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Hodgkin's Lymphoma

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General Information About Adult Hodgkin's Lymphoma

Adult Hodgkin's lymphoma is a disease in which malignant (cancer) cells form in the lymph system.

Adult Hodgkin's lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system.

The lymph system is made up of the following:

  • Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.

  • 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 filter substances in lymph and help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.

  • Spleen: An organ that produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.

  • Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.

  • Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils produce lymphocytes.

  • Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow produces white blood cells, red blood cells, and platelets.

Because lymph tissue is found throughout the body, Hodgkin's lymphoma can begin in almost any part of the body and spread to almost any tissue or organ in the body.

Lymphomas are divided into 2 general types: Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Hodgkin's lymphoma can occur in both adults and children; however, treatment for adults may be different than treatment for children. Hodgkin's lymphoma may also occur in patients who have acquired immunodeficiency syndrome (AIDS); these patients require special treatment.

There are 5 different types of Hodgkin's lymphoma. These 5 types are based on the way they look under a microscope.

  • Nodular sclerosing Hodgkin's lymphoma.
  • Mixed cellularity Hodgkin's lymphoma.
  • Lymphocyte depletion Hodgkin's lymphoma.
  • Lymphocyte-rich classical Hodgkin's lymphoma.
  • Nodular lymphocyte-predominant Hodgkin's lymphoma.

Age, gender, and Epstein-Barr infection can affect the risk of developing adult Hodgkin's lymphoma.

Risk factors for adult Hodgkin's lymphoma include the following:

  • Being in young or late adulthood.
  • Being male.
  • Being infected with the Epstein-Barr virus.
  • Having a first-degree relative (parent, brother, or sister) with Hodgkin's lymphoma.

Possible signs of adult Hodgkin's lymphoma include swollen lymph nodes, fever, night sweats, and weight loss.

These and other symptoms may be caused by adult Hodgkin's lymphoma or by other conditions. A doctor should be consulted if any of the following problems do not go away.

  • Painless, swollen lymph nodes in the neck, underarm, or groin.
  • Fevers (unexplained).
  • Drenching night sweats.
  • Weight loss (unexplained).
  • Itchy skin.
  • Tiredness.

Tests that examine the lymph nodes are used to detect (find) and diagnose adult Hodgkin's lymphoma.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's past illnesses and treatments will also be taken.

  • Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.

  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.

  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

  • 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. One of the following types of biopsies may be done:
    • Excisional biopsy: The removal of an entire lymph node.
    • Incisional biopsy or core biopsy: The removal of part of a lymph node.
    • Needle biopsy or fine-needle aspiration: The removal of a sample of tissue from a lymph node with a needle.

  • Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The patient's symptoms.
  • The stage of the cancer.
  • The type of Hodgkin's lymphoma.
  • Blood test results.
  • The patient's age, gender, and general health.
  • Whether the cancer is recurrent or progressive.

Adult Hodgkin's lymphoma can usually be cured if found and treated early.

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Stages of Adult Hodgkin's Lymphoma

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

The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For adult Hodgkin's lymphoma, CT scans of the chest, abdomen, and pelvis are taken.

  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

  • Bone marrow biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for signs of cancer.

  • Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy. This procedure is done only if it is needed to make decisions about treatment.

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

  • Needle or surgical biopsy: The removal of tissue using a thin needle or scalpel. A pathologist views the tissue under a microscope to look for cancer cells.

  • Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

Stages of adult Hodgkin's lymphoma may include A, B, E, and S.

Adult Hodgkin's lymphoma may be classified as follows:

  • A: The patient has no symptoms.
  • B: The patient has symptoms such as fever, weight loss, or night sweats.
  • E: "E" stands for extranodal and means the cancer is found in an organ or tissue other than the lymph nodes or extends to tissues beyond, but near, the major lymphatic areas.
  • S: "S" stands for spleen and means the cancer is found in the spleen.

The following stages are used for adult Hodgkin's lymphoma:

Stage I

Stage I is divided into stage I and stage IE.

  • Stage I: Cancer is found in a single group of lymph nodes.
  • Stage IE: Cancer is found in one area or organ other than the lymph nodes.

Stage II

Stage II is divided into stage II and stage IIE.

  • Stage II: Cancer is found in two or more lymph node groups on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

  • Stage IIE: Cancer is found in one area or organ other than the lymph nodes and in the lymph nodes near that area or organ, and may have spread to other lymph node groups on the same side of the diaphragm.

Stage III

Stage III is divided into stage III, stage IIIE, Stage IIIS, and stage IIIS+E.

  • Stage III: Cancer is found in lymph node groups on both sides of the diaphragm.

  • Stage IIIE: Cancer is found in lymph node groups on both sides of the diaphragm and in a nearby area or organ other than the lymph nodes.

  • Stage IIIS: Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.

  • Stage IIIS+E: Cancer is found in lymph node groups on both sides of the diaphragm, in a nearby area or organ, and in the spleen.

Stage III is also divided into stage III(1) and stage III(2) as follows:

  • Stage III(1): Cancer is limited to the upper abdomen above the renal vein.
  • Stage III(2): Cancer is found in lymph nodes in the pelvis and/or near the heart.

