Hodgkin

Hodgkin's lymphoma, previously called Hodgkin's disease, is a cancer that develops in lymphatic cells, major cells of immune system.

Hodgkin's lymphoma is characterized by uncontrolled growth of lymphatic cells which can spread to other parts of the body.

With the progression of Hodgkin's lymphoma, your body's ability to fight infection decreases.

Among the two types of cancers of lymphatic system, Hodgkin's lymphoma and non-Hodgkin's lymphoma, non-Hodgkin's lymphoma is more common.

With advancement of diagnostic and treatment technologies, Hodgkin's lymphoma has become curable for many people and has witnessed better prognosis. 

The signs and symptoms of Hodgkin’s lymphoma include:

• Inflamed lymph nodes in neck, armpits or groin, usually painless
• Persistent tiredness
• Fever and chills
• Sweating, especially during nights
• Unexplained weight loss, nearly 10 percent of your body weight or more
• Loss of appetite
• Itching
• Raised intolerance to alcohol or alcohol induced pain in lymph nodes

When to see a doctor?

Visit your doctor if you experience any worrisome signs and symptoms.

The cause of Hodgkin's lymphoma has not been explained yet. Mutations in the DNA of infection-fighting B cells causes “out-of-control” growth and multiplication of the B cells.

These abnormal cells, unlike the normal ones, live longer and accumulate to form a mass of cancerous cells. Hodgkin's lymphoma is classified on the basis of involvement of cells and their behavior.

Your treatment approach is guided by the type of Hodgkin's lymphoma.

Classical Hodgkin's lymphoma

It is the most common Hodgkin's lymphoma. In classical Hodgkin's lymphoma, large, abnormal cells called Reed-Sternberg cells are present in lymph nodes.

It is further classified as:

• Nodular sclerosis Hodgkin's lymphoma
• Mixed cellularity Hodgkin's lymphoma
• Lymphocyte-depleted Hodgkin's lymphoma
• Lymphocyte-rich classical Hodgkin's lymphoma

Lymphocyte-predominant Hodgkin's lymphoma

It is a rare type lymphoma which involves large, abnormal cells, sometimes called popcorn cells because of their appearance.

Treatment approach may differ from that of the classical type. If diagnosed early, it can be cured.

Making a diagnosis of Hodgin's lymphoma is done by performing several tests.

If suspected of having Hodgkin's lymphoma, your doctor may refer you to experts on treating the disease, such as hematologist, medical oncologist or radiation oncologist.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

• What could possible causes of my symptoms?
• What are the tests needed?
• How long will my condition last?
• Are there any alternatives to the primary approach that you're suggesting?
• Do I need to follow any restrictions?
• Should I see a specialist?
• Do you recommend a biopsy?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did the symptoms start appearing and how severe are they?
• Do your symptoms occur continuously or they come and go?
• Does anything improve or aggravate your symptoms?
• Do you have a family history of cancer, including Hodgkin's lymphoma or any other immune disorder?
• What infections did you have in the past, if any?
• Do you remember any event when you were exposed to toxins?

Following tests are performed for diagnosis of Hodgkin's lymphoma:

Physical exam

Your doctor examines if there are any swollen lymph nodes in your neck, underarm and groin. S/he also checks for swollen spleen or liver.

Blood tests

A sample of your blood is analyzed in a lab to detect any indications of cancer.

Imaging tests

X-ray, computerized tomography (CT) scan and positron emission tomography (PET) can be used to detect tumors in your body.

Surgery to remove a swollen lymph node

Minor surgery is performed to obtain all or part of an enlarged lymph node for laboratory analysis. Presence of abnormal Reed-Sternberg cells in the lymph node confirms Hodgkin's lymphoma.

Bone marrow biopsy

A sample of bone marrow is removed with a help of needle to check if there are any signs of cancer in the bone marrow.

Staging Hodgkin's lymphoma

Diagnosis is followed by staging of your Hodgkin's lymphoma. Staging helps to determine prognosis and treatment options. Stages of Hodgkin's lymphoma are:

Stage I

The cancer is confined to certain lymph node region or a single organ.

