Hodgkin Lymphoma (Hodgkin Disease)

Hodgkin lymphoma, once known as Hodgkin disease, is a group of blood cancers that usually develops in your lymphatic system. They’re acquired genetic disorders. You’re not born with these disorders. Instead, they happen when genes inside certain cells mutate or change.

While Hodgkin lymphomas are relatively rare, they’re the most common cancers in young adults. Every year, more people are living longer after treatment. Most of the time, people are cured of Hodgkin lymphoma because treatment eliminates all signs and symptoms. That said, this condition sometimes comes back (recurring Hodgkin lymphoma). Medical researchers are investigating treatments for this condition.

How common are Hodgkin lymphomas?

Hodgkin lymphomas are relatively rare, each year affecting about 3 in 100,000 people.

Who’s affected by these conditions?

Hodgkin lymphomas typically affect people in two age groups. The first group is people age 20 to 39. This age group has the highest rate of diagnosis. The second group includes people age 65 and older. Sometimes, people with a Hodgkin lymphoma also have viruses such as mononucleosis (Epstein-Barr virus) or less commonly, human immunodeficiency virus (HIV/AIDS). It may also affect children and teenagers. This article focuses on Hodgkin lymphomas in adults.

How do these conditions affect my body?

Hodgkin lymphomas most commonly affect the lymph nodes in your neck or your mediastinum (chest cavity). They may also develop in groups of lymph nodes under your arms, in your groin, your belly (abdomen) or pelvis.

A Hodgkin lymphoma happens when your B-cells mutate, or develop genetic changes. B-cells are white blood cells that help fight infection. When these cells mutate, they create abnormal cancerous cells called Reed-Sternberg cells.

Reed-Sternberg cells are larger-than-normal cells. They multiply faster and live longer than normal cells. They also make cytokines, substances that attract normal cells to lymph nodes carrying the abnormal cells.

The normal cells, like innocent bystanders in a crowd, get caught up in the action and release substances that make the Reed-Sternberg cells grow. The result is swollen lymph nodes that expanded to accommodate the crowd.

There are two main types of Hodgkin lymphoma: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL).

Classic Hodgkin lymphoma

This is the most common form of Hodgkin lymphoma, representing 95% of cases. Medical specialists called pathologists identify Hodgkin lymphoma by examining lymph nodes or other tissue and blood cells under a microscope for signs of Reed-Sternberg cells. There are four classic Hodgkin lymphoma subtypes:

• Nodular sclerosing Hodgkin lymphoma: This is the most common classic Hodgkin lymphoma subtype. It often affects young adults, especially women and people designated female at birth (DFAB). This subtype typically affects lymph nodes in the central part of your chest.
• Mixed cellularity Hodgkin lymphoma: This subtype typically affects people in their 60s. It sometimes develops in people’s bellies (abdomen). People with this subtype have lymph nodes carrying a mixture of many different cell types, including many Reed-Sternberg cells.
• Lymphocyte-rich classic Hodgkin lymphoma: This Hodgkin lymphoma subtype affects about 6% of people with Hodgkin lymphoma. It’s more common in men and people designated male at birth (DMAB) than in women and people DFAB. It’s called lymphocyte-rich because affected lymph nodes carry many normal lymphocytes along with Reed-Sternberg cells.
• Lymphocyte depleted Hodgkin lymphoma: This subtype only affects about 1% of people with Hodgkin lymphoma. It’s most common in people age 60 and older and people who have HIV/AIDS. As the name implies, the condition depletes or replaces normal cells in lymph nodes with abnormal cells.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)

This is a rare form of Hodgkin lymphoma. It affects about 5% of people who have Hodgkin lymphoma. It’s more common in people in their 20s than people in their 60s. It grows more slowly than classic Hodgkin lymphoma, so people may not need treatment right away.

What’s the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

There are several differences between non-Hodgkin lymphoma and Hodgkin lymphoma:

• Non-Hodgkin lymphoma typically affects people age 65 and older, while Hodgkin lymphoma may affect people in their 20s and 30s, as well as people age 65 and older.
• Hodgkin lymphoma is relatively rare. Non-Hodgkin lymphoma is the sixth most common cancer type.
• There are more than 70 different types of non-Hodgkin lymphoma. Hodgkin lymphoma has six different types.
• People with non-Hodgkin lymphoma don’t have Reed-Sternberg lymphocytes, the oversized white blood cells that healthcare providers look for when diagnosing Hodgkin lymphoma.
• In Hodgkin lymphoma, biopsy results show the Reed-Sternberg cells along with noncancerous lymphocytes and other immune cells. In contrast, biopsy results for non-Hodgkin lymphoma usually show cancerous lymphoma cells and very few, if any, noncancerous cells.