Hodgkin’s Lymphoma (Hodgkin’s Disease)

Diagnosis

Hodgkin lymphoma diagnosis usually starts with a physical examination to check for swollen lymph nodes in areas such as the neck, underarms, and groin, as well as an enlarged spleen or liver. Additional tests, including blood tests, imaging scans, and tissue sampling, help confirm the diagnosis and determine the extent of the disease.

Blood tests

Blood tests can reveal signs that may indicate lymphoma. These tests can help detect viruses like HIV, EBV, hepatitis B, and hepatitis C. They also measure lactate dehydrogenase (LDH) levels, which are often elevated in people with lymphoma.

Imaging tests

Imaging tests provide detailed pictures of the body to determine the location and spread of Hodgkin lymphoma. Common imaging methods include:

• Computed tomography (CT) scans

• Positron emission tomography (PET) scans

Biopsy

A biopsy is essential for confirming the diagnosis. It involves removing a sample of tissue, usually from a lymph node, for laboratory testing. Depending on symptoms and imaging findings, samples may be taken from other affected areas. In the lab, specialists look for cancer cells that indicate Hodgkin lymphoma.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy help check if lymphoma has spread to the bone marrow. A needle is used to collect samples of both the liquid and solid parts of the bone marrow, often from the hip bone. This test may be recommended if blood counts are low without a clear cause.

Testing Hodgkin lymphoma cells in the lab

Tissue samples from a biopsy or bone marrow test are analyzed in a lab. Specialists look for specific proteins, called markers, on the surface of cancer cells. These markers help determine whether the cells are Hodgkin lymphoma cells and identify the subtype of the disease.

Treatment

Treatment for Hodgkin lymphoma depends on the type, stage, and aggressiveness of the cancer, as well as your overall health and personal preferences. Options may include chemotherapy, radiation therapy, targeted therapy, immunotherapy, bone marrow transplant, or participation in clinical trials.

Chemotherapy

Chemotherapy uses powerful medicines to destroy cancer cells. Most chemotherapy drugs are administered intravenously, while some are taken orally.

• Often the first line of treatment for classic Hodgkin lymphoma

• May be combined with radiation, targeted therapy, or immunotherapy

• Used for refractory (resistant) or relapsed (recurring) lymphoma

Common side effects include nausea and hair loss, while long-term complications may include heart or lung damage, infertility, and secondary cancers.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to target and destroy cancer cells. It may be used alone in early-stage disease or combined with chemotherapy. In advanced cases, it helps relieve symptoms and improve quality of life.

Possible side effects include:

• Fatigue and skin irritation at the treatment site

• Dry mouth and thyroid issues if the neck is treated

• Heart and lung damage if the chest area is exposed

Targeted therapy

Targeted therapy uses medicines that focus on specific molecules in cancer cells, blocking their growth and survival mechanisms. This treatment may be used alone or in combination with chemotherapy, particularly in refractory or relapsed cases.

Side effects can include diarrhea, liver issues, high blood pressure, blood clotting problems, fatigue, and mouth sores.

Immunotherapy

Immunotherapy helps the immune system identify and destroy cancer cells by preventing them from hiding. It may be combined with other treatments or used when lymphoma returns after treatment.

Possible side effects include fever, chills, fatigue, nausea, and, rarely, allergic reactions.

Bone marrow transplant

A bone marrow, or stem cell, transplant replaces damaged bone marrow with healthy stem cells from your body (autologous) or a donor (allogeneic). It is typically used for relapsed or treatment-resistant lymphoma, following high-dose chemotherapy.

Short-term side effects can include fatigue, nausea, and mouth sores. Long-term effects may involve infertility, organ damage, secondary cancers, or bone weakness.

Clinical trials

Clinical trials explore new treatments and combinations that may improve outcomes for Hodgkin lymphoma. These trials may offer access to cutting-edge therapies, although side effects might not be fully known.

Monitoring after treatment

After treatment, regular follow-up visits are crucial to check for relapse. This may involve blood tests, imaging scans, or biopsies if new symptoms arise.

Side effects of treatment

Treatments for Hodgkin lymphoma can cause various side effects, including:

• Nausea, vomiting, fatigue, and fever

• Diarrhea, rash, and infection

Severe side effects may include:

• Bone marrow suppression, leading to low blood cell counts and higher infection risk

• Febrile neutropenia, where a low white blood cell count is accompanied by fever

• Medicine toxicity causing organ damage

• Reactivation of dormant viruses such as hepatitis B or C, leading to liver complications