Hodgkin lymphoma (HL) is a cancer of the lymph nodes and lymphatic tissue. HL happens when infection-fighting cells in the lymph nodes begin to grow out of control. It affects the immune system and is a “blood cancer”.

There are two types of HL: classical and nodular lymphocyte-predominant.

There are four subtypes of Classical Hodgkin lymphoma:

Nodular sclerosing (70%).
Mixed cellularity (20-25%).
Lymphocyte-depleted (5%).
Lymphocyte-rich (<1%).

Classical Hodgkin lymphoma makes up about 95% of all cases, while nodular lymphocyte-predominant (NLP) Hodgkin lymphoma is quite rare. The type of Hodgkin lymphoma you have is determined by a pathologist, who tests a piece of tissue of the involved node(s).

Pathologists look for a particular abnormal cell known as a Reed-Sternberg cell (also known as an "owl's eye" cell) to diagnose classic Hodgkin lymphoma.
Pathologists look for a "popcorn" cell to diagnose NLP Hodgkin lymphoma.

It is important to know if you have classical Hodgkin or NLP because are treated differently.

Risks

The cause of HL is not known, but there are some known risks:

Having had the Epstein-Barr virus.
Family history of HL.
Use of some pesticides and herbicides.
Immune system depression from organ/bone marrow transplant, inherited immune deficiencies, and infections, including HIV.

Screening

There are no screening tests for HL.

Signs of HL

The first sign of HL is often swelling of the lymph nodes. HL commonly affects the nodes in the neck, causing neck swelling. It can also cause swelling in the underarm, upper chest, belly, and groin. Other signs of HL are:

Fever.
Night sweats.
Weight loss.
Fatigue.
Itchy Skin.

Diagnosis of HL

If your healthcare provider thinks you have HL, they will do a health history and exam. A biopsy will be done of the swollen lymph node, removing some cells or the whole lymph node.

Other tests that may be done to see the cancer are:

Blood tests.
Chest x-ray.
CT scan or MRI of the chest, abdomen (belly), and pelvis.
PET scan.
Bone marrow biopsy.

Staging HL

Staging for HL is done based on the Ann Arbor staging system (Cotswold modification), which ranges from stages I through IV. Stage I is the least involved and stage IV is the most involved. Stages I and II are divided into two groups: favorable and unfavorable.

Stage I: One lymph node is involved.
Stage II: Two or more lymph node regions on the same side of the diaphragm are involved, or one lymph node region plus a nearby area or organ are involved. This is called locally advanced disease.
Stage III: Lymph nodes above and below the diaphragm are involved, or one node and one organ on opposite sides of the diaphragm are involved. This is called advanced disease.
Stage IV: The disease has spread outside the lymph nodes and spleen into one or more areas of the body including the bone, bone marrow, skin, and organs. This is called widespread disease.

Letters E, S, B, A, and X can be added to each stage to provide more information on the stage.

E means that there are HL cells in organs or tissues outside the lymphatic system.
S means HL cells are in the spleen.
A means that you have symptoms like fever, weight loss, and night sweats and B means that you don’t.
X may be used as part of your staging if you have what is called Bulky Disease (a tumor in the chest that is at least 1/3 as wide as the chest).

Treatment

HL treatment is chosen by the type of HL, the stage, and your health. Your plan may include more than one type of treatment.

Chemotherapy is the use of medications to treat the cancer.
Radiation uses high energy rays (similar to x-rays) to kill cancer cells in a targeted, small area of the body.
Stem cell transplants use a patient’s own, or another person’s bone marrow or stem cells to help the patient recover after high doses of chemotherapy.

This article is a basic guide to HL. You can learn more about HL diagnosis and treatment by using the link below.

Hodgkin Lymphoma: Staging and Treatment