|
Table of Contents General Information About Adult Hodgkin Lymphoma
Stages of Adult Hodgkin Lymphoma
Recurrent Adult Hodgkin Lymphoma
Treatment Option Overview
Treatment Options for Adult Hodgkin Lymphoma
To Learn More About Adult Hodgkin Lymphoma
Get More Information From NCI
Changes to This Summary (05/06/2008)
About PDQ
General Information About Adult Hodgkin Lymphoma
| Key Points for This Section
|
|
Adult Hodgkin lymphoma is a disease in which malignant
(cancer) cells form in the lymph system.
Adult Hodgkin lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system.
The lymph system is made up of the following:
- Lymph: Colorless,
watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the
body against infections and the
growth of tumors.
- Lymph vessels: A network of thin tubes that collect lymph
from different parts of the body and return it to the bloodstream.
- Lymph nodes:
Small, bean-shaped structures that filter lymph and store white blood cells that help fight
infection and disease. Lymph nodes are located along the network of lymph vessels
found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
- Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys
old blood cells. It is located on the left side of the abdomen near the stomach.
- Thymus: An organ
in which lymphocytes grow and multiply. The thymus is in the chest behind the
breastbone.
- Tonsils: Two small
masses of lymph tissue at the
back of the throat. The tonsils produce lymphocytes.
- Bone marrow: The
soft, spongy tissue in the center of large bones. Bone marrow produces white
blood cells, red blood cells, and platelets.
|
Enlarge
|
|
|
|
|
| Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart. |
Because lymph tissue is found throughout the body, Hodgkin
lymphoma can begin in almost any part of the body and spread to almost any
tissue or organ in the body.
Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. This summary is about the treatment of adult Hodgkin lymphoma. (See the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information.)
Hodgkin lymphoma can occur in both adults and children; however,
treatment for adults may be different than treatment for children. Hodgkin lymphoma may also occur in patients who have acquired immunodeficiency syndrome (AIDS); these
patients require special treatment.
See
the following PDQ summaries for more information:
Hodgkin lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age. However, treatment is different for pregnant women. This summary includes information about treating Hodgkin lymphoma during pregnancy.
There are two main types of Hodgkin lymphoma: classical and nodular lymphocyte-predominant.
Most Hodgkin lymphomas are the classical type. The classical type is broken down into the following four subtypes:
- Nodular sclerosing Hodgkin lymphoma.
- Mixed cellularity Hodgkin lymphoma.
- Lymphocyte depletion Hodgkin lymphoma.
- Lymphocyte-rich classical Hodgkin lymphoma.
Age, gender, and Epstein-Barr infection can affect
the risk of developing adult Hodgkin lymphoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for adult
Hodgkin lymphoma include the following:
- Being in young or late adulthood.
- Being male.
- Being infected with the Epstein-Barr
virus.
- Having a first-degree relative (parent, brother, or sister) with Hodgkin lymphoma.
Pregnancy is not a risk factor for Hodgkin lymphoma.
Possible signs of adult Hodgkin lymphoma include swollen lymph
nodes, fever, night sweats, and weight loss.
These and other symptoms may be caused by adult Hodgkin lymphoma.
Other conditions may cause the same symptoms. A doctor should be consulted if any of the following
problems do not go away:
- Painless, swollen lymph nodes in the neck, underarm, or
groin.
- Fever for no known reason.
- Drenching night sweats.
- Weight loss for no known reason.
- Itchy skin.
- Feeling very tired.
Tests that examine the lymph nodes are used to detect (find)
and diagnose adult Hodgkin lymphoma.
The following tests and procedures may be used:
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The patient's symptoms.
- The stage of the cancer.
- The type of Hodgkin lymphoma.
- Blood test results.
- The patient's age, gender, and general health.
- Whether the cancer is recurrent or progressive.
For Hodgkin lymphoma during pregnancy, treatment options also depend on:
- The wishes of the patient.
- The age of the fetus.
Adult Hodgkin lymphoma can usually be cured if found and treated early.
 Back to Top Stages of Adult Hodgkin Lymphoma
| Key Points for This Section
|
|
|
After adult Hodgkin lymphoma has been diagnosed, tests are
done to find out if cancer cells have spread within the lymph system or to
other parts of the body.
