Hodgkin lymphoma, also known as Hodgkin’s disease, is a type of cancer that originates in white blood cells called lymphocytes, which are part of the lymphatic system. The lymphatic system is a network of vessels and nodes that extends throughout the body and helps fight infections and diseases. In Hodgkin lymphoma, diseased lymphocytes grow abnormally and spread throughout the body, affecting the lymph nodes, spleen, liver, bone marrow, and other organs.
Symptoms of Hodgkin lymphoma
Hodgkin lymphoma can manifest with a variety of symptoms, some subtle at first. It is important to note that these symptoms can be common in other less serious diseases, so their presence does not necessarily imply a diagnosis of Hodgkin lymphoma. The most common symptoms are:
Painless swelling of the lymph nodes:
in the neck, armpits, or groin. This is often the first sign of the disease.
Persistent fatigue:
extreme tiredness that does not improve with rest.
Fever:
without apparent cause, which can come and go.
Night sweats:
excessive sweating during the night.
Unexplained weight loss:
without changes in diet or exercise.
Itchy skin:
it can be generalized or localized.
Persistent cough or difficulty breathing:
if the lymphoma affects the lymph nodes in the chest.
Pain in the lymph nodes:
after consuming alcohol, although this symptom is less common.
Classification of Hodgkin lymphoma
There are two main types of Hodgkin lymphoma:
Classic Hodgkin lymphoma: it is the most common type and is subdivided into four subtypes, according to the characteristics of the cancer cells:
Nodular sclerosis: it is the most common subtype, accounting for between 60% and 80% of cases. It is characterized by the presence of bands of fibrous tissue (sclerosis) that divide the lymph node into nodules. Reed-Sternberg cells are often variants called “lacunar cells,” which appear to have a clear halo around them due to cytoplasmic retraction during sample processing. It generally has a good prognosis, responding well to treatment.
Mixed cellularity: it represents between 15–30% of cases. It shows a diverse mixture of inflammatory cells, including lymphocytes, eosinophils, neutrophils, and histiocytes, along with classic Reed-Sternberg cells. It does not show the sclerosis bands of the previous subtype. The prognosis is generally favorable, although slightly lower than that of nodular sclerosis.
Lymphocyte-rich: it is the least common type, accounting for about 5% of cases. It is characterized by an abundance of small lymphocytes and a relatively small number of Reed-Sternberg cells. It has a favorable prognosis, with high cure rates in early stages.
Lymphocyte-depleted: it is the least frequent and most aggressive subtype, representing less than 1% of cases. It is characterized by a scarcity of lymphocytes and a higher proportion of Reed-Sternberg cells, often with atypical characteristics. It can present in two forms: one with diffuse sclerosis and the other with diffuse cellularity. It has the most unfavorable prognosis of the four subtypes, with a higher risk of progression and relapse.
Nodular lymphocyte-predominant Hodgkin lymphoma: it is less common and generally has a good overall prognosis.
Causes of Hodgkin lymphoma
Although the exact cause of Hodgkin lymphoma is unknown, certain factors are believed to increase the risk of developing it, such as Epstein-Barr virus (EBV) infection and a weakened immune system.
Although the cause of Hodgkin lymphoma is unknown, there are some factors that may increase the risk of developing this disease. It is important to note that the presence of these risk factors does not necessarily mean that a person will develop Hodgkin lymphoma, and many people with these factors never develop it. Some of the most commonly recognized risk factors include:
Epstein-Barr virus (EBV) infection: EBV, which causes infectious mononucleosis, has been linked to an increased risk of Hodgkin lymphoma.
Weakened immune system: people with weakened immune systems, such as those with HIV or who have received an organ transplant, have a higher risk.
Family history: having a close relative with Hodgkin lymphoma may slightly increase the risk.
Age: Hodgkin lymphoma is more common in young people between the ages of 15 and 30 and in adults over 55 years of age.
Diagnosis of Hodgkin lymphoma
The diagnosis of Hodgkin lymphoma is a process that begins with clinical suspicion based on the patient’s symptoms, such as swollen lymph nodes. To confirm the diagnosis and determine the extent of the disease, the following tests are performed:
1. Lymph node biopsy: this is the fundamental test for diagnosis. A whole lymph node or part of it is removed for laboratory analysis. The pathologist examines the sample under the microscope looking for the presence of Reed-Sternberg cells, which are characteristic of Hodgkin lymphoma. There are different types of biopsy:
Excisional biopsy: the entire lymph node is removed. It is the most widely used method, as it provides the most complete sample for analysis.
