Lymphoma Education Series
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Understanding Lymphoma
Hodgkin Lymphoma
Causes and Risk Factors
Signs and Symptoms
Diagnosis and Staging
Treatment
Treatment Side Effects
Follow-up Care
Clinical Trials
Talking to the Specialist
Get More Information
Contact Us
Understanding Lymphoma
Lymphoma is the name for a group of blood cancers. Hodgkin lymphoma and non-Hodgkin lymphoma (NHL) are the two main types of lymphoma.
In 2009, about 601,180 people are living with lymphoma or are in remission. This number includes about 148,460 people with Hodgkin lymphoma and about 452,720 people with non-Hodgkin lymphoma. It is estimated that Hodgkin lymphoma will represent 11.4 percent of all types of lymphoma diagnosed in 2009.
Lymphoma originates in the lymphatic system. The lymphatic system is part of the body's immune system, which is the body's defense against infection. The marrow and lymphocytes are part of the immune system. Some other parts of the immune system are the lymph nodes, the lymphatic vessels and the spleen.
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Hodgkin Lymphoma
Hodgkin lymphoma is one of the most curable forms of cancer. It can be cured in about 75 percent of all patients. It is most likely to be diagnosed in people in their twenties or thirties. It is less common in middle age and becomes more common again after age 60.
Hodgkin lymphoma is distinguished from other types of lymphoma by the presence of Reed-Sternberg cells (named for the scientists who first identified them). Other cells associated with the disease are called Hodgkin cells.
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Causes and Risk Factors
Lymphoma starts with a change to a lymphocyte. The change to the lymphocyte causes it to become a lymphoma cell. The lymphoma cells pile up and form masses that gather in the lymph nodes or other parts of the lymphatic system.
Doctors don't know what causes most cases of Hodgkin lymphoma. Most cases occur in people who do not have identifiable risk factors. However, a few risks factors are associated with Hodgkin lymphoma:
A history of confirmed infectious mononucleosis confers a threefold increased risk of developing young-adult Hodgkin lymphoma compared to the risk incurred by the general population.
People infected with human T-cell lymphocytotropic virus (HTLV) or human immunodeficiency virus (HIV) also have an increased probability of developing Hodgkin lymphoma.
There are occasional cases of familial clustering, as with other cancers, and there is an increase in the incidence of Hodgkin lymphoma in siblings of patients with the disease. These cases are uncommon, but doctors are studying why there is a higher incidence of lymphoma for some families.
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Signs and Symptoms
The most common sign of Hodgkin lymphoma is one or more enlarged (swollen) lymph nodes. The enlarged lymph node is usually painless and may be in the neck, upper chest, armpit, abdomen or groin.
Signs and symptoms of Hodgkin lymphoma may include
- Swollen lymph nodes
- Cough and shortness of breath
- Fever
- Night sweats
- Tiredness
- Weight loss
Itchy skin.
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Diagnosis and Staging
Having the correct diagnosis is important for getting the right treatment. Some patients may need to get a second medical opinion about the diagnosis before they begin treatment. Talk to the doctor about the tests used to make the diagnosis.
Doctors do a test called a lymph node biopsy to determine if a patient has Hodgkin lymphoma. To do the biopsy, a surgeon removes all or part of an enlarged lymph node. The lymph node is examined under a microscope by a pathologist.
The diagnosis of Hodgkin lymphoma can be difficult and often requires an experienced pathologist to analyze the biopsy slides. It may be important to get another opinion about the biopsy results from a second pathologist if there is any doubt about the diagnosis.
Sometimes, immunophenotyping can be used to help distinguish Hodgkin lymphoma from other types of lymphoma or other non-cancerous conditions. The pathologist looks for the presence of Reed-Sternberg cells and Hodgkin cells to confirm the diagnosis of Hodgkin lymphoma.
The doctor will do other tests to see how widespread the disease is. This is called staging. The tests for staging include
- Blood tests - to check red cell, white cell and platelet counts; blood tests are also done to check for other signs of disease
- Bone marrow tests (bone marrow aspiration and bone marrow biopsy) - to look for Hodgkin lymphoma cells in the marrow.
- Imaging tests - to create pictures of the chest and abdomen and see if there are lymphoma masses in the lymph nodes, liver, spleen or lungs. Examples of imaging tests are
- Chest x-ray
- CT (computed tomography) scan
- MRI (magnetic resonance imaging)
- PET (positron emission tomography) scan.
Staging provides important information for treatment planning. The blood tests, bone marrow tests and imaging tests help the doctor to evaluate
- The location and distribution of lymph node enlargement
- Whether organs other than lymph nodes are involved
- Whether there are very large masses of tumors in one site or another.