Stage II

Two lymph node regions are affected or the cancer has spread to one organ and the neighboring lymph nodes. However, the cancer is still confined to certain part of the body either above or below the diaphragm.

Stage III

The cancer has spread to lymph nodes above and below the diaphragm. Cancer may have invaded certain area of tissue or an organ near the lymph node groups or the spleen.

Stage IV

The most advanced stage of Hodgkin's lymphoma, Stage IV, means the cancer has spread to one or more organs and tissues, such as the liver, lungs or bones.

Your doctor may also use letters “A” and “B” to specify whether you have symptoms of Hodgkin's lymphoma.

“A” means you have not experienced any significant symptoms whereas B indicates you have experienced symptoms such as fever, unplanned weight loss or severe night sweats.

Treatment approach for your Hodgkin's lymphoma is guided by the type and stage of your cancer, your health condition, and your preferences. Treatment aims to destroy cancer cells and reduce severity of your disease.

The treatments include:

Chemotherapy

It uses oral or injectable chemicals to kill cancer cells. Chemotherapy drugs circulate throughout your body.

Combination of chemotherapy and radiation therapy is chosen for people with early-stage classical type Hodgkin's lymphoma. Chemotherapy is followed by radiation therapy.

Chemotherapy either alone or in combination with radiation therapy is opted for advanced Hodgkin's lymphoma. Different chemotherapy drugs are usually combined to treat Hodgkin's lymphoma.

Some common side effects of chemotherapy are hair loss and nausea. Heart damage, lung damage, fertility problems and other cancers, such as leukemia are long-term complications of chemotherapy.

Radiation

It uses ionizing radiations like X-rays to destroy cancer cells. Classical Hodgkin's lymphoma can be treated with radiation therapy only, but radiation is often used after chemotherapy.

People with early-stage lymphocyte-predominant Hodgkin's lymphoma can be treated with radiation therapy only. During radiation therapy, radiation coming out from a machine is targeted to specific areas of your body like affected lymph nodes and the neighboring areas of nodes where the disease can spread.

The stage of the disease determines the length of radiation treatment. Radiation therapy can cause skin redness and hair loss at the points where radiation is targeted.

Most of the people feel extreme tiredness while undergoing radiation therapy. Other complications are heart disease, stroke, thyroid problems, infertility and other cancers, such as breast or lung cancer.

Stem cell transplant

In stem cell transplant, your unhealthy bone marrow is replaced by healthy stem cells to generate new bone marrow. It is an option for recurring Hodgkin's lymphoma.

No alternative medicines are effective in treating Hodgkin's lymphoma.

Alternative medicine may be used to deal with the stress of cancer and side effects of cancer treatment.

Different alternative therapies, such as:

• acupuncture,
• aromatherapy,
• massage,
• meditation
• relaxation techniques

can be opted.

Lifestyle modifications are necessary in order to cope with Hodgkin's lymphoma.

Diagnosis of Hodgkin's lymphoma can cause a heap of stress and anxiety.

Following tips may be helpful to deal with the stress:

• Expand and update your knowledge on Hodgkin's lymphoma to be aware of your condition and possible treatment options.
• Join support group in your community or online.
• Find someone to talk to. You may talk to your friend or a family member about your anxiety, stress. Venting your emotions can make you feel lighter.
• Keep moving towards your treatment goal.
• Give yourself some time. Eat healthy food, exercise, relax and get enough rest to deal with the stress and fatigue of cancer.
• Stay active. If you feel well, continue doing things that you usually do or enjoy.

There are several risks associated with Hodgkin's lymphoma, which include:

• Age: People of ages 15 and 30 and older than 55 seem to be at greater risk.
• A family history of lymphoma: Your risk of Hodgkin's lymphoma or non-Hodgkin's lymphoma increases if anyone from your family has had Hodgkin's lymphoma.
• Sex: Males are more likely to develop Hodgkin's lymphoma.
• History of Epstein-Barr infection: People who have had infectious mononucleosis, infection due to Epstein-Barr virus, are at risk of developing Hodgkin's lymphoma compared to people who haven’t been infected by Epstein-Barr virus.
• A weakened immune system: HIV\AIDS or intake of immune suppressing medication weaken your immune system and increase your risk of Hodgkin’s lymphoma.