Hodgkin s Lymphoma. This reference summary explains what Hodgkin s lymphoma is, as well as its causes, symptoms and treatment options.

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1 Hodgkin s Lymphoma Introduction Hodgkin s lymphoma is a form of cancer that begins in cells of the immune system. The immune system fights infections and other diseases. Hodgkin s lymphoma happens when cells in the immune system become abnormal and begin to make copies of themselves in an uncontrollable way. Hodgkin s lymphoma is highly treatable. Most people diagnosed with Hodgkin s lymphoma can now be cured, or their disease can be controlled for many years. This reference summary explains what Hodgkin s lymphoma is, as well as its causes, symptoms and treatment options. Anatomy Lymphatic System The lymphatic system is part of the immune system. The immune system fights infections and other diseases. The lymphatic system is made up of lymph vessels, lymph, and lymph nodes. Lymph is a nearly clear fluid produced by the body that drains waste from cells. It travels through the lymphatic system, which is made up of channels and bean-shaped structures called lymph nodes. Groups of lymph nodes are found in the neck, underarms, chest, abdomen, and groin. Lymph nodes contain immune system cells that act as a barrier, stopping bacteria and viruses from attacking the body. These cells are divided into two very broad categories known as B and T cells. The channels of the lymphatic system are called lymph vessels and are spread out over most of the body, like blood vessels. The lymphatic system uses these channels to drain excess fluids and waste. 1

2 Other parts of the body also contain lymphatic tissue, including the: Tonsils. Thymus. Spleen. Other body parts that contain lymphatic tissue include the: Stomach. Skin. Small intestine. Hodgkin s Lymphoma and Causes Hodgkin s disease is a type of lymphoma. Lymphomas are cancers that develop in the lymphatic system, from the B type of immune system cells. Cells contain hereditary, or genetic, materials called chromosomes. Chromosomes control the growth of cells. Normal cells in the body grow and die in a controlled way. When the chromosomes in a cell become abnormal, the cell can lose the ability to control its growth. In Hodgkin s lymphoma, cells in the lymphatic system begin growing abnormally. In most cases of Hodgkin s lymphoma, the abnormal cells are called Reed-Sternberg cells. The new abnormal cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Chromosome Sudden changes in genetic material can happen for a variety of reasons. These changes are sometimes inherited. Changes in chromosomes may also happen as a result of exposure to infections, drugs, tobacco, chemicals or other factors. Other risk factors for Hodgkin s lymphoma include: Age. A family history of lymphoma. Gender: males are at a higher risk than females. Past infections with the Epstein Bar virus and a weakened immune system. 2

3 There are two main types of Hodgkin s lymphoma: classical Hodgkin s lymphoma and nodular lymphocytepredominant Hodgkin s lymphoma. Most people with Hodgkin s lymphoma have the classical type. Classical Hodgkin s lymphoma begins when a lymphocyte, usually a B cell, becomes abnormal. Nodular lymphocytepredominant Hodgkin s lymphoma is a rare type of Hodgkin s lymphoma. The abnormal cells are called popcorn cells. It may be treated differently from the classical type. Because lymphatic tissue is in many parts of the body, Hodgkin s lymphoma can start almost anywhere. Usually, it's first found in a lymph node above the diaphragm, the thin muscle that separates the chest from the abdomen. Hodgkin s lymphoma also may be found in a group of lymph nodes. Sometimes it starts in other parts of the lymphatic system. Signs & Symptoms The most common symptom of Hodgkin s Lymphoma is a painless swelling in the lymph nodes in the neck, underarm or groin. Other common symptoms may include: Fever and chills. Severe night sweats. Weakness and tiredness. Unexplained weight loss. Trouble breathing, coughing or chest pain. Other symptoms include: Becoming more sensitive to the effects of alcohol or having painful lymph nodes after drinking alcohol. Persistent fatigue. Itching. These symptoms may not be caused by Hodgkin s lymphoma. Common problems like infections or the flu can cause similar symptoms. Make sure to see a health care provider if your symptoms last more than two weeks. 3