Hodgkin Lymphoma Stages
Stage I - Hodgkin lymphoma is in just one lymph node region or a single organ.
Stage II - Hodgkin lymphoma is in two or more lymph node regions that are near each other and on the same side of the diaphragm. For example, the lymphoma is in the upper body regions (neck, chest and armpit) or the lymphoma is in the lower body regions (abdomen and groin).
Stage III - Hodgkin lymphoma is in two or more lymph node regions above and below the diaphragm such as the neck, chest and abdomen.
Stage IV - Hodgkin lymphoma is widespread in the lymph nodes and other parts of the body, such as the lungs, liver or bone.
Patients are also divided into either "A" or "B" categories.
- "A" patients don't have fever, excessive sweating and weight loss.
- "B" patients have fever, a lot of sweating and weight loss. Patients in the B category often require more aggressive treatment.
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Treatment
Hodgkin lymphoma can be cured in about 75 percent of all patients. The cure rate in younger patients is about 90 percent.
A patient with Hodgkin lymphoma is usually treated by a doctor called a hematology oncologist. It is important to get treatment in a center where doctors are experienced in the care of patients with Hodgkin lymphoma. Some patients may want to get a second medical opinion.
There are different types of Hodgkin lymphoma. Talk to your doctor about the type of Hodgkin lymphoma that you have and your treatment choices.
Factors that may affect treatment include
- The type of Hodgkin lymphoma
- The stage and category of the disease
- Disease that has not responded to treatment
- Disease that has come back after treatment
- Other medical problems, such as a very low red cell count (anemia), diabetes mellitus, heart or kidney disease.
Combination chemotherapy along with "involved field radiation therapy" is the most common treatment. Involved field radiation therapy uses high-energy rays to target the Hodgkin lymphoma cells. Other parts of the body are protected to reduce harm to healthy cells.
Chemotherapy without radiation therapy may be the treatment for patients with widespread Hodgkin lymphoma and fever, night sweats or weight loss. Chemotherapy is given in cycles, usually several weeks apart. A number of cycles are needed. The treatment may last from six to ten months. It is outpatient treatment for most patients. Some patients may have to stay in the hospital for a short time - if they develop a fever or have other signs of infection. Some patients who need antibiotics may stay in the hospital until the infection is gone.
High doses of chemotherapy may also kill normal blood-forming cells in the marrow. Chemotherapy may cause very low counts of red cells, white cells or platelets. Some patients may need a blood transfusion or drugs called "blood cell growth factors" until the side effects of chemotherapy wear off. Examples of red cell growth factors are Aranesp® (darbepoetin alfa) and Procrit® (epoetin alfa). These can increase red cell counts.
Hodgkin lymphoma affects the body's ability to fight infection. Chemotherapy and radiation can add to the problem. Good treatment and following the doctor's advice will help lower the risk of infection. White cell growth factors may be part of treatment. Neupogen® or Neulasta® (also called "G-CSF") and Leukine® (also called "GM-CSF") can increase the number of neutrophils (white cells).
Autologous Stem Cell Transplantation
Hodgkin lymphoma patients who have high-dose chemotherapy may also need an autologous stem cell transplant. The patient's own cells are used in this type of transplant.
The goal of autologous stem cell transplantation is to help the body start a new supply of blood cells after high-dose chemotherapy. With an autologous transplant
- The patient's own stem cells are collected from the patient's blood or marrow and stored after the first cycles of drug therapy are completed.
- Then, the patient is given high-dose chemotherapy to kill the lymphoma cells. This treatment also kills normal stem cells in the marrow.
- Next, the stem cells collected before chemotherapy are infused back into the patient's blood through a central line.
This treatment is not a good choice for all lymphoma patients. The decision to have an autologous transplant depends on a number of factors, such as what other good treatment choices the patient may have and the patient's physical ability to have a stem cell transplant.
Relapsed Hodgkin Lymphoma
In some patients, Hodgkin lymphoma may come back (called a recurrence or relapse). The doctor will treat these patients again with chemotherapy. The treatment often gives patients very long disease-free periods.
Childhood Hodgkin Lymphoma
Children and teens with Hodgkin lymphoma should be treated at medical centers that have a pediatric oncology team.
It is important for young adults and parents of children to talk to members of the oncology team about the
- Stage of the disease
- Type of Hodgkin lymphoma
- Lab test results.
Doctors use this information about the patient's disease in order to determine the most effective therapy. Children and young adults with Hodgkin lymphoma are usually treated with combination chemotherapy, sometimes with the addition of radiation therapy to increase local control of the disease.
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Treatment Side Effects
There are many possible side effects of treatment for Hodgkin lymphoma. Patients react to treatment in different ways. Most side effects are mild and last only a short time. Other side effects may be serious or last a long time. When side effects occur, most
- Can be helped with treatment
- Do not last long
- Clear up when treatment ends.
