Hodgkin's Lymphoma: Symptoms, Stages, Causes, Survival Rate

Hodgkin’s Lymphoma, or Hodgkin’s disease, is a type of cancer that affects the lymphatic system. It is characterised by the presence of abnormal cells called Reed-Sternberg cells. These cells are a distinctive feature of this disease. They are large and abnormal white blood cells. 

The lymphatic system is a part of the immune system. It consists of lymph nodes, spleen, thymus, and other tissues. It produces and stores white blood cells called lymphocytes.

In Hodgkin’s lymphoma, lymphocytes grow out of control, resulting in swollen lymph nodes and growth throughout the body. 

Hodgkin’s lymphoma is typically classified into two main types. These types differ in their characteristics and behaviour. The type of lymphoma also helps determine the treatment options. These include:

1. Classical Hodgkin’s Lymphoma: This is the more common type of Hodgkin’s lymphoma, accounting for about 95% of cases. Individuals diagnosed with this type have Reed-Sternberg cells in their lymph nodes. Classical Hodgkin’s lymphoma is further divided into several subtypes, including:

1. Nodular Sclerosis Hodgkin’s Lymphoma: The most common subtype of classical Hodgkin’s lymphoma, it usually affects young adults, especially women. It affects lymph nodes in the central part of the chest. 

2. Mixed Cellularity Hodgkin’s Lymphoma: It usually affects individuals in their 60s. This type of lymphoma sometimes develops in the abdomen. It is characterised by an abundance of Reed-Sternberg cells mixed with other types of cells.

3. Lymphocyte-rich Hodgkin’s Lymphoma: It constitutes 5% of all Hodgkin’s lymphoma cases and is more common in men than women. It is called lymphocyte-rich as it has more lymphocytes and fewer Reed-Sternberg cells. 

4. Lymphocyte-depleted Hodgkin’s Lymphoma: The rarest subtype constitutes only about 1% of Hodgkin’s lymphoma cases. It commonly affects people aged 60 and older and those with HIV/AIDS. It is characterised by a scarcity of lymphocytes and many Reed-Sternberg cells.

2. Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma (NLPHL): This type of Hodgkin’s lymphoma is less common, accounting for about 5% of cases. 

1. It is characterised by the presence of lymphoma cells known as “popcorn cells” due to their appearance. 

2. NLPHL tends to have a slower growth rate and is often diagnosed earlier. It generally carries a better prognosis than classical Hodgkin’s lymphoma.

Hodgkin’s Lymphoma Stages

Hodgkin’s lymphoma is staged to determine the extent and spread of the disease. The staging system commonly used for Hodgkin’s lymphoma is the Lugano classification, based on the older Ann Arbor staging system.

Hodgkin’s lymphoma stages are classified as I, II, III, and IV.

1. Stage I: Either of the following indicates HL in stage I.

1. Cancer is limited to only one lymph node region or organ, such as the thymus. 

2. IE: Cancer is found in one area of one organ outside the lymph node. IE denotes that lymphoma is in an extranodal site. 

2. Stage II: Either of the following indicates HL in stage II.

1. Cancer involves two or more lymph node regions on the same side of the diaphragm (the thin muscle beneath the lungs separating the chest and abdomen).

2. The cancer spreads from one lymph node area into a nearby organ. 

3. Stage III: Either of the following indicates HL in stage III.

1. Cancer involves lymph node regions on both sides of the diaphragm. 

2. Cancer is in lymph nodes above the diaphragm and the spleen. 

4. Stage IV: In this stage, the cancer has spread to one or more organs or tissues beyond the lymphatic system. These organs may include the bone marrow, liver, lungs, etc.

Hodgkin’s lymphoma can cause several symptoms. However, these symptoms may vary from one person to another. Common Hodgkin’s lymphoma symptoms include:

1. Painless Swollen Lymph Nodes: The most common symptom of Hodgkin’s lymphoma is the presence of painless swelling of lymph nodes, generally in the neck, underarms, or groin. 

2. Persistent Fatigue: Another common symptom is feeling more tired than usual or lacking energy for at least several days.

3. Fever: A fever of 103℉ for two or more hours or longer than two days 

4. Night Sweats: Excessive sweating, particularly at night, often accompanied by soaking the bedclothes

5. Unexplained Weight Loss: Significant and unexplained weight loss, typically defined as losing 10% or more of body weight within six months

6. Pruritus: Persistent itching of the skin, especially after taking a bath or drinking alcohol

7. Chest Pain, Coughing, and Difficulty Breathing: These Hodgkin’s lymphoma symptoms may develop if the disease affects the lymph nodes inside the chest cavity. 

