and you produce more than you normally would. The abnormal lymphocytes can’t fight infection well, so you may catch more infections or infections that other people would not usually get.

The abnormal lymphocytes can collect in your lymph nodes causing swellings. Over time, these abnormal cells can travel to other areas such as your spleen, liver or bone marrow.

Hodgkin vs non-Hodgkin lymphoma

Hodgkin and non-Hodgkin lymphoma are both cancers of white blood cells. When the cells are looked at under a microscope, people with Hodgkin lymphoma will have a specific type of cell called a Reed-Sternberg cell. These cells are the type of white blood cell that has turned cancerous. Non-Hodgkin lymphoma is any other lymphoma that does not contain these specific cells.

It’s important that a distinction is made between the two types of lymphoma as the treatments are different. 

What are the symptoms of Hodgkin lymphoma?

Hodgkin lymphoma can present with many different symptoms. The most common is a swelling in your groin, neck or armpit. Most of the time these swellings are painless but they can ache in others. They can also ache when you drink alcohol.

There are also some non-specific symptoms you may experience:

• Night sweats

• Unintentional weight loss

• A high temperature

• Feeling breathless

• Itching all over your body

If the lymphocytes are dividing in your bone marrow, the amount of other blood cells may decrease causing a low white cell count, platelet count or anaemia. This can result in:

• Tiredness and fatigue

• Shortness of breath

• More frequent, more serious infections

• Bleeding more easily – you may have nosebleeds, heavier periods or bruises and bleeds under the skin

Who is at risk of Hodgkin lymphoma?

Although we don’t know exactly what causes Hodgkin lymphoma, there are things that may increase your risk of developing it:

• Your age – anyone can develop Hodgkin lymphoma, but it’s more likely if you’re a young adult, between 20 and 40, or over 75

• Your sex – Hodgkin lymphoma is more common in males

• If you’re immunocompromised – if you have a weakened immune system because of a medical condition or because you’re taking medication that lowers your immune system

• Your family history – if your parent or siblings have a blood cancer

• If you’ve previously had the Epstein-Barr virus – this is the virus that causes glandular fever.

What is Hodgkin lymphoma staging?

Staging is a score of how far the cancer has spread throughout your body. Staging is scored between 1 and 4, with higher scores meaning the cancer has spread further. The stages are:

1)      The cancer is in only 1 group of lymph nodes, for example in your neck nodes or your groin nodes

2)      The cancer is in 2 or more lymph node groups but is only one side of your diaphragm (the large muscle that helps you breathe)

3)      The cancer is in lymph nodes above and below the diaphragm

4)      The cancer is outside the lymphatic system and is in your organs or bone marrow

How is Hodgkin lymphoma diagnosed?

If a doctor suspects you haveHodgkin lymphoma, they will refer you to a hospital for more tests. These tests normally include a lymph node biopsy, which involves removing a part of a lymph node and sending it to a lab to be looked at under a microscope. Usually, you’ll be awake and a local numbing injection will be used,  but if the lymph node is hard to get to then you may need a general anaesthetic.

Further tests you may have include:

• Blood tests

• Bone marrow sampling – similar to a lymph node biopsy but with a sample of bone marrow from the pelvis

• Chest x-ray, CT scan or MRI scan

• PET scan – this measures the activity of cells. Cancer cells are very active so will show up on a PET scan as more active than your healthy body cells.

How is Hodgkin lymphoma treated?

Treatment plans vary from patient to patient. A group of healthcare professionals who specialise in different areas will discuss your treatment – this is known as a multidisciplinary team (MDT). The MDT will help you decide which treatment is most suitable for you.

Treatments may include one of or a mixture of the following:

• Chemotherapy

• Steroids

• Radiotherapy

• Immunotherapies – specialised drugs designed to attack specific types of lymphoma such as rituximab or brentuximab

Each treatment option has its own side effects. A doctor will discuss these with you in detail before starting treatment.

When should I seek help?

If you have symptoms of Hodgkin’s lymphoma then see a doctor as soon as possible. Although it may not likely be lymphoma, a persistent lymph node when you do not have an infection should still be checked by a doctor.

Hodgkin lymphoma in children

Hodgkin lymphoma is even less common in children but may occur. The likelihood increases if you are aged 15 and over. Treatments and symptoms are similar in children.

Additional support

Receiving a diagnosis of lymphoma for yourself or someone you love can be extremely tough, so when diagnosed you will be signposted to further help. Macmillan have lots of information on their website as well as support lines.