Incisional biopsy: only part of the lymph node is removed. It is performed when complete removal is difficult or risky.
Core needle biopsy (CNB): a sample of cells is extracted from the lymph node using a thick needle (trucut). It is less invasive, but may not provide enough tissue for a definitive diagnosis.
At HM Hospitales, we perform image-guided lymph node biopsies (ultrasound or CT scan) to ensure accuracy and minimize discomfort during the procedure.
2. Blood tests: blood tests are performed to assess the patient’s overall health, including a complete blood count, biochemistry, and liver and kidney function tests. These tests can also help detect tumor markers, although they are not specific to Hodgkin lymphoma.
3. Imaging tests: imaging tests are crucial for determining the extent of the disease (staging) and planning treatment. The most common tests are:
Computerized Tomography (CT scan): it provides detailed images of the body, allowing visualization of affected lymph nodes and possible involvement of other organs.
Magnetic Resonance Imaging (MRI): it offers high-resolution images, especially useful for assessing the involvement of the central nervous system and bone marrow.
Positron Emission Tomography (PET): it allows for the detection of the metabolic activity of cancer cells, helping to identify areas of active disease and to evaluate the response to treatment.
Chest X-ray: it can show involvement of the lymph nodes in the mediastinum, the area between the lungs.
4. Bone marrow aspiration and biopsy: this procedure is performed to determine if the disease has spread to the bone marrow. A bone marrow sample is taken from the hip for analysis in the Pathology, Cytometry and Hematology laboratory.
5. Staging assessment: once the diagnosis is confirmed, an assessment of the stage of the disease is carried out. The stage describes the extent of the lymphoma in the body. The Ann Arbor staging system is the most widely used and is based on the involvement of lymph nodes and other organs. It can be classified into four stages depending on whether lymph nodes above and/or below the diaphragm muscle are affected or if other organs are affected. The presence of B symptoms (fever, night sweats, and weight loss) is also considered in staging.
Treatment of Hodgkin lymphoma
The treatment of Hodgkin lymphoma is individualized based on the stage of the disease, the histological subtype, the patient’s age, overall health, and other factors. The main treatment modalities are:
Chemotherapy: it is the main treatment for most patients with Hodgkin lymphoma. Combinations of medications are used to destroy cancer cells. These medications are administered in cycles, with rest periods to allow the body to recover.
Radiotherapy: radiotherapy uses high-energy radiation to destroy cancer cells. It can be used alone or in combination with chemotherapy. Radiotherapy can be directed to specific areas of the body where the lymphoma is located. There are different radiotherapy techniques, which are selected based on the location and extent of the disease. At HM Hospitales, we have advanced radiotherapy technology, which allows us to administer precise doses of radiation to the affected areas, minimizing damage to surrounding healthy tissues.
Stem cell transplantation: stem cell transplantation, also known as bone marrow transplantation, is used in some cases of recurrent or refractory Hodgkin lymphoma. This procedure allows for the administration of higher doses of chemotherapy, which may be necessary to control the disease, but which can also damage the bone marrow. Stem cell transplantation helps restore bone marrow function. There are two main types of transplants:
Autologous transplantation: the patient’s own stem cells are used.
Allogeneic transplantation: stem cells from a compatible donor are used.
Targeted therapy: targeted therapy uses drugs that specifically target cancer cells, minimizing damage to healthy cells.
Immunotherapy: immunotherapy stimulates the patient’s immune system to attack cancer cells. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, are examples of immunotherapies used in the treatment of Hodgkin lymphoma. In some cases, brentuximab, a monoclonal antibody directed against diseased cells in Hodgkin lymphoma, may be used.
Early diagnosis and treatment of Hodgkin lymphoma are essential to improve the chances of a cure. The earlier lymphoma is diagnosed and treated, the greater the likelihood of successful treatment.
The care of patients with Hodgkin lymphoma often involves a multidisciplinary team of specialists, which may include hematologists, oncologists, radiation therapists, specialized nurses, and other health professionals. This comprehensive approach ensures that patients receive the best possible care.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have Hodgkin lymphoma, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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