8. Abdominal Pain or Swelling: An enlarged spleen may cause abdominal pain, swelling, or a feeling of fullness after eating a few bites. 

9. Pain in Lymph Nodes after Drinking Alcohol: Swollen lymph nodes in Hodgkin’s lymphoma are usually painless. However, individuals may experience pain after drinking alcohol. 

The exact Hodgkin’s lymphoma causes are not known. However, researchers and doctors know that cancer begins when there are changes in the DNA of cells called lymphocytes. The DNA contains instructions that inform the cell what to do. 

Changes or mutations in the cells’ DNA tell them to grow rapidly. These abnormal cells continue living when other cells would have naturally died. This accumulation of cells in the lymph nodes can cause swelling and other Hodgkin’s lymphoma symptoms. 

Hodgkin’s Lymphoma Risk Factors 

Several risk factors have been identified that may increase the likelihood of developing Hodgkin’s lymphoma. It is important to note that having one or more risk factors does not necessarily mean an individual will develop the disease. Here are some known risk factors:

1. Age: Hodgkin’s lymphoma can occur at any age, but it is more commonly diagnosed in two peak age groups: young adulthood (between 20 and 40 years) and older adulthood (over 55 years old).

2. Gender: Males have a slightly higher risk of developing Hodgkin’s lymphoma than females. One exception to this is nodular sclerosis, Hodgkin’s lymphoma, which is more common in women than men. 

3. Family History: Having a close family member, such as a sibling or parent, with Hodgkin’s lymphoma increases the risk of developing the disease. However, the majority of cases occur without a family history.

4. Weakened Immune System: Those with a weakened immune system have an increased risk of developing Hodgkin’s lymphoma. These may include people with HIV/AIDS or individuals who have undergone organ transplantation and require immunosuppressive medications. 

5. Epstein-Bar Virus (EBV) Infection: Infection with the Epstein-Barr virus (a highly contagious infection that spreads through bodily fluids) is associated with an increased risk of developing Hodgkin’s lymphoma. 

Since the aetiology of Hodgkin’s lymphoma is still unknown, currently, there are no known specific measures to prevent the development of Hodgkin’s lymphoma. Some precautions that people can take to reduce the risk of the disease include:

1. Avoid Tobacco Smoking: Since tobacco use can increase the risk of several types of cancers, it is best to avoid smoking. 

2. Maintain a Healthy Lifestyle: Regular physical activity and a nutritious diet can contribute to overall well-being and may help reduce the risk of certain cancers.

3. Protect against infections: HIV can increase the risk of CLL. Individuals should avoid known risk factors for HIV, like unprotected sex with multiple partners and intravenous drug use. 

4. Check-ups and Screenings: Regular medical check-ups and screenings can help in early cancer diagnosis.  

Hodgkin’s lymphoma diagnosis typically involves several steps and tests to determine the presence of the disease and its characteristics. The healthcare professional will perform a physical examination to look for enlarged lymph nodes and ask the patient about their medical history.
They may order certain tests and procedures, including:

1. Blood tests: They are performed to assess general health and identify any abnormalities. Blood tests may be used to look for viruses linked to Hodgkin’s lymphoma. These tests include:

1. Complete Blood Count (CBC): The test measures the levels of different blood cells. People with Hodgkin’s lymphoma can sometimes have abnormal blood counts. 

2. Erythrocyte Sedimentation Rate (ESR): It evaluates inflammation in the body by placing red blood cells in a test tube and measuring how long it takes to settle at the bottom. Inflammation levels may be elevated in some people with HL. 

3. Blood Chemistry Study: This blood test measures substances a person’s tissues and organs release in the bloodstream. 

2. Imaging tests: Various imaging techniques are used to visualise the lymph nodes, organs, and tissues in the body. Commonly used imaging tests include:

1. Computed Tomography Scan: CT scans provide detailed cross-sectional images of the body. They are used to assess the extent of lymph node involvement. 

2. Magnetic Resonance Imaging Scan: MRI scans create detailed pictures of areas inside the body using strong magnets and radio waves. 

3. Positron Emission Tomography Scan: PET scans involve injecting a small amount of radioactive material. The radioactive material helps identify tissues likely to contain cancer. 

3. Biopsy: While other tests can suggest the presence of cancer, a biopsy is the only test that helps diagnose the condition. Doctors may perform two types of biopsy:

1. Lymph Node Biopsy: The procedure involves removing all or part of the lymph node to examine tissues for signs of Reed-Sternberg cells. 

