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Hodgkin lymphoma
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 (glands) and other parts of the body.
Hodgkin lymphoma is distinguished from all other types of lymphoma because of the presence, under the microscope, of a special kind of cancer cell called a Reed-Sternberg cell .
How common is it?
Each year in Australia, around 400 people are diagnosed with Hodgkin lymphoma*. Overall, Hodgkin lymphoma 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 with over a third of all cases diagnosed between the ages of 15 and 30 years. Around 25 children (0-14 years) are diagnosed with Hodgkin lymphoma each year.
Hodgkin lymphoma occurs more frequently in males than in females.
What causes Hodgkin lymphoma?
In most cases the causes 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 the alterations in the immune system may play a role in some cases. People with a weakened immune system (immunosuppressed) due to an inherited immune deficiency disease, HIV infection and drugs taken to prevent rejection of a transplanted organ, all have an increased chance of developing lymphoma. Infection with Epstein-Barr virus (EBV), the virus that causes glandular fever, may be involved, particularly in people who are immunosuppressed.
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 treated for 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 chemotherapy and radiotherapy. When Hodhkin's lymphoma is more widespread in the body (advanced stage) it is usually treated with chemotherapy. Chemotherapy is a form of systemic therapy, because once it is given it travels in the bloodstream and destroys cancer cells found in different parts of the body. Radiotherapy is a form of local therapy, because it only destroys cancer cells in the treated area (radiation field). It is commonly used to treat disease which is confined to one area of the body.
Chemotherapy is given as a combination of drugs, in several cycles (or courses) of treatment with a rest period of a few weeks in between each cycle. It can be given in either in tablet form or intravenously, into a vein in your hand or arm, or through a special line called a central venous catheter inserted before you start treatment.
Occasionally, a stem cell transplant is given, providing some people a better chance of cure or long-term control of their disease. It is generally only suitable in situations where the lymphoma has come back ( relapsed) or is at high risk of relapse, and where it doesn't respond well to standard (conventional) treatment.
Side effects of treatment
All treatments can cause side effects. The type and severity however will vary between individuals, depending on the type of treatment used and how an individual responds to it. In general, more intensive treatment is associated with more severe side-effects. 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.
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.
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. These are called long-term or late effects and may include fertility problems and a higher risk of developing a myelodysplastic syndrome or secondary cancer later in life. Your doctor will discuss any potential long-term effects of treatments and the steps that can be taken to help reduce or prevent them.
For further information click on the links below:
* Sources:
Australian Institute of Health and Welfare and Australian Associated Cancer Registry (2004) Cancer in Australia 2001 AIHW (2005) Cancer Incidence Projections for Australia 2002 - 2011
Australian Institute of Health and Welfare and Australian Associated Cancer Registry (2004) Cancer in Australia 2001