4 Diagnosis If you have swollen lymph nodes or another symptom that suggests Hodgkin s lymphoma, your health care provider will try to find out what is causing the problem. Your health care provider may ask about your personal and family medical history. Your health care provider will check for swollen lymph nodes in your neck, underarms and groin. Your health care provider may also check for a swollen spleen or liver. Your health care provider may order a CBC, also known as a complete blood count test. This gives information about the quantity and quality of each type of cell in your blood. Your health care provider may order other tests such as a CT scan, MRI scan, PET scan, x-rays and a lymph node biopsy. Chest x-rays may be ordered to look for swollen lymph nodes or other signs of lymphoma in your chest. This is done to see how far the lymphoma has spread. It is known as staging. CT stands for Computed Tomography. A specialized x-ray machine linked to a computer takes a series of detailed pictures of your chest, abdomen and pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for your health care provider to see swollen lymph nodes and other abnormal areas on the scan. MRI stands for Magnetic Resonance Imaging. A powerful magnet linked to a computer is used to make detailed pictures of your bones, brain, or other tissues. Your health care provider can view these pictures on a monitor and can print them on film. During a PET scan you receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells and areas with lymphoma look brighter on the pictures. A biopsy is the only sure way to diagnose Hodgkin s lymphoma. There are several different kinds of biopsies. In a fine needle aspiration, a needle may be inserted in a lymph node, and fluid and tissue samples taken for pathological studies. Usually this kind of biopsy cannot get a large enough sample to diagnose Hodgkin s lymphoma. 4

5 In an incisional biopsy, a small part of a lymph node is taken out through an incision. In an excisional biopsy, an entire lymph node and some surrounding tissue is removed through an incision. This type of biopsy is the best at getting a good enough sample for diagnosis. The pathologist uses a microscope to check the tissue for Hodgkin s lymphoma cells. A person with Hodgkin s lymphoma usually has large, abnormal cells known as Reed-Sternberg cells. They are not found in people with non-hodgkin s lymphoma. Staging A stage is an indication of how widely the disease has spread. Staging involves several procedures to determine what parts of the body are affected by the disease. Treatment can be recommended based on the stage of the cancer. Hodgkin s lymphoma tends to spread from one group of lymph nodes to the next. For example, Hodgkin s lymphoma that starts in the lymph nodes in the neck may spread first to the lymph nodes above the collarbones, and then to the lymph nodes under the arms and within the chest. In time, the Hodgkin s lymphoma cells can invade blood vessels and spread to almost any other part of the body. For example, it can spread to the liver, lungs, bone and bone marrow. Staging can involve one or more of the following tests: CT scans, MRIs, PET scans and a bone marrow biopsy. A thick needle is used to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for Hodgkin s lymphoma cells in the sample. Your health care provider may also recommend biopsies of the other lymph nodes, the liver or other tissue. The stage is decided based on the number of lymph nodes that have Hodgkin s lymphoma cells, if these lymph nodes are on one or both sides of the diaphragm, and if the disease has spread to the bone marrow, spleen, liver or lung. The diaphragm is a large, thin muscle that divides the chest from the abdomen. It is very important in 5

6 breathing. Stages are usually described using the numbers 1-4. A lower number indicates an earlier stage. Stage 1: The lymphoma cells are in one lymph node group, such as in the neck or underarm. Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ, such as the lung. Stage 2: The lymphoma cells are in at least two lymph node groups on the same side of the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ on the same side of the diaphragm. There may be lymphoma cells in other lymph node groups on the same side of the diaphragm. Stage 3: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ such as the liver, lung, or bone near these lymph node groups. It may also be found in the spleen. Stage 4: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ, such as the liver, lung, or bone, and in distant lymph nodes. The disease is considered recurrent if it returns after treatment. In addition to these stage numbers, your health care provider may also describe A or B symptoms: A: You have not had weight loss, drenching night sweats, or fevers. B: You have had weight loss, drenching night sweats, or fevers. Patients with B symptoms have a worse prognosis than patients with A symptoms Treatment Treatment for Hodgkin s lymphoma aims at killing as many abnormal cells as possible. Your options for treatment depend on many different factors. Your health care provider 6

