General Information About Adult Hodgkin Lymphoma

Hodgkin lymphoma is a type of cancer that forms in the lymph system. The lymph system is part of the immune system. It helps protect the body from infection and disease.

The lymph system is made up of the following:

Lymph: Colorless, watery fluid that travels through the lymph vessels and carries lymphocytes (white blood cells).
Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
Lymph nodes: Small, bean-shaped structures that are found along a network of lymph vessels throughout the body. Groups of lymph nodes are found in the neck, underarm, mediastinum, abdomen, pelvis, and groin.
Spleen: An organ on the left side of the abdomen near the stomach that makes lymphocytes and stores blood cells.
Tonsils: Two small masses of lymph tissue at the back of the throat. There is one tonsil on each side of the throat.
Bone marrow: The soft, spongy tissue in the center of certain bones. White blood cells, red blood cells, and platelets are made in the bone marrow.

The two main types of Hodgkin lymphoma are classic and nodular lymphocyte-predominant.

Being in early or late adulthood, being male, past Epstein-Barr infection, and a family history of Hodgkin lymphoma can increase the risk of adult Hodgkin lymphoma.
Signs and symptoms of adult Hodgkin lymphoma include swollen lymph nodes, fever, drenching night sweats, weight loss, and fatigue.
Tests that examine the lymph system and other parts of the body are used to help diagnose and stage adult Hodgkin lymphoma.
Certain factors affect prognosis (chance of recovery) and treatment options.

Types of Hodgkin lymphoma

Classic Hodgkin lymphoma

Most Hodgkin lymphomas are the classic type.

When a sample of lymph node tissue is looked at under a microscope, Hodgkin lymphoma cancer cells, called Reed-Sternberg cells, may be seen.

The classic type is broken down into the following four subtypes:

Nodular sclerosing Hodgkin lymphoma.
Mixed cellularity Hodgkin lymphoma.
Lymphocyte-depleted Hodgkin lymphoma.
Lymphocyte-rich classic Hodgkin lymphoma.

Nodular lymphocyte-predominant.

Nodular lymphocyte-predominant Hodgkin lymphoma is rare and tends to grow slower than classic Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma often presents as a swollen lymph node in the neck, chest, armpit, or groin.

Most people do not have any other signs or symptoms of cancer at diagnosis.

Treatment is often different from classic Hodgkin lymphoma.

Signs and symptoms of adult Hodgkin lymphoma

Check with your doctor if you have any of the following symptoms that do not go away:

Painless, swollen lymph nodes in the neck, underarm, or groin.
Fever for no known reason.
Drenching night sweats.
Weight loss for no known reason in the past 6 months.
Itchy skin, especially after bathing or drinking alcohol.
Feeling very tired.

Fever for no known reason, weight loss for no known reason, and drenching night sweats are called B symptoms.

B symptoms are an important part of staging Hodgkin lymphoma and understanding the patient's chance of recovery.

Tests to help diagnose and stage adult Hodgkin lymphoma

Physical exam and health history
Complete blood count (CBC): a blood sample is checked for the number of red blood cells, white blood cells, and platelets
Blood chemistry studies: a blood sample is checked to measure the amounts of salts (electrolytes), liver function, kidney function, sugar.
LDH test and ESR: important blood tests in in Hodgkin lymphoma.
Hepatitis B and hepatitis C test. HIV test if necessary
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, pelvis, and lymph nodes
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Bone marrow aspiration and biopsy: The removal of bone marrow and a small piece of bone by inserting a needle into the hipbone to look for signs of cancer.
Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells called Reed-Sternberg cells. Reed-Sternberg cells are common in classic Hodgkin lymphoma.

Reed-Sternberg cell. Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.

Factors affecting prognosis (chance of recovery) and treatment options

The prognosis and treatment options depend on the following:

The patient's signs and symptoms, including whether or not they have B symptoms (fever for no known reason, weight loss for no known reason, or drenching night sweats).
The stage of the cancer (the size of the cancer tumors and whether the cancer has spread to other parts of the body or lymph nodes).
The type of Hodgkin lymphoma.
Blood Test Results: ESR and amount of lactate dehydrogenase (LDH)
Whether there are certain changes in the genes.
The patient’s age, sex, and general health.
Whether the lymphoma is newly diagnosed, continues to grow during treatment, or has recurred (come back).

Stages of Adult Hodgkin Lymphoma

After adult Hodgkin lymphoma has been diagnosed, tests are done to find out whether cancer cells have spread within the lymph system or to other parts of the body.

The following stages are used for adult Hodgkin lymphoma:

Stage I: Cancer is found in one or more lymph nodes in a group of lymph nodes
Stage II: cancer is found in two or more groups of lymph nodes that are either above the diaphragm or below the diaphragm. In stage II, the term bulky disease refers to a larger tumor mass.
Stage III: cancer is found in groups of lymph nodes both above and below the diaphragm
Stage IV: cancer has spread throughout one or more organs outside the lymph system such as the bone marrow, liver, lung.