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Hodgkin lymphoma (HL) is a malignant condition (cancer) affecting a type of white blood cells called lymphocytes. Hodgkin lymphoma was formerly known as Hodgkin's disease. Unlike leukaemia, in lymphoma, the cancer cells are found in organs and tissues of the lymphatic system although rarely it can involve the bone marrow too.
The lymphatic system is a network of fine vessels, glands and channels which occur throughout the body. It also conveys nutrients and cells, and is responsible for draining fluid and waste products away from tissues, and into the blood stream to be processed. The lymphatic system is an important part of the immune system and is made up of lymph nodes and vessels and of collections of lymphocytes in other tissues.
Thomas Hodgkin was a British doctor who first described the disease now known as lymphoma. Originally, all lymphomas were called Hodgkin’s disease; now the term Hodgkin lymphoma (HL) is only used for one type of lymphoma. In Hodgkin lymphoma, a particular type of abnormal B cell called a Reed-Sternberg cell can be seen in samples of tissue. All other types of lymphoma are known as non-Hodgkin lymphoma (NHL).
Hodgkin lymphoma (HL) is separated into classical and nodular lymphocyte-predominant (NLP). There are four types of classical HL which differ in symptoms and causes but they are all treated in effectively the same way. There are few or no Reed-Sternberg cells in NLP HL and it behaves very different from classical HL.
The four types of classical HL are:
NOTE: NLP HL is rare and the information in this factsheet describes the classical form of HL.
The most common sign of Hodgkin lymphoma is a lump in the neck, armpit or groin or stomach. These are usually, but not always, painless and are often described as feeling “rubbery”.
Other common symptoms include:
In most cases of lymphoma, there is no obvious cause. There are some things which are known to be associated with a higher than average chance of developing lymphoma. These include:
It is important to understand that:
The most important test for diagnosis of HL is a biopsy of affected tissue. This may mean removing a whole abnormal lymph node (excision biopsy) or just a sample of tissue.
Other tests which may be done include:
Staging is the use of test results to show how widely the lymphoma has spread. There are four stages in the standard system used:
Stages 1-2 are known as early-stage disease and stages 3-4 are known as advanced-stage disease.
This stage description may be modified by adding the letters A, B, E or S:
A small number of patients who have HL do not start treatment straight away. If patients are not being treated they have regular check-ups. This is known as “watch and wait” or “active monitoring”. Almost all patients with HL will start treatment soon after diagnosis.
HL is often curable with standard treatments. HL may come back, this is known as a relapse and it can usually be treated again, using similar treatments as were used the first time.
The main ways in which HL is treated are:
Chemotherapy is the use of cell-killing drugs. These kill the cancer cells and/or stop them from dividing. Chemotherapy is usually given in blocks or ‘cycles’ of treatment. One cycle of treatment will consist of a series of doses of chemotherapy followed by a break for the healthy cells to recover.
Chemotherapy is normally given as a combination of drugs, which will usually include steroids. Steroids used to treat HL are a laboratory-made version of chemicals naturally made by the body. They are very different from the type of steroids sometimes misused by body-builders or sportsmen.
The details of your treatment will vary depending on the stage and type of your HL and your general fitness. You will be given a chance to discuss treatment options and detailed information on your treatment plan before it starts. The side effects of treatment vary between different types of treatment and different patients. You will be given detailed information about any likely side effects before you start treatment.
We understand going through a blood cancer through journey can be difficult. It may help to talk to a close friend or relative about how you are feeling. Here are some questions that may be useful to ask your doctor.