What is Hodgkin’s disease?
Hodgkin’s disease (HD) is a type of lymphoma, which is a blood cancer that starts in the lymphatic system. The lymphatic system helps the immune system get rid of waste and fight infections. HD is also called Hodgkin disease, Hodgkin lymphoma, and Hodgkin’s lymphoma.
HD originates in white blood cells that help protect you from germs and infections. These white blood cells are called lymphocytes. In people with HD, these cells grow abnormally and spread beyond the lymphatic system. As the disease progresses, it makes it more difficult for your body to fight infections.
HD can be either classic Hodgkin’s disease or nodular lymphocytic predominant Hodgkin’s lymphoma (NLPHL). The type of HD is based on the types of cells involved in your condition and their behavior.
The main cause of HD isn’t known. The disease has been linked to DNA mutations, or changes, as well as to the Epstein-Barr virus (EBV), which causes mononucleosis. HD can occur at any age, but it most commonly affects people between ages 15 and 40 and people over age 55.
The most common symptom of HD is swelling of the lymph nodes, which causes a lump to form under the skin. This lump usually isn’t painful. It may form in one or more of the following areas:
- on the side of the neck
- in the armpit
- around the groin
Other symptoms of HD include:
- night sweats
- itchy skin
- unintended weight loss
- persistent cough, trouble breathing, chest pain
- pain in the lymph nodes after consuming alcohol
- enlarged spleen
Call your doctor right away if you have any of these symptoms. They can be signs of other conditions, and it’s important to get an accurate diagnosis.
To diagnose HD, your doctor will perform a physical exam and ask you about your medical history. Your doctor will also order certain tests so they can make a proper diagnosis. The following tests may be done:
- imaging tests, such as X-rays or CT scans
- lymph node biopsy, which involves removing a piece of lymph node tissue to test for the presence of abnormal cells
- blood tests, such as a complete blood count (CBC), to measure levels of red blood cells, white blood cells, and platelets
- immunophenotyping to determine the type of lymphoma cells that are present
- lung function tests to determine how well your lungs are working
- an echocardiogram to determine how well your heart is working
- bone marrow biopsy, which involves the removal and examination of marrow inside your bones to see if the cancer has spread
Once an HD diagnosis has been made, the cancer is assigned a stage. Staging describes the extent and severity of the disease. It will help your doctor determine your treatment options and outlook.
There are four general stages of HD:
- Stage 1 (early stage) means that cancer is found in one lymph node region, or the cancer is found in only one area of a single organ.
- Stage 2 (locally advanced disease) means that cancer is found in two lymph node regions on one side of the diaphragm, which is the muscle beneath your lung, or that cancer was found in one lymph node region as well as in a nearby organ.
- Stage 3 (advanced disease) means that cancer is found in lymph node regions both above and below your diaphragm or that cancer was found in one lymph node area and in one organ on opposite sides of your diaphragm.
- Stage 4 (widespread disease) means that cancer was found outside the lymph nodes and has spread widely to other parts of your body, such as your bone marrow, liver, or lung.
Treatment for HD typically depends on the stage of the disease. The main treatment options are chemotherapy and radiation.
Radiation therapy uses high-energy beams of radiation to destroy cancer cells. Chemotherapy involves the use of medications that can kill cancer cells. Chemotherapy drugs may be given orally or injected through a vein, depending on the specific medication.
Radiation therapy alone may be sufficient for treating early stage NLPHL. If you have NLPHL, you may only need radiation since the condition tends to spread more slowly than classic HD. In advanced stages, targeted therapeutic drugs may be added to your chemotherapy regimen.
Immunotherapy or a stem cell transplant may also be used if you don’t respond to chemotherapy or radiation. A stem cell transplant infuses healthy cells called stem cells into your body to replace the cancerous cells in your bone marrow.
After treatment, your doctor will want to follow up with you on a regular basis. Be sure to keep all your medical appointments and follow your doctor’s instructions.
Treatments for HD can have long-term side effects and can increase your risk of developing other serious medical conditions. HD treatments may increase your risk of:
- second cancers
- thyroid problems
- lung damage
You should get regular mammograms and heart disease screenings, keep up with vaccinations, and avoid smoking.
It’s also important to attend regular follow-up appointments with your doctor. Make sure to tell them about any concerns you may have about long-term side effects and what you can do to help reduce your risk.
Advances in the treatment of HD over the past few decades have greatly increased the survival rate. According to the American Cancer Society, the relative survival rates for all people diagnosed with HD are as follows:
- The five-year survival rate is about 86 percent.
- The 10-year survival rate is about 80 percent.
The following are the five-year survival rates for the different stages:
- Stage 1 HD is about 90 percent.
- Stage 2 HD is about 90 percent.
- Stage 3 HD is about 80 percent.
- Stage 4 HD is about 65 percent.
These rates may vary depending on the stage of the disease and the age of the individual.
Dealing with an HD diagnosis can be challenging. Support groups and counseling can help you manage your anxiety and provide a safe place for you to discuss concerns and feelings about your experience. The National Cancer Institute and American Cancer Society also provide resources for people who’ve recently received an HD diagnosis.