Hodgkin Lymphoma

Hodgkin lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections.

The lymphatic system includes:

  • Lymph — Fluid containing lymphocyte cells.
  • Lymph vessels — Thin tubes that carry lymph fluid throughout the body.
  • Lymphocytes — White blood cells that fight infection and disease.
  • Lymph nodes — Bean-shaped organs, found in the underarm, groin, neck, chest, and abdomen, that act as filters for the lymph fluid as it circulates through the body.

Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection and cause swelling in the lymph nodes. Hodgkin lymphoma cells can also spread (metastasize) to other organs and tissue.

Hodgkin lymphoma accounts for a small percentage of childhood cancers. Hodgkin lymphoma occurs most often in people between the ages of 15 and 34, and in people over age 55. The disease, for unknown reasons, affects males more than twice as often as females.

What Causes Hodgkin Lymphoma?

The specific cause of Hodgkin lymphoma is unknown. It is possible that a genetic predisposition and exposure to viral infections may increase the risk for developing Hodgkin lymphoma. There is a slightly increased chance for Hodgkin lymphoma to occur in siblings and cousins of patients.

There has been much investigation into the association of the Epstein-Barr virus (EBV) which causes the infection mononucleosis; as well as with human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). Both of these infectious viruses have been correlated with a greater incidence of children diagnosed with Hodgkin lymphoma, although the direct link is unknown.

There are many individuals, however, who have infections related to EBV and HIV that do not develop Hodgkin disease.

What Are the Symptoms of Hodgkin Lymphoma?

The following are the most common symptoms of Hodgkin lymphoma. However, each child may experience symptoms differently. Symptoms may include:

  • Painless swelling of the lymph nodes in neck, underarm, groin, and chest
  • Difficulty breathing (dyspnea) due to enlarged nodes in the chest
  • Fever
  • Light sweats
  • Tiring easily (fatigue)
  • Weight loss/decreased appetite
  • Itching skin (pruritus)
  • Frequent viral infections (i.e., cold, flu, sinus infection)

The symptoms of Hodgkin's lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.

How Is Hodgkin Lymphoma Diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Hodgkin's lymphoma may include:

  • Blood and urine tests
  • X-rays of the chest
  • Lymph node biopsy — A sample of tissue is removed from the lymph node and examined under a microscope
  • Computed tomography scan of the abdomen, chest, and pelvis (also called a CT or CAT scan)
  • Positron emission tomography (PET) scan
  • Lymphangiogram (LAG)
  • Bone marrow aspiration and/or biopsy

Hodgkin Lymphoma Staging

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that are used for Hodgkin lymphoma. Always consult your child's physician for information on staging. One method of staging Hodgkin lymphoma is the following:

  • Stage I usually involves a single lymph node region or structure.
  • Stage II involves two or more lymph node regions or structures on the same side of the body.
  • Stage III involves lymph node regions or structures on both sides of the body and is further classified depending on the organs and areas involved.
  • Stage IV involves the disease in other areas (metastasis), in addition to the lymphatic system involvement

Stages are also noted by the presence or absence of symptoms of the disease:

  • Asymptomatic (A)
  • Symptomatic (B) (fever, night sweats, weight loss)

For example, stage IIIB is disease that is symptomatic, involves lymph node regions or structures on both sides of the body, and is further classified depending on the organs and areas involved.

How Is Hodgkin Lymphoma Treated?

Specific treatment for Hodgkin lymphoma will be determined by your child's physician based on:

  • Your child's age, overall health and medical history
  • The extent/stage of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Appearance of the tumor under the microscope
  • Your opinion or preference

Treatment may include (alone or in combination):

  • Chemotherapy
  • Radiation
  • Surgery
  • Bone marrow transplant (used in cases that recur or do not respond to other methods of treatment)
  • Supportive care (for pain, fever, infection, and nausea/vomiting)
  • Continued follow-up care (to determine response to treatment, detect recurrent disease, and manage side effects of treatment)

Aggressive therapy, while increasing long-term survival, also carries some serious side effects. Discuss with your child's physician a complete list of known side effects for treatment plans and therapies.

What Is the Long-term Outlook for Hodgkin Lymphoma?

Prognosis greatly depends on:

  • The extent of the disease
  • Presence or absence of metastasis
  • The response to therapy
  • Age and overall health of the child
  • Your child's tolerance for specific medications, procedures, or therapies

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis are structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with Hodgkin lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.