National Cancer Institute


Posted Date: Jul 22, 2003

TABLE OF CONTENTS


Description

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What is Hodgkin's lymphoma?

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Hodgkin's lymphoma is a type of lymphoma. Lymphomas are cancers that develop in the lymph system, part of the body's immune system.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.

Because there is lymph tissue in many parts of the body, Hodgkin's lymphoma can start in almost any part of the body. The cancer can spread to almost any organ or tissue in the body, including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), and spleen.

Lymphomas are divided into two general types: Hodgkin's lymphomas and non-Hodgkin's lymphomas. The cancer cells in Hodgkin's lymphoma look a certain way under a microscope. (Refer to the PDQ summaries on Adult Non-Hodgkin's Lymphoma Treatment and Childhood Non-Hodgkin's Lymphoma Treatment for more information.)

Adult Hodgkin's lymphoma most commonly affects young adults and people older than 55 years of age. It may also be found in patients with acquired immunodeficiency syndrome (AIDS); these patients require special treatment. (Refer to the PDQ summary on AIDS-Related Lymphoma Treatment for more information.) Hodgkin's lymphoma can also occur in children and is treated differently from that in adults. (Refer to the PDQ summary on Childhood Hodgkin's Lymphoma Treatment for more information.)

A doctor should be seen if any of the following symptoms persist for longer than 2 weeks:

  • Painless swelling of the lymph nodes in the neck, underarm, or groin
  • Fever; night sweats
  • Tiredness
  • Weight loss without dieting
  • Itchy skin

If there are symptoms, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, a doctor may need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), the size of the swollen areas, the results of blood tests, the type of symptoms, and the patient's age, sex, and overall condition.


Stage Explanation

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Stages of adult Hodgkin's lymphoma

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Once Hodgkin's lymphoma is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. A doctor needs to know the stage of the disease to plan treatment.

A doctor may determine the stage of the disease by conducting a thorough examination which may include blood tests and different kinds of x-rays. This type of staging is called clinical staging. In some cases, the doctor may need to do an operation called a laparotomy to determine the stage of the cancer. During this operation, the doctor cuts into the abdomen and carefully looks at the organs inside to see if they contain cancer. The doctor will cut out (biopsy) small pieces of tissue during the operation and look at them under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done only when it is needed to help the doctor plan treatment.

Each stage for Hodgkin's lymphoma is further divided by an A or B, based on whether there are certain symptoms called B symptoms. B symptoms include the following: loss of more than 10% of weight in the previous 6 months, fever without any known cause other than Hodgkin's lymphoma, and night sweats that leave the body soaked. For example, if a patient had stage I disease without any B symptoms, the patient would have stage IA disease; if the patient had stage I disease with B symptoms, then the patient would have stage IB disease.

The following stages are used for Hodgkin's lymphoma:


Stage I

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Cancer is found in only one lymph node area or in only one area or organ outside of the lymph nodes.


Stage II

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Either of the following means the disease is stage II:

  1. Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps us breathe).
  2. Cancer is found in only one area or organ outside of the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.


Stage III

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Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.


Stage IV

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Either of the following means the disease is stage IV:

  1. Cancer has spread in more than one spot to an organ or organs outside the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs.
  2. Cancer has spread to only one organ outside the lymph system, but lymph nodes far away from that organ are involved.


Recurrent

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Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.


Treatment Option Overview

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How adult Hodgkin's lymphoma is treated

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There are treatments for all patients with adult Hodgkin's lymphoma. Two types of treatment are used:

  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors)
  • Chemotherapy (using drugs to kill cancer cells and shrink tumors)

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for Hodgkin's lymphoma usually comes from a machine outside the body (external-beam radiation therapy). Radiation therapy given to the neck, chest, and lymph nodes under the arms is called radiation therapy to a mantle field. Radiation therapy given to the mantle field and to the lymph nodes in the upper abdomen, the spleen, and the lymph nodes in the pelvis is called total nodal irradiation. Radiation therapy may be used alone or in addition to chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Also, bone marrow transplants are being studied in clinical trials for certain patients. Bone marrow transplantation is a newer type of treatment. Sometimes Hodgkin's lymphoma becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the bones before treatment. The marrow is then frozen, and the patient is given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow is taken from another person, the transplant is called an allogeneic transplant.

