In 2021 about 8,800 Americans will be diagnosed with Hodgkin Lymphoma and about
960 will die from it. However Hodgkin Lymphoma is recognized as one of the most treatable cancers,
with more than 90 percent of people surviving more than five years. Today I am going to explain
what Hodgkin Lymphoma is, discuss the most common types, talk about how the cancer may spread, things
that may put you at risk for developing Hodgkin Lymphoma, and discuss the diagnosis and treatment.
What is Lymphoma?
Lymphoma is cancer that begins in cells of the lymphatic system.
The lymphatic system or lymph system is made up of organs and tissues that produce and
transport your white blood cells which are the cells that fight infections and other diseases.
The parts of your body included in the lymph system are the lymph vessels, lymph nodes, spleen,
thymus gland, tonsils, and bone marrow. When the white blood cells in these organs or tissues start
growing at faster rates than normal the lymphatic organs swell and this is what is known as lymphoma.
What is Hodgkin Lymphoma?
Hodgkin Lymphoma is a type of lymphoma that affects lymph nodes in the neck or in the areas between the lungs and behind the breastbone.
It may also develop in lymph nodes under an arm, in the abdomen, or in the groin. 90%
of patients with this disease survive more than five years making Hodgkin Lymphoma one of the most
treatable cancers.
What are the most common types of Hodgkin Lymphoma?
Classic Hodgkin Lymphoma or CHL is the most common type of Hodgkin Lymphoma with about 95% of cases falling into this category.
There are two major categories of Classical Hodgkin Lymphoma with nodular sclerosis Hodgkin
lymphoma being the type that about 80 percent of people are diagnosed with. Approximately 5 percent
of people with lymphoma develop nodular lymphocyte predominant hodgkin lymphoma.
Nodular lymphocyte predominant hodgkin is similar to non-hodgkin lymphoma,
however this type of lymphoma is very treatable. An extremely small proportion of those with nodular
lymphocyte predominant lymphoma may develop the more severe and aggressive non-hodgkin lymphoma
known as diffuse large b-cell lymphoma.
Can hodgkin lymphoma spread?
If Hodgkin lymphoma spreads, the usual locations where it spreads are the lungs, spleen, liver, bone marrow or bone.
Given the predictable nature of Hodgkin lymphoma it is possible but unlikely to spread anywhere else in the body.
What are risk factors?
About 20 to 25% of people with classic Hodgkin lymphoma are positive with EBV virus.
People with HIV also have a higher risk of developing Hodgkin lymphoma.
Hodgkin lymphoma is also more common in younger people often between the ages of 15 and 40.
One in six of all cancers affecting young people have this type of cancer. Men are slightly more
likely to develop this cancer than women except in the case of nodular sclerosis Hodgkin lymphoma,
which is more common in women. There are no widely accepted genetic or familial
links directly associated with Hodgkin lymphoma. However, a person's risk is increased if a parent,
sibling, or child has had lymphoma.
How is someone diagnosed with lymphoma?
If your doctor suspects you have lymphoma, a number of tests are done to discover whether you have cancer
and to categorize which type of lymphoma it is. These tests might begin with something as simple as a physical exam where your doctor checks
for swollen lymph nodes or a blood test to check your white blood cell counts. The results of these tests may suggest the need for other procedures such as removing
a sample of bone marrow for study. The process of removing a sample of tissue for testing
is known as a biopsy, and there are several common types of biopsies used to diagnose lymphoma.
The best biopsy and the gold standard is an excisional biopsy which removes a whole lymph node. This is
the preferred method since it provides the most information on the architecture of the lymph node
and provides additional material for specialized testing. If this is not possible you may consider
an incisional biopsy which removes parts of a lymph node, but this is much less preferred.
Other types of biopsies you may hear about include a core needle biopsy which takes a small sample
of a lymph node, or a laparoscopic or keyhole biopsy, which removes all or part of a lymph node.
A fine needle aspiration is usually not recommended since it will not provide
enough information for classifying the type of lymphoma or doing additional studies. A doctor can
use imaging tests such as a CT, MRI, or PET scan to get a picture of what your cancer looks like
and in what areas of the body are impacted.
How is Hodgkin lymphoma treated considering how many various types there are of this disease?
The main treatment for Hodgkin lymphoma is chemotherapy.
Sometimes with additional radiation or monoclonal antibody therapy. Treatment for Hodgkin lymphoma
has been successful at curing people since the original treatments that were developed in the
1960s and 70s. Newer treatments however, are being developed to reduce the side effects associated
with the older forms of treatment such as infertility, heart problems, and secondary cancers.
The most frequently used Hodgkin lymphoma chemotherapy combination in the United
States is referred to as ABVD (adriamycin bleomycin vinblastine and dicarbazine).
This is combined with radiation for certain patient populations. There are also additional
medication recommendations such as: biacop, bleomycin, atopicide, doxorubicin cyclophosphamide,
vincristine, procarbazine, and prednisone and the Stanford five: doxorubicin, vinblastine,
chlormethine, Vincristine, Bleomycin, Etoposide, and Prednisone. Specifics around your treatment,
the use of radiation, and treatment length should be discussed with the treating physician.