Hodgkin Lymphoma

So, what is Hodgkin lymphoma? This cancer starts in white blood cells in your lymph nodes called lymphocytes. These cells help your body fight illness and infection. A specific type of lymphocyte, B-cells, develops genetic changes (mutations). This causes the B-cells to make abnormal cancerous cells (Reed-Sternberg cells).

These large cells grow and multiply faster than regular cells. And they live longer, too. They also make a substance called cytokines. This attracts healthy cells to the lymph nodes, where the cancer cells start to crowd them out. In response, the lymph nodes swell to help all cells fit.

Types of Hodgkin lymphoma

There are two types of Hodgkin lymphoma. The most common one is classic Hodgkin lymphoma. About 95% of people with Hodgkin lymphoma have the classic type. It has four different variations (subtypes):

• Nodular sclerosing Hodgkin lymphoma: Usually found in nodes at the center of your chest.
• Mixed cellularity Hodgkin lymphoma: Often develops in your abdomen. It involves many different kinds of cells, including Reed-Sternberg cells.
• Lymphocyte-rich classic Hodgkin lymphoma: Has a high number of lymphocytes in the nodes — including Reed-Sternberg cells.
• Lymphocyte-depleted Hodgkin lymphoma: Replaces (depletes) normal cells in your lymph nodes with abnormal ones.

The second, less common kind is nodular lymphocyte-predominant Hodgkin lymphoma. It’s a slower-growing type than the classic Hodgkin lymphoma. And it’s rarer — only about 5% of people with Hodgkin lymphoma have this kind.

With any Hodgkin lymphoma, you’ll often have painless, swollen lymph nodes in your neck, underarm, chest or groin. You might also feel tired all the time. Or have unexplained fevers, weight loss and night sweats. Or you could have abdominal or chest pain. All are signs it’s time to see a healthcare provider.

What to expect at your first visit

A cancer diagnosis can make you feel all kinds of things. Worry. Stress. Uncertainty. Our cancer treatment experts understand this. That’s why they work to make you feel as comfortable as possible.

When you first meet with your provider, they’ll ask you a lot of questions. They’ll want to know if you’ve had any symptoms and for how long. And they’ll ask if you’ve had cancer before or other health conditions. You’ll want to be prepared to talk about your family health history, too. During your visit, you can also expect to have a physical exam and get orders for tests. All of this is important in helping our team confirm your diagnosis — or rule out other conditions. It also helps us to see how far the cancer has progressed (cancer staging).

Testing for Hodgkin lymphoma

You may have bloodwork like a complete blood count (CBC) to count each kind of blood cell. We may also do a blood chemistry study that measures substances your body releases into your bloodstream. And you may have an erythrocyte sedimentation rate (ESR). This tests for inflammation, a common lymphoma symptom.

You may also have imaging tests to take a closer look at what’s going on inside your body, like:

• CT scan (computed tomography scan).
• PET scan (positron emission tomography).
• MRI (magnetic resonance imaging).
• Ultrasound.

Typically, the diagnosis is confirmed when all or part of a swollen lymph node or other abnormal tissue is removed. This is called a biopsy. And our pathologists study the sample under a microscope to look for signs of Reed-Sternberg cells or other indicators of Hodgkin lymphoma.

Second opinions for Hodgkin lymphoma

How is it possible that you may have blood cancer? What seemed unthinkable has become real. And you’ll want to be sure you find the best care. Getting a second opinion can help relieve some of the worry and uncertainty of a cancer diagnosis.

Our lymphoma team will meet with you and talk about your diagnosis. They’ll answer your questions and help you understand treatment and recovery. Second opinions can give you peace of mind, knowing you’re in control of your care and what lies ahead.

Meet Our Lymphoma Team

Our team-based approach to care lets us personalize your treatment. We build a team of providers from different specialties based on your needs, like:

• Oncologists.
• Hematologists.
• Radiologists.
• Radiologic technologists.
• Pathologists.
• Nurse practitioners.
• Social workers.
• Care coordinators (specialists who keep you up to date on your treatment plan and advocate on your behalf).

These providers work together to plan treatment based on your test results. And they keep a close eye on your progress by meeting regularly. They talk about the next steps and any changes they may need to make to your plan.

When treating Hodgkin lymphoma, we try to eliminate all its signs and symptoms. This means you’re in remission. Usually, the remission lasts the rest of your life, meaning you’re cured. But sometimes, the cancer may come back (recur).

If tests show you have slow-growing nodular lymphocyte-predominant Hodgkin lymphoma, you may not need treatment. Your care team may choose to keep a close eye on things. You’ll have regular check-ups and testing to see if the cancer progresses.

If it does, or if you have any variety of classic Hodgkin lymphoma, you may have one or a combination of treatments, like:

Systemic therapies

We use systemic therapies to destroy Reed-Sternberg cancer cells or keep them from spreading throughout your body. You may have:

• Chemotherapy.
• Targeted therapy.
• Checkpoint inhibitors and other immunotherapy.

Radiation therapy

We may recommend radiation therapy as part of your treatment plan. This lets us target areas of cancer without damaging healthy cells nearby.

Stem cell transplantation

You may need a stem cell transplant if your cancer doesn’t respond to other treatments or it comes back. A transplant replaces abnormal stem cells (immature cells in your blood). These may be healthy ones from your body (autologous stem cell transplant). Or donor stem cells (allogeneic stem cell transplant). We’ll likely recommend chemotherapy and/or radiation to help you prepare for a transplant.

Life After Hodgkin Lymphoma Treatment

You may be relieved to hear treatment may stop all signs and symptoms of Hodgkin lymphoma. And it may go into permanent remission. But it’s also important to remember that it could come back at any time. That’s why you’ll have regular check-ups with your care team and testing to make sure the cancer is still in remission. If we ever discover it’s come back, we can start treatment right away.

We also realize that having cancer can cause a lot of stress. And stress can get in the way of your treatment and recovery. If you’re feeling overwhelmed by your diagnosis and treatment, we can help. Our counselors are here to talk with you. And there are many different support groups you can join to connect with people going through similar experiences.

Taking the Next Step

It can be more than a little unsettling to learn you may have blood cancer. The good news? Hodgkin lymphoma is highly treatable. Our lymphoma team is here to make sure you get personalized care and support. We’ll make sure you understand what to expect from treatment and recovery. And we’ll stay by your side through follow-up visits for many years.