Another type of autologous transplant is called a peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop), and then returns the blood to the patient. This procedure is called leukapheresis and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to the patient. This procedure may be done alone or with an autologous bone marrow transplant.

A greater chance for recovery occurs if a doctor chooses a hospital which does more than five bone marrow transplantations per year.


Treatment by stage

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Patients may be immunized with influenza, pneumonia, and meningitis vaccines both before and every few years after treatment in order to guard against infection.

Treatment of adult Hodgkin's lymphoma depends on the type and stage of the disease, and the patient's age, pregnancy status, past surgery to determine the stage of the disease, symptoms, and general health.

Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. Within 5 to 15 years after treatment, some patients develop another form of cancer as a result of their treatment; you should visit your doctor regularly to be checked for this possibility. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of adult Hodgkin's lymphoma. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


Stage I Adult Hodgkin's Lymphoma

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Treatment depends on whether the patient has stage IA or stage IB disease and where the cancer is found.


Stage IA

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If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

  1. Combination chemotherapy and radiation therapy.
  2. Combination chemotherapy alone.
  3. Radiation therapy to a mantle field and to the lymph nodes in the upper abdomen.
  4. Radiation therapy to a mantle field only, after surgery to determine the stage of the tumor.

If the cancer is above the diaphragm but involves a large part of the chest, treatment may be one of the following:

  1. Radiation therapy to a mantle field plus chemotherapy.
  2. Radiation therapy to a mantle field and to the lymph nodes in the upper abdomen.

If the cancer is below the diaphragm, treatment may be one of the following:

  1. Radiation therapy.
  2. Combination chemotherapy with radiation therapy.
  3. Clinical trials of chemotherapy alone.


Stage IB

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Treatment may be one of the following for patients with B symptoms:

  1. Combination chemotherapy with radiation therapy.
  2. Chemotherapy alone.


Stage II Adult Hodgkin's Lymphoma

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Treatment depends on whether the patient has stage IIA or stage IIB disease and where the cancer is found.


Stage IIA

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If the cancer is above the diaphragm and does not involve a large part of the chest, treatment may be one of the following:

  1. Combination chemotherapy and radiation therapy.
  2. Combination chemotherapy alone.
  3. Radiation therapy to a mantle field and to the lymph nodes in the upper abdomen.
  4. Radiation therapy to a mantle field only, after surgery to determine the stage of the tumor.

If the cancer is above the diaphragm but involves a large part of the chest, treatment may be the following:

  • Radiation therapy to a mantle field plus chemotherapy.


Stage IIB

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Treatment may be the following for patients with B symptoms:

  • Combination chemotherapy with or without radiation therapy.


Stage III Adult Hodgkin's Lymphoma

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Treatment depends on whether the patient has stage IIIA or stage IIIB disease and where the cancer is found.


Stage IIIA

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If the cancer does not involve a large part of the chest, treatment may be one of the following:

  1. Combination chemotherapy alone.
  2. Combination chemotherapy plus radiation therapy.

If the cancer involves a large part of the chest, treatment may be:

  • Combination chemotherapy with radiation therapy.


Stage IIIB

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Treatment may be the following:

  • Combination chemotherapy with or without radiation therapy.


Stage IV Adult Hodgkin's Lymphoma

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Treatment may be the following:

  • Combination chemotherapy.


Recurrent Adult Hodgkin's Lymphoma

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The treatment depends on where the disease comes back and the treatment received before. If the treatment received before was radiation therapy without chemotherapy, chemotherapy may be given. If the treatment received before was chemotherapy without radiation therapy and the cancer comes back only in the lymph nodes, radiation therapy to the lymph nodes with or without more chemotherapy may be given. If the disease comes back in more than one area, more chemotherapy may be given or a clinical trial of high doses of chemotherapy with bone marrow or peripheral stem cell transplantation may be presented as an option.


Changes to This Summary (07/22/2003)

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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ

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PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


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