2. Bone Marrow Biopsy: It involves removing a sample of bone marrow and examining it under a microscope to see if cancer has spread. 

4. Immunophenotyping: A lab test that uses biopsy samples to determine if lymphoma cells are present. Furthermore, it helps determine the type of lymphoma cells. 

5. Heart and lung function tests: An echocardiogram (ultrasound of the heart) and lung function tests can help evaluate how well the heart and lungs are working.

How to Prepare for Doctor’s Consultation?

Preparing for a doctor’s consultation for Hodgkin’s lymphoma cancer can help ensure that individuals make the most of their appointment and have a productive discussion with their healthcare provider. Here are some steps they can take to prepare:

1. Take a prior appointment

2. Make a list of all the symptoms

3. Write down personal information

4. Enlist all medications, including vitamins and supplements

5. Prepare questions for the doctor

6. Bring a supportive person

What to Expect from the Doctor?

During a consultation for Hodgkin’s lymphoma, the doctor will likely ask patients several questions to gather information about their symptoms, medical history, and overall health. While the specific questions may vary, here are some common ones they can expect:

1. When did you first notice any symptoms?

2. What are the specific symptoms you have been experiencing?

3. Have the symptoms been continuous or occasional?

4. Does anything seem to improve or worsen the symptoms?

5. Do you have a family history of Hodgkin’s lymphoma or other cancers?

6. Do you have a history of immune system disorders or infections?

7. Have you or your family ever been exposed to toxins?

What to Ask the Doctor?

Patients must ask questions during a Hodgkin’s lymphoma consultation to better understand their condition, treatment options, and prognosis. Here are some questions they may consider asking their doctor:

1. What type and stage of Hodgkin’s lymphoma do I have?

2. What tests do I need to determine the diagnosis and staging?

3. Is Hodgkin’s lymphoma curable?

4. Will I need treatment?

5. What are the recommended treatment options for my stage and type of Hodgkin’s lymphoma?

6. What are the potential benefits and risks of each treatment option?

7. How will treatment affect my daily life, including work, family, and other commitments?

8. How long will the treatment last?

9. Are there any clinical trials or newer treatment approaches that I should consider?

10. What is the expected Hodgkin’s lymphoma prognosis in my specific case?

11. Should I seek a second opinion regarding my diagnosis or treatment plan?

12. Who can help me regarding the cost and insurance coverage for my diagnosis and treatment?

Hodgkin’s lymphoma treatment aims at destroying as many lymphoma cells as possible and bringing the disease into remission. The treatment choice depends on various factors, including the stage of the disease, the subtype of Hodgkin’s lymphoma, the patient’s overall health, and individual preferences. The main treatment options for Hodgkin’s lymphoma include:

1. Chemotherapy: Chemotherapy is the primary treatment for most cases of Hodgkin’s lymphoma. It involves using powerful drugs to kill cancer cells or prevent their growth and division. Hodgkin’s lymphoma chemotherapy can be taken as a pill or through a vein in the arm.
   While it may be the only treatment needed for classical Hodgkin’s lymphoma, chemotherapy may be combined with radiation therapy or targeted therapy for NLPHL. 

2. Radiation Therapy: This treatment targets and destroys cancer cells by using high-energy beams, such as X-rays. Depending on the disease extent, it may be used alone or combined with chemotherapy.
   Radiation therapy is often directed at the areas affected by lymphomas, such as lymph nodes or the organs involved. For early-stage NLPHL, radiation therapy may be the only treatment required. 

3. Immunotherapy: Immunotherapy uses drugs to stimulate the body’s immune system to recognise and attack cancerous cells. One example of immunotherapy in Hodgkin’s lymphoma is brentuximab vedotin, specifically targeting CD30-positive Hodgkin’s lymphoma cells.

4. Targeted Therapy: Targeted therapy drugs specifically target certain molecules or genetic mutations in cancer cells. For NLPHL, targeted therapies are often combined with chemotherapy. 

5. Bone Marrow Transplant: In certain cases, high-dose chemotherapy and/or radiation therapy may be followed by a bone marrow transplant. Stem cells from the patient (autologous transplant) replace damaged bone marrow with healthy stem cells.
   This procedure may be an option for a Hodgkin’s lymphoma relapse or when it does not respond to other treatments. Less frequently, providers may perform an allogeneic stem cell transplant (taking stem cells from a donor).

Please note: The treatment choice is based on the patient’s health and the treating doctor’s opinion. 

Cost of Hodgkin’s Lymphoma Treatment

The expense of treating Hodgkin's lymphoma in India can differ based on various factors. These factors include the specific type and stage of cancer, the chosen treatment method, the age of the patient, the location and type of hospital, and the doctor's level of expertise. 