Stage IV

In stage IV, the cancer either:

  • is found throughout at least one organ other than the lymph nodes and may be in lymph nodes near those organs; or

  • is found in one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

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Recurrent Adult Hodgkin's Lymphoma

Recurrent adult Hodgkin's lymphoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the lymph system or in other parts of the body.

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Treatment Option Overview

There are different types of treatment for patients with adult Hodgkin's lymphoma.

Different types of treatment are available for patients with adult Hodgkin's lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Patients with Hodgkin's lymphoma should have their treatment planned by a team of doctors with expertise in treating lymphomas.

Treatment will be overseen by a medical oncologist, a doctor who specializes in treating cancer. The medical oncologist may refer you to other doctors who have experience and expertise in treating adult Hodgkin's lymphoma and who specialize in certain areas of medicine. These may include the following specialists:

  • Neurosurgeon.
  • Neurologist.
  • Rehabilitation specialist.
  • Radiation oncologist.
  • Endocrinologist.
  • Hematologist.
  • Other oncology specialists.

Three types of standard treatment are used:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Surgery

Laparotomy is a procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy. If cancer is found, the tissue or organ is removed during the laparotomy.

Other types of treatment are being tested in clinical trials. These include the following:

High-dose chemotherapy and radiation therapy with stem cell transplantation

High-dose chemotherapy and radiation therapy with stem cell transplantation is a method of giving high doses of chemotherapy and radiation therapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Clinical trials comparing new methods of treatment

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

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Treatment Options by Stage

Stage I Adult Hodgkin's Lymphoma

Treatment of stage I depends on whether the patient has stage IA (without symptoms) or stage IB (with symptoms) and where the cancer is.

  • Stage IA

    If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may include the following:

    • Combination chemotherapy with or without radiation therapy.
    • Radiation therapy to lymph nodes in the mantle field (neck, chest, and armpits), including those near the aorta, with radiation therapy to the spleen if laparotomy is not done.
    • Radiation therapy to the mantle field, with or without laparotomy.
    • A clinical trial of combination chemotherapy with or without radiation therapy.

    If the cancer is above the diaphragm and does involve a large part of the chest, treatment may include the following:

    • Combination chemotherapy and radiation therapy to the mantle field (neck, chest, and armpits).
    • A clinical trial of combination chemotherapy with or without radiation therapy.

    If the cancer is below the diaphragm, treatment may include the following:

    • Radiation therapy to the groin.
    • Combination chemotherapy with radiation therapy to involved areas.
    • A clinical trial of chemotherapy.
  • Stage IB. Treatment of stage IB is usually combination chemotherapy with or without radiation therapy.

Stage II Adult Hodgkin's Lymphoma

Treatment of stage II depends on whether the patient has stage IIA (without symptoms) or stage IIB (with symptoms) and where the cancer is.

  • Stage IIA

    If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may include the following:

    • Combination chemotherapy with or without radiation therapy.
    • Radiation therapy to lymph nodes in the mantle field (neck, chest, and armpits), including those near the aorta, with radiation to the spleen if laparotomy is not done.
    • Radiation therapy to the mantle field with or without laparotomy.
    • A clinical trial of combination chemotherapy with or without radiation therapy.

    If the cancer is above the diaphragm and does involve a large part of the chest, treatment may include the following:

    • Combination chemotherapy and radiation therapy to the mantle field.
    • A clinical trial of combination chemotherapy with or without radiation therapy.

  • Stage IIB. Treatment of stage IIB may include the following:
    • Combination chemotherapy with or without radiation therapy.
    • A clinical trial of combination chemotherapy with or without radiation therapy.

Stage III Adult Hodgkin's Lymphoma

Treatment of stage III depends on whether the patient has stage IIIA (without symptoms) or stage IIIB (with symptoms) and where the cancer is.

  • Stage IIIA

    If the cancer does not involve a large part of the chest, treatment may include the following:

    • Combination chemotherapy with or without radiation therapy.
    • A clinical trial of combination chemotherapy with or without radiation therapy.

    If the cancer does involve a large part of the chest, treatment may include the following:

    • Combination chemotherapy with radiation therapy.
    • A clinical trial of combination chemotherapy with or without radiation therapy.
    • A clinical trial of combination chemotherapy and stem cell transplantation.
  • Stage IIIB. Treatment of stage IIIB may include the following:
    • Combination chemotherapy with or without radiation therapy.
    • A clinical trial of combination chemotherapy with or without radiation therapy.
    • A clinical trial of combination chemotherapy and stem cell transplantation.

Stage IV Adult Hodgkin's Lymphoma

Treatment of stage IV may include the following:

  • Combination chemotherapy.
  • A clinical trial of combination chemotherapy with or without radiation therapy.
  • A clinical trial of chemotherapy and stem cell transplantation.
  • A clinical trial of new treatment options.

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Treatment Options for Recurrent Adult Hodgkin's Lymphoma

Treatment of recurrent adult Hodgkin's lymphoma may include the following:

  • Combination chemotherapy.
  • Combination chemotherapy followed by high-dose chemotherapy and stem cell transplantation with or without radiation therapy.
  • Radiation therapy with or without chemotherapy.
  • Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
  • A clinical trial of high-dose chemotherapy and stem cell transplantation.

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Hodgkin's Lymphoma