What is it?
Hodgkin lymphoma, also called Hodgkin disease, is a cancer of the lymphatic system. The lymphatic system forms part of the immune system. It contains specialised white blood cells called lymphocytes that help protect the body from infection and disease. Hodgkin lymphoma arises when developing lymphocytes undergo a malignant change, and multiply in an uncontrolled way. These abnormal lymphocytes, called lymphoma cells, form collections of cancer cells called tumours, in lymph nodes (sometimes known as ‘glands’) and other parts of the body.
Hodgkin lymphoma is distinguished from all other types of lymphoma because of the presence of a special kind of cancer cell called a Reed-Sternberg cell.
How common is it?
Each year in Australia, around 550 people are diagnosed with Hodgkin lymphoma*. Overall, it is a rare disease accounting for 0.5% of cancers diagnosed.
Who gets it?
Hodgkin lymphoma can occur at any age but it is most common in adolescents and young adults. Over a third of all cases diagnosed are between the ages of 15 and 30. Around 25 young people aged 0–14 are diagnosed with Hodgkin lymphoma in Australia each year. Hodgkin lymphoma occurs more frequently in males than in females.
What causes Hodgkin lymphoma?
The causes of most cases of Hodgkin lymphoma remains unknown but it is thought to result from damage to one or more of the genes that normally controls blood cell development. Research is going on all the time into possible causes of this damage and it is thought that alterations in the immune system may play a role in some cases. Infection with Ebstein-Barr virus (EBV), that causes glandular fever, is believed to have a connection with the disease. There are a number of factors that can lead to an increased chance of developing lymphoma. These include a weakened immune system, (immunosuppressed) due to an inherited immune deficiency disease, HIV infection, or drugs taken to prevent rejection of a transplanted organ.
What are the symptoms?
The most common symptom of Hodgkin lymphoma is a firm, usually painless swelling of a lymph node (swollen glands), usually in the neck, under the arms or in the groin. Other symptoms may include:
- recurrent fevers
- excessive sweating at night
- unintentional weight loss
- persistent fatigue and lack of energy
- generalised itching or a rash
How is it diagnosed?
Hodgkin lymphoma is diagnosed by a full blood count (FBC) and a bone marrow biopsy/examination.
How is it treated?
Treatment depends mainly on the stage, or extent of disease in your body. Other factors which will be considered include the exact type of Hodgkin lymphoma you have, your age and general health. These days, most people with Hodgkin lymphoma can be cured. Many others who are treated remain disease-free and well for a long time.
Early-stage Hodgkin lymphoma, which is limited to one or two areas in the body, is often treated with a combination of chemotherapy and radiotherapy. If Hodgkin lymphoma is more widespread in the body (advanced stage) it is usually treated with chemotherapy.
Chemotherapy is given as a combination of drugs, in several cycles (or courses) of treatment. A rest period of a few weeks is given in between each cycle. The drugs can be given either in tablet form or intravenously, into a vein in your hand or arm, or through a special line called a central venous catheter, or a PICC line.
A stem cell transplant may be given if the lymphoma has relapsed, is at high risk of relapse, or where it doesn't respond well to standard (conventional) treatment.
Side-effects of treatment
All treatments can cause side-effects. The type and severity of side effects vary, depending on the type of treatment used and the response to it. In general, more intensive treatment is associated with more severe side-effects. It is important that symptoms are reported immediately.
Possible side effects of chemotherapy include:
- feeling sick - nausea and/or vomiting
- feeling tired and weak
- a drop in blood counts, especially white cells (with increased susceptibility to infection)
- hair loss and thinning
- mouth problems such as mucositis or ulcers
- diarrhoea or constipation
- skin problems such as dryness, rash or sensitivity to sunlight.
It is important to report any symptoms you are having to your doctor or nurse. In most cases they can be treated and are reversible.
Radiotherapy can cause similar side-effects to those caused by chemotherapy including nausea and vomiting, hair loss and fatigue. In general however the type of side-effects seen with radiotherapy depends on the area of the body which has been treated. Skin reactions are common.
Many people enjoy long and healthy lives after being successfully treated for Hodgkin lymphoma. Sometimes, however, the treatment can affect a person's health for months or even years after it has finished. The long-term or late effects and can include fertility problems, a higher risk of developing a secondary cancer later in life, as well as cardiac and gut problems.
Your doctor will discuss any potential long-term effects of treatments and the steps that can be taken to help reduce or prevent them.