The following table provides information on the costs associated with different treatment options for lymphoma.

Hodgkin’s Lymphoma Survival Rate

Hodgkin’s lymphoma survival rate varies depending on various factors such as the stage of the disease, age at diagnosis, overall health, and response to treatment. One must note that survival rates are statistical estimates that may not reflect an individual’s prognosis.

1. The five-year survival rate for people with localised Hodgkin’s lymphoma is 93%. 

2. When the cancer spreads regionally, the five-year survival rate is 95%. 

3. Stage 4 Hodgkin’s lymphoma survival rate (cancer has spread to different body parts) is 83%. 

Hodgkin’s lymphoma and its treatment can lead to several complications. Some of the potential complications associated with Hodgkin’s lymphoma include:

1. Weakened Immune System: A common complication of Hodgkin’s lymphoma that becomes more severe during treatment. A weak immune system makes individuals more prone to infections and a greater risk of complications. 

2. Infertility: Treatments like chemotherapy and radiation therapy for Hodgkin’s lymphoma can cause infertility in men and women. Reduced or lost fertility may be short-termed or permanent. 

3. Other Health Problems: People with Hodgkin’s lymphoma also risk developing other health conditions in the future. These health conditions may include cardiovascular problems and lung diseases. 

4. Secondary Cancers: While rare, Hodgkin’s lymphoma survivors have a slightly increased risk of developing secondary cancers later in life. These can include solid tumours, such as lung or breast cancer, or other types of lymphoma or leukaemias. 

When to See a Doctor?

Seeking prompt medical attention allows for timely evaluation and appropriate diagnosis if necessary. Patients must see their doctor if they experience persistent or unexplained symptoms for over a few weeks. These symptoms may include:

1. Swollen lymph nodes

2. Unexplained weight loss

3. Persistent fever

4. Night sweats

5. Fatigue

If a person is receiving treatment, they should contact their doctor when they notice changes in the body that may indicate the condition is worsening despite treatment. 

Eating a balanced diet is important for individuals with Hodgkin’s lymphoma to support overall well-being and provide adequate nutrition during treatment. While no specific diet can cure or treat Hodgkin’s lymphoma, the following dietary recommendations can be beneficial:

1. Eat a Nutritious Diet: A well-balanced nutritious diet should include the following:

1. Fruits and vegetables like citrus fruits, berries, broccoli, and leafy greens

2. Proteins like chicken, eggs, fish, and lentils

3. Healthy fats, like avocados, nuts, and extra virgin olive oil

4. Complex carbohydrates, like beans, starchy vegetables, oats, and other whole grains

2. Stay Hydrated: Individuals should drink lots of water throughout the day to stay hydrated. Proper hydration supports overall health and can help manage potential side effects of treatments, such as diarrhoea and vomiting. 

During Hodgkin’s lymphoma treatment, it is essential to minimise food safety risks to protect the weakened immune system. Here are some tips to help reduce the risk of foodborne illnesses: 

1. Practice Good Hygiene: Individuals should wash their hands with soap and water before and after handling food. They should also wipe any surfaces used for cooking before preparing a meal and use separate plates for raw and cooked foods.

2. Be Careful with Fresh Produce: Wash all fruits and vegetables thoroughly before eating or cooking, even if they will be peeled or cooked.

3. Cook Food Thoroughly: Cook all meats, poultry, fish, eggs, sprouts, and sushi thoroughly to kill harmful bacteria or pathogens.

4. Avoid High-risk Foods: During treatment, it is recommended to avoid certain high-risk foods. These foods include raw or undercooked eggs, raw or undercooked seafood, and unpasteurised dairy products like milk, cheese, and juices. 

5. Be Mindful of Food Storage: Perishable items should be refrigerated as soon as possible after grocery shopping. Also, the food should be inspected for spoilage and expiry date. 

Hodgkin’s lymphoma is a type of cancer affecting the lymphatic system. It can cause various symptoms, including swollen lymph nodes, fatigue, night sweats, and weight loss. Prompt and accurate diagnosis, followed by appropriate treatment, is essential for favourable outcomes.

Depending on the individual’s specific case, treatment options may include chemotherapy, radiation therapy, immunotherapy, stem cell transplantation, and targeted therapies.

HexaHealth understands the challenges faced by individuals diagnosed with Hodgkin’s lymphoma. We provide invaluable support through our comprehensive healthcare platform. Our team facilitates seamless communication with healthcare providers, enabling patients to ask questions, discuss treatment options, and seek second opinions.

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