One day while shaving, Justin noticed a lump on the side of his neck. He didn't think much of it at first, assuming it would go away. But after a week, the lump was still there, so Justin went to see the doctor. He was a little surprised at the questions his doctor asked. Had Justin lost weight? Was he easily tired? Did he ever get fever or night sweats? As Justin answered yes to these questions, he wondered what they had to do with the lump on his neck.
The doctor explained that the lump was a swollen lymph node and that he wanted to monitor it closely. He prescribed antibiotics because swollen lymph nodes are often caused by infections. But when the medicine did not decrease the swelling, the doctor recommended some tests, telling Justin and his mother that they were necessary to check for disease, including lymphoma.
What Is Hodgkin Lymphoma?
Hodgkin lymphoma is a type of cancer called a lymphoma, which is a cancer of the lymphatic system.
The lymphatic system helps the body's immune system to filter out bacteria, viruses, and other unwanted substances. The lymphatic system includes the lymph nodes (which are sometimes called glands), thymus, spleen, tonsils, adenoids, and bone marrow, as well as the channels (called lymphatics or lymph vessels) that connect them.
Most people don't notice the workings of their lymphatic systems; in fact, the only time you may be aware of your lymphatic system is when your lymph nodes swell up. This often happens when a person is sick — a sign that the lymphatic system is working hard to filter an infection out of the body.
Lymphoma is a disease in which cancer cells form in a person's lymphatic system and start to grow uncontrollably. There are several different types of lymphomas, and they are divided into two broad categories: Hodgkin lymphoma and non-Hodgkin lymphoma.
Lymphomas that involve a particular type of cell, called a Reed-Sternberg cell, are classified under the heading Hodgkin lymphoma. There are several different subtypes of Hodgkin lymphoma, based on how the cancerous tissue looks under a microscope.
No one really knows exactly what causes Hodgkin lymphoma. People who have a close relative who has had Hodgkin lymphoma seem to be slightly more likely to get the disease, as are people who have had Epstein-Barr Virus (EBV, also called infectious mononucleosis), an organ transplant, or who have AIDS (acquired immunodeficiency syndrome).
But just because you've had an organ transplant or have a compromised immune system doesn't mean you'll get Hodgkin lymphoma. Most people with Hodgkin lymphoma don't have any of these risk factors.
What Are the Signs and Symptoms?
The signs and symptoms of Hodgkin lymphoma vary from person to person. Some people may not notice symptoms at all or they may think their symptoms are caused by something else.
Some of the more common signs and symptoms are:
- swollen lymph nodes in the neck, armpit, or groin area that don't go away
- night sweats
- weight loss over several months despite eating normally
- tiredness and weakness
- coughing or shortness of breath
- itching or rash
The symptom that most people notice first is swollen lymph nodes. Of course, swollen lymph nodes usually don't mean cancer — they're most often a sign of a common illness, like an infection. In fact, all of the symptoms of Hodgkin lymphoma can also be caused by other conditions, which is why only a doctor can determine what's really wrong.
How Is It Diagnosed?
In addition to doing a physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. This is called the medical history.
One of the things doctors might look for if they suspect lymphoma is enlargement of the lymph nodes. Doctors may try to treat swollen lymph nodes with antibiotics, because infections are the most common cause of swollen lymph nodes. But if the lymph nodes remain swollen, the doctor may order a biopsy.
A biopsy is a type of test in which a doctor removes a tiny bit of tissue or fluid from the body and sends it out to a laboratory for a specialist to examine under a microscope.
There are several kinds of biopsies. In the case of Hodgkin lymphoma, a doctor usually orders one of two types:
- Core biopsy. In cases where a lymph node is deep and can’t be felt, the doctor uses a needle to remove a small amount of tissue from the lymph node.
- Excisional or incisional biopsy. The doctor opens the skin to remove the entire enlarged lymph node (excisional) or only part of it (incisional).
A doctor may use either local anesthesia (where only a part of the body is numbed) or general anesthesia (where a person is asleep) to ensure the person doesn't feel any pain during these biopsies.
If your family doctor suspects Hodgkin lymphoma, he or she will refer you to an oncologist (pronounced: on-KOL-uh-jist), a doctor who specializes in the treatment of cancer. The oncologist will do more tests to find out whether the cancer has spread. This process is called staging.
Some of these tests are:
- blood tests
- a chest X-ray
- a computed tomography (CT or CAT) scan, a type of X-ray that rotates around the patient and creates a picture of the inside of the body from different angles
- a bone marrow biopsy to check for cancer in the bone marrow
- a positron emission tomography (PET) scan, which can tell the difference between normal and abnormal cells based on their metabolic activity
How Is It Treated?
Treatment for Hodgkin lymphoma is very effective for most people. The type and length of treatment varies, depending on the stage and type of the disease; where the disease is found in the body; and the person's age, physical maturity, and overall health.
Treatment can include radiation therapy (using high-energy X-rays to kill cancer cells and keep them from growing and multiplying), chemotherapy (using medicine to kill cancer cells), or both, depending on the type and stage of the cancer as well as the age and health of the person.
Researchers are constantly working on new treatments for cancer. Some people decide to participate in clinical trials, which are ways to test new cancer treatments or compare their effectiveness with existing treatments. If you have Hodgkin lymphoma, your doctor can tell you whether this is a good idea for the particular type you have.
What to Expect
Treatment for Hodgkin lymphoma is powerful. It destroys good cells along with bad, which can create certain side effects.
Although the side effects depend on the individual and the medicine that a doctor prescribes, the most common short-term side effects of chemotherapy are nausea, vomiting, and a flu-like feeling. (The good news is medicine can be used to prevent most of the nausea and vomiting.) Some people feel weak or dizzy after their treatments, or they run a fever. Others get sores in their mouths or don't feel much like eating. It's also common for people to lose some or all of their hair.
The short-term side effects of radiation can be similar to those of chemotherapy, although the side effects of radiation are usually more localized, meaning they affect only the area that receives the radiation treatment. People can continue to feel side effects for several weeks after their treatment ends.
Chemotherapy and radiation treatments can weaken the immune system. If you're getting one of these treatments, steer clear of friends and family with colds, the flu, or other infections. You also need to avoid cuts and other injuries. It's best to put sports and the more strenuous forms of physical activity on hold, but you can still stay active with gentle forms of exercise, like walking.
Tell your doctor if you experience any side effects of treatment. Your doctor can also tell you about possible long-term side effects of the type of treatment you are having.
It can be hard to deal with the side effects of treatment. Perhaps you feel tired and nauseous, and you have to deal with losing your hair. It's important to lean on your parents, other family, and friends. If you want, ask to talk to a psychologist, who will listen to your feelings privately and without judgment.
You also can join a support group, where you'll meet and talk to people who have Hodgkin or other cancers and are dealing with the same problems you are.
If you have or have had Hodgkin lymphoma, it's important to see your doctor regularly for many years following treatment. Occasionally, cancer may return, and follow-up appointments with your cancer specialist can help you catch it early if it does. Your doctor will also watch for any late side effects of your treatment.
After Hodgkin lymphoma is gone, most people never get it again. However, some do. The term "recurrent" describes Hodgkin lymphoma that returns after treatment to the same area or a new one. If you have symptoms, tell your parents and your doctor. Some people can also develop other cancers after being treated for Hodgkin, which will require more treatments.
Even though Hodgkin lymphoma is a serious illness, most people survive and go on to live normal, productive lives.
Reviewed by: Robin Miller, MD
Date reviewed: July 2015