About the Condition
Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body. The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes. In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.
Hodgkin lymphoma can develop at any age, but it mostly affects young adults in their 20s and older adults over the age of 70*. Slightly more men than women are affected. Around 1,900 people are diagnosed with Hodgkin lymphoma in the UK each year*.
While the cause of the initial mutation that triggers Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition:
- having a medical condition that weakens your immune system, such as HIV
- having medical treatment that weakens your immune system – for example, taking medication to suppress your immune system after an organ transplant
- being previously exposed to the Epstein-Barr virus (EBV), a common virus that causes glandular fever
- having previously had non-Hodgkin lymphoma, possibly because of treatment with chemotherapy or radiotherapy
The most common symptom of Hodgkin lymphoma is a swelling in the neck, armpit or groin. The swelling is usually painless, although some people find that it aches, and it is caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph node which are pea-sized lumps of tissue found throughout the body containing white blood cells that help to fight infection.
Some people with Hodgkin lymphoma also have other more general symptoms. These can include:
- night sweats
- unexplained weight loss
- a high temperature (fever)
- persistent tiredness or fatigue
- difficulty recovering from infections or developing infections more often
- a persistent cough or feeling of breathlessness
- persistent itching of the skin all over the body
Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the stomach is affected, you may have abdominal pain or indigestion.
A few people with Hodgkin lymphoma have abnormal cells in their bone marrow when they are diagnosed. This can reduce the number of healthy cells in the blood and cause some of the above symptoms. It can also cause excessive bleeding, such as nosebleeds, heavy periods and spots of blood under the skin.
In some cases, people with Hodgkin lymphoma experience pain in their lymph glands when they drink alcohol.
If any of these symptoms apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.
If you are referred to CCL for diagnosis, your consultant or oncologist will perform a test called a biopsy, which is the only way to confirm a diagnosis of Hodgkin lymphoma. This is a minor surgical procedure where a sample of affected lymph node tissue is removed.
Once the patient has been diagnosed with Hodgkin lymphoma, a variety of other tests are conducted to work out how far the cancer has spread, and what stage it has reached. These include:
- A blood test to measure the levels of different types of blood cells
- A lumbar puncture, where a needle is used to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether leukaemia has reached your nervous system, and this test is carried out using local anaesthetic
- A bone marrow biopsy, during which a haematologist will take a small sample of bone marrow to examine under a microscope. This involves inserting a needle into a large bone, usually the hip bone, to extract the marrow, and is done under local anaesthetic
- A Magnetic Resonance Imaging (MRI) scan, which is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body
- A Positron Emission Tomography (PET) scan, which uses a very small amount of an injected radioactive drug to show where cells are active in the body
- A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
- An chest x-ray, where low level radiation is used to create an image of the body
Stages of Hodgkin lymphoma
When the testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far it has spread. The main stages of Hodgkin lymphoma are:
- stage 1 – the cancer is limited to one group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs)
- stage 2 – two or more lymph node groups are affected, either above or below the diaphragm
- stage 3 – the cancer has spread to lymph node groups above and below the diaphragm
- stage 4 – the cancer has spread through the lymphatic system and is now present in organs or bone marrow
Health professionals also add the letters “A” or “B” to your stage to indicate whether or not you have certain symptoms. “A” is put after your stage if you have no additional symptoms other than swollen lymph nodes. “B” is put after your stage if you have additional symptoms of weight loss, fever or night sweats
At CCL, patients with Hodgkin lymphoma are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT, from our Haemato-Oncology department, headed by Professor Ray Powles, CBE. This team works together to create a treatment plan to suit the individual needs of the patient.
Hodgkin lymphoma is a relatively aggressive cancer and can quickly spread through the body. Despite this, it is also one of the most easily treated types of cancer and can usually be treated successfully with the following methods:
- Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.
- Radiotherapy, which is where high-energy rays are used to destroy the cancer cells.
Cancer doesn’t just leave a physical impact on an individual, it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.
At CCL we provide support that caters to both the physical and emotional needs of the patient, before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible.
Hodgkin Lymphoma Consultants