Hodgkin’s Lymphoma

Hodgkin’s Lymphoma is a disease of the lymph system.  The lymph system is a part of the immune system. This disease is caused by irregular cells in the lymph system.  The irregular cells do not grow like normal lymph cells.
In 2018, the estimated number of new Hodgkin’s Lymphoma cases was 8,500 in the US. In the US, 86.6% of patients survive after 5 years or more of being diagnosed with Hodgkin’s lymphoma. This means out of 100 patients with Hodgkin’s Lymphoma, about 87 patients have survived the disease for 5 years or more.
Risk Factors
The things that raise the chances of having Hodgkin's lymphoma include:

• Age. Hodgkin's lymphoma happens more in patients between the ages of 15 and 30 years. It also occurs more frequently in those over 55 years old.
  
• Family history of Hodgkin's lymphoma. Those with blood relatives who have Hodgkin's have an increased risk of having the disease.
  
• Gender. Male patients have a somewhat higher chance of having Hodgkin's lymphoma compared to women.
  
• Previous illness from the Epstein-Barr virus (EBV). Patients who have a history of the virus have an increased risk of having Hodgkin’s lymphoma compared to people with no history of the virus.
  

Symptoms
Symptoms of Hodgkin’s Lymphoma include: swelling lymph nodes in the neck-groin or underarm, constant feeling of tiredness, increases in temperature, sweating at night, unplanned loss of weight, irritated and scratchy skin, effects of alcohol are more pronounced, and pain after alcohol consumption near lymph nodes.
 
Diagnosis
Based on a patient’s personal/familial medical history, a doctor may conduct tests to establish if there is a diagnosis of Hodgkin's lymphoma.

• A physical checkup. A doctor will look for swollen lymph nodes in the neck, armpits or groin. The doctor will also look for an enlarged liver or spleen.
  
• Lab tests.  A small vial of blood may be taken. A laboratory will look at a patient’s blood and look for signs of cancer.
  
• Diagnostic imaging. A doctor will use machines/techniques to see what is going on inside a patient’s body.  These techniques include X-ray, CT and positron emission tomography.
  
• Lymph node biopsy. A piece of lymph node will be removed from the body to help find out information about the disease.  
  
• Bone marrow biopsy.  A sample of bone marrow is collected from the hip bone. The sample is used to find Hodgkin’s lymphoma cells.
  

Treatment for Hodgkin’s Lymphoma

• Chemotherapy. These are drugs that reach most parts of the body. They are used to kill the lymphoma cells. These drugs can be used in combination with radiation or by itself. The drugs are taken as pills or injections.
  
• Radiation therapy. This is a release of energy in the form of waves or particles. This energy injures cancer cells and prevents them from growing. Examples of this therapy this include X-rays and protons.
  
• Bone marrow transplant. Bone marrow transplant/ stem cell transplant.  This is when abnormal or unhealthy bone marrow is substituted by hardy and healthy cells. This is a possible treatment if the lymphoma returns after chemotherapy/radiation therapy.
  

Before a transplant there are a few steps that are taken.  Progenitor or stem blood cells are collected. Chemotherapy or radiation is then used to kill off the sickly cells. The healthy stem cells are then injected back into the body and help to recreate healthy bone marrow cells.      

• Additional drug treatment (targeted therapy and immunotherapy). Targeted therapy concentrates on distinctive weakness in the lymphoma cells. Immunotherapy uses the patient’s own immune system to destroy the cancer cells. If other treatments do not work there may be lab testing to look for genetic mutations or weakness in the cancer cells. This will help the doctor pick out the right targeted therapy or immunotherapy.
  

References:
“Cancer Stat Facts: Hodgkin Lymphoma.” National Institutes of Health National Cancer Institute, 2019, https://seer.cancer.gov/statfacts/html/hodg.html .
“Hodgkin's lymphoma (Hodgkin's disease).” Mayo Foundation for Medical Education
and Research, 2019.
https://www.mayoclinic.org/diseases-conditions/hodgkins-lymphoma/symptoms-causes/syc-20352646.

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