Hodgkin’s Lymphoma – Diagnosis and Treatment
Diagnosis
Doctor’s Exam and Medical History
At the start, a health professional asks about symptoms like swollen lymph nodes, fever, fatigue, night sweats, and weight loss.
They gather detailed health and family history to identify potential risk factors like Epstein-Barr virus (EBV), immune system issues, or family cancer history.
During the physical exam, the doctor checks for swelling in lymph nodes in the neck, underarm, and groin. The spleen, liver, and tonsils might also be checked for abnormal size or tenderness.
Blood Work and Lab Analysis
Blood tests help doctors check general health and find signs of lymphoma. A complete blood count (CBC) measures red and white blood cells, as well as platelets.
Doctors also look at levels of lactate dehydrogenase (LDH) and erythrocyte sedimentation rate (ESR) to reveal inflammation or organ involvement. These results, along with signs like B symptoms (fever, weight loss, and night sweats), guide further testing.
Sampling Lymph Node Tissue
Doctors diagnose Hodgkin lymphoma primarily through a biopsy. Usually, they remove a whole lymph node or a large section (excisional biopsy), though sometimes they use a core needle biopsy.
Key points:
- Doctors study the tissue sample under a microscope for Reed-Sternberg cells, which are unique to Hodgkin lymphoma.
- Further testing can help identify the specific subtype, such as nodular sclerosis, mixed cellularity, lymphocyte-rich, or lymphocyte-depleted.
- Sometimes doctors perform biopsies on other tissues, like the liver, if the disease has spread.
Scans and Imaging to Detect Disease
Doctors often use imaging tests to understand the spread of lymphoma. Common tests include:
| Test | Purpose |
|---|---|
| Chest X-ray | Checks for enlarged lymph nodes or masses in the chest |
| CT scan | Looks for affected nodes and organs in the body |
| MRI | Useful for brain and spinal assessments |
| PET/CT scan | Shows both the size and activity of lymphoma cells |
Imaging helps doctors detect adenopathy (swollen lymph nodes), spleen, liver, and thymus involvement, and stage the disease.
Collecting Bone Marrow Samples
If cancer spread is suspected, doctors perform a bone marrow aspiration and biopsy. They remove a small amount of bone marrow, usually from the hip bone, to check for lymphoma cells. Bone marrow involvement can affect treatment choices and prognosis.
How Stages Are Determined
Doctors use the Lugano classification to assign a stage from 1 to 4:
- Stage 1: One lymph node area or organ is involved.
- Stage 2: Two or more areas on the same side of the diaphragm are involved.
- Stage 3: Lymph nodes on both sides of the diaphragm are affected.
- Stage 4: Spread to distant organs, such as the bone marrow, liver, or lungs.
Each stage gets an “A” or “B” based on symptoms. “A” means no B symptoms. “B” means fever, night sweats, or weight loss are present.
Treatment
Medicines That Destroy Cancer (Chemotherapy)
Chemotherapy serves as a main treatment for Hodgkin lymphoma. It uses powerful drugs designed to attack and kill cancer cells throughout the body. Doctors often begin with this approach because it can treat both early and advanced stages of lymphoma.
Doctors may use chemotherapy alone or combine it with other methods like radiation or targeted treatments. They administer the drugs through a vein (IV) or as pills, depending on the specific type and treatment plan.
Common chemotherapy combinations for Hodgkin lymphoma include ABVD, BEACOPP, and Stanford V. Each combination is chosen based on the cancer’s features and how the patient is responding to treatment.
Side effects are common. Patients might experience tiredness, nausea, vomiting, hair loss, or an increased risk of infections.
Some long-term risks include heart or lung problems, fertility concerns, or even a higher chance of getting other cancers in the future. Doctors watch closely for both short- and long-term side effects.
| Chemotherapy regimens | Used for |
|---|---|
| ABVD | Standard Hodgkin lymphoma |
| BEACOPP | Advanced or high-risk cases |
| Stanford V | Some advanced Hodgkin lymphoma |
| CHOP | Primarily for non-Hodgkin lymphoma |
Focused Energy Treatment (Radiation Therapy)
Radiation therapy treats cancer by aiming high-energy beams at specific areas where lymphoma cells are found. This method targets the cancer without affecting the whole body.
Most patients receive radiation in addition to chemotherapy, especially for early-stage Hodgkin lymphoma or if the disease is in one area.
Treatment sessions usually take place a few times a week for several weeks. The machine moves around the patient, focusing energy onto affected lymph nodes or nearby areas.
Possible side effects include tiredness and red, irritated skin in the treated location.
The risks also depend on where the beams are directed—such as cough or breathing problems if the chest is targeted, or thyroid issues if the neck receives radiation.
Doctors work to use the lowest dose needed to keep side effects as small as possible.
Restoring Healthy Blood Cells (Bone Marrow Stem Cell Transplant)
Doctors use a bone marrow transplant, or stem cell transplant, when Hodgkin lymphoma doesn’t respond well to other treatments or comes back after earlier therapy (called refractory or relapsed Hodgkin lymphoma).
This method lets doctors use very strong doses of chemotherapy and sometimes radiation to destroy as many cancer cells as possible.
Types of transplants:
- Autologous Stem Cell Transplant: Doctors use the patient’s own cells—commonly used for Hodgkin lymphoma.