7 will discuss your treatment options with you. What treatments are right for you depend on: Your type of Hodgkin s lymphoma. Most people have classical Hodgkin s lymphoma. Its stage, or where the lymphoma is found. If you have a tumor that is more than 4 inches, or 10 centimeters, wide. Your age. Whether you've had weight loss, drenching night sweats or fevers. Treatment for Hodgkin s lymphoma usually involves radiation therapy or chemotherapy. Sometimes both are given. Treatment decisions are made depending on the stage of the disease, its location in the body, which symptoms are present and the general health and age of the patient. For early stages of Hodgkin s lymphoma, radiation therapy may be used. It is usually used after chemotherapy. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. The radiation that treats the cells comes from a machine that aims the rays at a specific area of the body. Early cases of the nodular lymphocyticpredominant type may be treated by radiation therapy alone. Hodgkin s lymphoma patients usually receive radiation therapy as an outpatient in a hospital or clinic. It must be given 5 days a week for several weeks. Outpatient means that the patient goes home after each treatment. The side effects of radiation therapy depend mainly on the type of radiation therapy, the dose of radiation, and the part of the body that is treated. Possible common side effects may include nausea, vomiting and diarrhea. You may develop a dry, sore throat and some trouble swallowing. In addition, your skin in the treated area may become red, dry and tender, and you may lose your hair in the treated area. Chemotherapy, or chemo for short, is used for more advanced stages of Hodgkin s lymphoma. Chemotherapy is the use of drugs 7

8 to kill cancer cells. To treat Hodgkin s lymphoma, the health care provider prescribes a combination of drugs that work together. These are called chemotherapy regimens. There are many different kinds of chemotherapy that may be used. The chemo may be given in different ways. Some are given by mouth and others are injected into a vein. The drugs travel through the bloodstream to almost every part of the body. The chemotherapy side effects depend mainly on which drugs are given and their doses. The chemotherapy drugs can harm normal cells that divide rapidly such as: Blood cells which can affect your ability to fight off infections. Cells in hair roots which can cause hair loss. Cells that line the digestive tract which can cause nausea, vomiting, diarrhea, mouth or lip sores and trouble swallowing. Chemotherapy is usually given in cycles, with a treatment period followed by a rest period, then another treatment and so on. Stem cell transplant may be an option if Hodgkin s lymphoma returns despite treatment. Stem cells are the cells that allow the bone marrow to replenish all its blood cells. Stem cell transplants take place in the hospital. In this treatment, stem cells are collected from a donor or from the patient, frozen, and stored for later use. If taken from the patient the cells may be treated to kill lymphoma cells that may be present before freezing and storing them. High doses of chemotherapy and radiation therapy are used to wipe out the bone marrow and with it hopefully all the cancerous cells. The stem cells that were collected are then given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells. 8

9 The stem cells may come from your own body or from a donor. There are several different types of stem cell transplantation, including: Autologous stem cell transplantation - This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you. Allogeneic stem cell transplantation - Your brother, sister or parent may be the donor. Or the stem cells may come from an unrelated donor. Health care providers use blood tests to be sure the donor's cells match your cells. Syngeneic stem cell transplantation - This type of transplant uses stem cells from a patient's healthy identical twin. Summary Hodgkin s disease is a type of lymphoma. Lymphomas are cancer that develop in the lymphatic system, part of the body s immune system. The job of the lymphatic system is to help fight diseases and infection. Hodgkin s lymphoma is caused by changes in genetic material. This can happen for a variety of reasons. These changes are sometimes inherited. Changes in chromosomes may also happen as a result of exposure to infections, drugs, tobacco, chemicals, or other factors. Hodgkin s lymphoma is usually treated with radiation therapy, chemotherapy or a combination of the two, and stem cell transplant. The kind of treatment prescribed depends on the stage of the cancer and the health of the patient. Thanks to advances in medicine, most people diagnosed with Hodgkin s lymphoma can now be cured, or their disease can be controlled for many years. 9

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