The process used to find out if cancer has spread within the lymph
system or to other parts of the body is called staging. The information gathered from the staging
process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the
body, taken from different angles. The pictures are made by a computer
linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This
procedure is also called computed tomography, computerized tomography, or
computerized axial tomography. For adult Hodgkin
lymphoma, CT scans of the chest, abdomen, and pelvis are taken.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
| Enlarge | | | | Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope. |
- Laparotomy: A surgical procedure in which an incision (cut) is made in the wall
of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. This procedure is done only if it is needed to make decisions about treatment.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Surgical biopsy: The removal of tissue using a scalpel. A pathologist views the tissue under a microscope to look for cancer cells.
- Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
For pregnant women with Hodgkin lymphoma, staging tests that protect the fetus from the harms of radiation are used. These include:
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stages of adult Hodgkin lymphoma may include
A, B, E, and S.
Adult Hodgkin lymphoma may be described as
follows:
- A: The patient has no symptoms.
- B: The patient has symptoms such as fever, weight loss, or night
sweats.
- E: "E" stands for extranodal and means the cancer is found in an area or organ other than the lymph
nodes or has spread to tissues beyond, but near, the major lymphatic areas.
- S: "S" stands for spleen and means the cancer is found in the spleen.
The following stages are used for adult Hodgkin
lymphoma:
Stage I
Stage I is divided
into stage I and stage IE.
Stage II
Stage II is divided
into stage II and stage IIE.
Stage III
Stage III is divided
into stage III, stage IIIE, Stage IIIS, and stage
IIIS+E.
Stage III is also divided into stage III(1) and stage
III(2) as follows:
Stage IV
In stage IV, the cancer either:
- is found throughout one or more organs other than the lymph nodes and may be in lymph nodes near those organs; or
- is found in one organ other than the lymph nodes and has
spread to lymph nodes far away from that organ.
Adult Hodgkin lymphoma may be grouped for treatment as follows:
Early Favorable
Early favorable adult Hodgkin lymphoma is stage I or stage II, without risk factors.
Early Unfavorable
Early unfavorable adult Hodgkin lymphoma is stage I or stage II with one or more of the following risk factors:
Advanced Favorable
Advanced favorable adult Hodgkin lymphoma is stage III or stage IV with three or fewer of the following risk factors:
- Having a low blood albumin (protein) level (below 4).
- Having a low hemoglobin level (below 10.5).
- Being male.
- Being aged 45 years or older.
- Having stage IV disease.
- Having a high white blood cell count (15,000 or higher).
- Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).
Advanced Unfavorable
Advanced unfavorable Hodgkin lymphoma is stage III or stage IV with four or more of the following risk factors:
- Having a low blood albumin (protein) level (below 4).
- Having a low hemoglobin level (below 10.5).
- Being male.
- Being aged 45 years or older.
- Having stage IV disease.
- Having a high white blood cell count (15,000 or higher).
- Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).
Back to Top Recurrent Adult Hodgkin Lymphoma
Recurrent adult Hodgkin lymphoma is cancer that has recurred (come back)
after it has been treated. The cancer may come back in the lymph system or in other parts of the body.
Back to Top Treatment Option Overview
| Key Points for This Section
|
|
|
There are different types of treatment for patients with adult
Hodgkin lymphoma.
Different types of treatment are available for patients with adult Hodgkin lymphoma. Some treatments
are standard (the currently used treatment), and some are being tested in clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the new treatment may
become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
For pregnant patients with Hodgkin lymphoma, treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother’s wishes, the stage of the Hodgkin lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Patients with Hodgkin lymphoma should have their treatment
planned by a team of health care providers with expertise in treating lymphomas.
Treatment will be overseen by a medical
oncologist, a doctor who specializes in treating cancer. The
medical oncologist may refer you to other health care providers who have experience and
expertise in treating adult Hodgkin lymphoma and who specialize in certain
areas of medicine. These may include the following specialists:
Three types of standard treatment are used:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.
When a pregnant woman is treated with chemotherapy for Hodgkin lymphoma, it isn't possible to protect the fetus from being exposed to the chemotherapy. Some chemotherapy regimens may cause birth defects if given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects when given in the second half of pregnancy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed |
 and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))
. Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))
)
 is inserted into the patient\'s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))