- Allogeneic Stem Cell Transplant: Doctors use donor cells—less common, for certain advanced cases.
Here’s how the process works:
- Doctors remove stem cells from the patient (autologous transplant) or a donor (allogeneic transplant).
- The patient receives very high doses of chemotherapy and sometimes radiation.
- Doctors give the stem cells back through an IV, like a blood transfusion, so they can start making new blood cells.
There is a higher risk of infections until the stem cells begin to work. Patients also need close monitoring for other side effects like bleeding and organ damage.
Medicine Targeting Cancer’s Weak Spots (Targeted Therapy)
Targeted therapy works by blocking certain chemicals or pathways that cancer cells need to survive and grow. These medicines look for specific proteins or weak spots unique to Hodgkin lymphoma cells.
Unlike chemotherapy, they are designed to spare healthy cells when possible.
Brentuximab vedotin is a targeted therapy commonly used for Hodgkin lymphoma. It attaches to CD30, a protein found on cancer cells, and helps deliver medicine directly into them.
Doctors sometimes use targeted therapies if the disease comes back after other treatments, or together with chemotherapy for some types (like nodular lymphocyte-predominant Hodgkin lymphoma).
Side effects depend on the specific medicine. They may include nerve problems, low blood counts, tiredness, and infection risk.
Boosting the Body’s Defenses (Immunotherapy)
Immunotherapy uses the body’s natural defenses to fight Hodgkin lymphoma. Medicines called checkpoint inhibitors are examples. These drugs help immune cells find and attack lymphoma cells, even if the cancer is trying to “hide.”
Doctors often reserve immunotherapy for cases that have not responded to other treatments. It can also be an option for people who can’t have standard chemotherapy or radiation.
Common side effects include tiredness, rash, joint pain, diarrhea, and sometimes inflammation of organs. Doctors monitor for these side effects during treatment.
Integrative Health Approaches
There are no proven alternative medicines that cure Hodgkin lymphoma. However, integrative therapies may help manage stress and ease side effects from standard treatments.
Art therapy, exercise, meditation, music therapy, relaxation techniques, and spiritual practices are some options people may use. Always discuss any new practices with a healthcare provider before starting.
Ways to Manage and Find Support
Building a Reliable Support Network
Having people to turn to can make tough times easier. Friends, family members, and groups for people with cancer can provide much-needed comfort and advice.
Support can also come from online communities or professionals who specialize in helping those with health challenges.
Creating Achievable Personal Goals
Setting goals provides a sense of direction and purpose. It’s helpful to choose goals that match what a person can do at the time.
For example, someone might reduce their workload but continue to work part-time. Keeping goals realistic helps avoid stress and disappointment.
Taking Care of Yourself
Looking after personal health is important. Eating healthy foods, getting enough sleep, and making time to relax can all help manage stress and tiredness. Scheduling breaks and quiet time is a good way to recharge.
Keeping Up with Everyday Activities
Staying involved in activities or hobbies can improve mood and energy. If a person feels well enough, it’s encouraged to keep doing things they enjoy. Keeping active, within safe limits, supports both physical and emotional strength.
Getting Ready for Your Visit
Steps You Can Take Before Seeing the Doctor
Being well-prepared before the appointment can help make the process smoother. Here are some steps that can make things easier:
- Check for any special instructions. Ask if there are any preparations you need to do, like not eating before certain tests.
- List your symptoms. Write down all symptoms you have, even if they do not seem related.
- Note down important personal details. These could be major changes in your life or anything currently causing you stress.
- Prepare a list of all the medications and supplements you use. Include everything, such as vitamins and herbal remedies.
- Bring someone with you if possible. A family member or friend can help remember information and give support.
- Plan questions ahead of time. Write the most important questions at the top of your list.
It may be helpful to use a table like this to stay organized:
| What to Bring | Details |
|---|---|
| List of symptoms | Include all, even minor or unrelated ones. |
| Medication list | Note all prescriptions, over-the-counter meds, vitamins, etc. |
| Recent life changes | Family, work, or other situations that might affect health. |
| Questions to ask | List in priority order. |
| Support person | Someone to help remember details and ask questions. |
Some example questions patients often ask about Hodgkin lymphoma include:
- What type do I have?
- What stage is it?
- Are more tests needed?
- What are the treatment options?
- What side effects can happen?
- How will treatment affect daily life?
- Can I work during treatment?
- How long will treatment last?
- Is there a recommended specialist?
- What sources do you trust for good information?
- Will insurance cover everything?
Don’t hesitate to ask anything else that comes to mind, even if it’s not on your list.
Questions Your Healthcare Provider May Ask
Healthcare providers gather information to help them make the best decisions. Patients can expect to answer questions such as:
- When did the symptoms start?
- Are the symptoms constant or do they come and go?
- How strong or severe are the symptoms?
- Does anything make the symptoms better?
- Does anything make the symptoms worse?
- Is there a family history of cancer, especially Hodgkin lymphoma?
- Does anyone in the family have immune system problems?
- Have you had any infections before?
- Has anyone in your home or workplace been exposed to chemicals or toxins?
If you keep a record of your symptoms, family history, and recent exposures, you can answer these questions more easily. This gives you more time during the visit to talk about treatment, next steps, and concerns.
When you stay organized and ready, you can feel more confident and have a better visit.
