Hodgkin Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections. The lymphatic system also helps maintain the fluid balance in different parts of the body by bringing excess fluid back into the bloodstream.

The lymphatic system includes the following:

  • Lymph. Fluid containing white blood cells, especially those called lymphocytes.

  • Lymph vessels. Thin tubes that carry lymph fluid throughout the body.

  • Lymphocytes. White blood cells that fight infection and disease.

  • Lymph nodes. Bean-shaped organs, found in the underarm, groin, neck, chest, abdomen, and other parts of the body, that act as filters for the lymph fluid as it circulates through the body.

Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection and causing the lymph nodes to swell. Hodgkin lymphoma cells can also spread (metastasize) to other organs and tissue. It is a rare disease in children, accounting for about 4 percent of all cases of childhood cancer in the U.S. Hodgkin lymphoma occurs most often in people between the ages of 15 and 40, and in people over age 55. About 10 to 15 percent of cases are found in children and teenagers. The disease, for unknown reasons, affects males more often than females.

What causes Hodgkin lymphoma?

The specific cause of Hodgkin lymphoma is unknown. It is possible that a genetic predisposition and exposure to viral infections may increase the risk for developing Hodgkin lymphoma. There is a slightly increased chance for Hodgkin lymphoma to occur in siblings of patients.

There has been much investigation into the association of the Epstein-Barr virus (EBV), which causes the infection mononucleosis. This virus has been correlated with a greater incidence of children diagnosed with Hodgkin lymphoma, although the direct link is unknown.

There are many individuals, however, who have infections related to EBV who do not develop Hodgkin disease.

What are the symptoms of Hodgkin lymphoma?

The following are the most common symptoms of Hodgkin lymphoma. However, each child may experience symptoms differently. Symptoms may include:

  • Painless swelling of the lymph nodes in the neck, underarm, groin, and/or chest

  • Difficulty breathing (dyspnea), coughing, or chest pain due to enlarged nodes in the chest

  • Fever

  • Night sweats

  • Tiring easily (fatigue)

  • Weight loss/decreased appetite

  • Itching skin (pruritus)

  • Frequent viral infections (for example, cold, flu, sinus infection)

The symptoms of Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's doctor for a diagnosis.

How is Hodgkin lymphoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Hodgkin lymphoma may include:

  • Blood and urine tests

  • X-rays of the chest. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film.

  • Lymph node biopsy. A sample of tissue is removed from the lymph node and examined under a microscope. A biopsy is needed to confirm the diagnosis of Hodgkin disease and to tell what type it is.

  • Computed tomography scan of the abdomen, chest, and pelvis (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is not often used for Hodgkin disease unless the doctor is concerned it may have spread to the brain or spinal cord. 

  • Positron emission tomography (PET) scan. A type of nuclear medicine procedure. For this test, a radioactive sugar is injected into the bloodstream. Because cancer cells use more of the sugar than normal cells, the radioactivity tends to collect in them, and can be detected with a special camera. A PET scan image is not finely detailed like a CT scan, but it can sometimes spot cancer cells in different areas of the body even when they cannot be seen by other tests. This test is often used in combination with a CT scan. 

  • Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells. This test may be used to see if cancer cells have reached the bone marrow.

How is Hodgkin lymphoma staged?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that are used for Hodgkin lymphoma. Always consult your child's doctor for information on staging. One method of staging Hodgkin lymphoma is the following:

  • Stage I. Usually involves a single lymph node region or organ.

  • Stage II. Involves two or more lymph node regions on the same side of the body (above or below the diaphragm, the thin muscle that separates the chest from the abdomen), or the cancer has spread from one lymph node into a nearby organ.

  • Stage III. Involves lymph node regions on both sides of the body and is further classified depending on the organs and areas involved.

  • Stage IV. Involves wide spread of the disease in other areas outside the lymphatic system (metastasis), in addition to the lymphatic system involvement.

Stages are also noted by the presence or absence of certain symptoms of the disease:

  • Asymptomatic (A). No fever, night sweats, or weight loss.

  • Symptomatic (B). Symptoms include fever, night sweats, or weight loss.

For example, stage IIIB is disease that is symptomatic, involves lymph node regions on both sides of the body, and is further classified depending on the organs and areas involved.

What is the treatment for Hodgkin lymphoma?

Specific treatment for Hodgkin lymphoma will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent/stage and location of the disease

  • Type of Hodgkin disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include (alone or in combination):

  • Chemotherapy

  • Radiation

  • Bone marrow/stem cell transplant

  • Supportive care (for pain, fever, infection, and nausea/vomiting)

  • Continued follow-up care (to determine response to treatment, detect recurrent disease, and manage side effects of treatment)

Aggressive therapy, while increasing long-term survival, also carries some serious side effects. Discuss with your child's doctor a complete list of known side effects for treatment plans and therapies.

What is the long-term outlook for a child with Hodgkin lymphoma?

Prognosis greatly depends on:

  • The extent of the disease.

  • Presence or absence of metastasis.

  • The response to therapy.

  • Age and overall health of the child.

  • Your child's tolerance of specific medications, procedures, or therapies.

  • New developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis are structured around the child. Prompt medical attention and treatment are important for the best prognosis. Continuous follow-up care after treatment is essential for the child diagnosed with Hodgkin lymphoma. Side effects of radiation and chemotherapy, including second cancers, can occur in survivors of Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.