The number of red cells may decrease (anemia) in patients treated with chemotherapy. Blood transfusions or growth factors to increase red cells may be needed. Aranesp and Procrit are drugs that might be given to increase the red cell count.
A severe drop in white cells may lead to an infection. Infections caused by bacteria or fungi are treated with antibiotics. To help a patient's white cell count to improve
- The amount of chemotherapy drugs may be reduced.
- The time between treatments may be increased.
- Growth factors such as Neupogen, Neulasta and Leukine may be given to increase the number of neutrophils.
Some common side effects of treatment for Hodgkin lymphoma are
- Mouth sores
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Bladder irritation
- Blood in the urine.
Other side effects of treatment may include
- Extreme tiredness
- Fever
- Cough
- Rash
- Hair loss
- Weakness
- Tingling sensation
- Lung, heart or nerve problems.
Talk to your doctor about the possible side effects of your treatment. You can also call the Information Resource Center.
Long-Term and Late Effects
Patients should talk with their health care providers about any possible long-term effects or late effects of treatment. Cancer-related fatigue is one type of long-term effect.
Fertility (the ability to conceive a baby) may be affected by treatment in both men and women. Patients who are concerned about fertility should talk to their doctors about this before treatment begins. For example, men who plan to have children in the future may want to consider banking sperm before starting treatment. If a couple's ability to have children is not affected by treatment, their chance of having a healthy baby is the same as that of the general population.
For more information, you can view, print or order the LLS free booklet, Understanding Drug Therapy and Managing Side Effects, and the free fact sheets, Cancer-Related Fatigue Facts, Long-Term and Late Effects of Treatment for Childhood Leukemia or Lymphoma, and Long-Term and Late Effects of Treatment in Adults.
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Follow-up Care
Regular medical follow-up for Hodgkin lymphoma survivors enables doctors to assess the effects of therapy, identify recurrence of the disease and detect long-term or late effects. Survivors of Hodgkin lymphoma are advised to
- Keep a record of the treatments received.
- Get blood tests every 5 years to measure cholesterol levels if they were treated with chest radiation.
- Have regular screening for heart disease.
- Have regular screening for cancer. Cancers of the breast, lung, stomach, bone and soft tissues have been reported as soon as 5 years after initial therapy.
- Practice breast self-examination, have early baseline mammograms (within 10 years after therapy or by age 25) and repeat mammograms every two to three years if treated with chest radiation for childhood or adult Hodgkin lymphoma.
- Have regular lung cancer screening if treated with chest radiation. Smoking further increases the risk of lung cancer and several other types of cancer including acute myelogenous leukemia and myelodysplastic syndromes.
- Have regular thyroid function check-ups.
- Seek medical and psychosocial support for fatigue, depression and other long-term effects if needed.
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Clinical Trials
Clinical trials are used to study new drugs, new treatments or new uses for approved drugs or treatments. Doctors are testing new drugs and new combinations of drugs in clinical trials to treat all types of lymphoma. A growing number of clinical trials include older adults.
There are clinical trials for
- Newly diagnosed Hodgkin lymphoma patients
- Patients who do not get a good response to treatment
- Patients who relapse after treatment
- Patients who continue treatment after remission (maintenance).
Some clinical trials test new ways to use drugs that are already approved. For example, changing the amount of the drug or giving the drug along with another type of treatment might be better. Ask your doctor if treatment in a clinical trial is right for you. You can also call the Information Resource Center for information about clinical trials; or use the free LLS clinical trials service.
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It is important to choose a doctor who specializes in treating Hodgkin lymphoma and who knows about the most up-to-date treatments. This type of specialist is usually called a "hematology oncologist." Or your local cancer specialist can work with a Hodgkin lymphoma specialist.
You can talk with your doctor about how he or she plans to treat your Hodgkin lymphoma. This will help you to be actively involved in your care and to make decisions. It may be helpful to write down questions to ask your doctor. You can also write down or record your doctor's answers and review them later. You may want to bring a family member or friend with you to the doctor. This person can listen, take notes and offer support.
Click here for more information on discussing treatment options and other concerns with your specialist.
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The Leukemia & Lymphoma Society (LLS) offers ongoing education programs featuring leading lymphoma specialists discussing the latest issues in the diagnosis and treatment of lymphoma. Visit the Lymphoma Education Series page to find out about upcoming and archived programs. These programs are offered at no charge.
You can also view, print or order the following free LLS booklets
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Contact Us
For more information, contact:
The Leukemia & Lymphoma Society
1311 Mamaroneck Ave.,
White Plains, NY 10605
Or call the Information Resource Center at (800) 955-4572.
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