The most common sign of both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) is a painless swelling in one or more of the lymph nodes of the neck, collarbone region, armpits, or groin. But it is important to remember that most lymph node swelling—especially in children—is caused by an infection, not by lymphoma. Affected lymph nodes usually return to normal size within a few weeks or months after an infection has cleared. Physicians often observe swollen lymph nodes during this time to see if they change in size following antibiotic treatment. However, if a lymph node(s) is larger than one inch in size (> 1 in), and if there are other suspicious symptoms, the physician may choose to perform an immediate biopsy to rule out or confirm a diagnosis of cancer.

Hodgkin's disease has a characteristic pattern of lymphatic spread that may aid in diagnosis. The disease typically invades the lymph nodes of the neck, collarbone, armpits, and/or chest above the diaphragm (large abdominal muscle that controls breathing) without "skipping" a nodal group.

If HD or NHL involves lymphatic tissue within the abdomen the belly may become swollen, and even resemble pregnancy in some female patients. Fluid may build up within the abdominal cavity, and swelling near the intestines may block the normal passage of feces. Such blockage may cause sensations of abdominal pressure or pain.


Doctors seldom know why one person develops Hodgkin lymphoma and another does not. But research shows that certain risk factors increase the chance that a person will develop this disease.

The risk factors for Hodgkin lymphoma include the following:

Age: Hodgkin lymphoma is most common among teens and adults aged 15 to 35 years and adults aged 55 years and older.

Certain viruses: Having an infection with the Epstein-Barr virus (EBV) or the human immunodeficiency virus (HIV) may increase the risk of developing Hodgkin lymphoma. However, lymphoma is not contagious. You can't catch lymphoma from another person.

Family history: Family members, especially brothers and sisters, of a person with Hodgkin lymphoma or other lymphomas may have an increased chance of developing this disease.

Weakened immune system: The risk of developing Hodgkin lymphoma may be increased by having a weakened immune system (such as from an inherited condition or certain drugs used after an organ transplant).

Having one or more risk factors does not mean that a person will develop Hodgkin lymphoma. Most people who have risk factors never develop cancer.


Hodgkin lymphoma can cause many symptoms:

• Becoming more sensitive to the effects of alcohol or having painful lymph nodes after drinking alcohol
• Coughing, trouble breathing, or chest pain
• Fever that does not go away
• Itchy skin
• Soaking night sweats
•  Swollen lymph nodes (that do not hurt) in the neck, underarms, or groin
• Weight loss for no known reason
• Weakness and tiredness that don't go away

Most often, these symptoms are not due to cancer. Infections or other health problems may also cause these symptoms. Anyone with symptoms that last more than 2 weeks should see a doctor so that problems can be diagnosed and treated.

The stage of the cancer means whether your cancer is localised in one area of the body or is in more than one area. The tests and scans you have to diagnose your lymphoma will give some information about the stage. Your doctor uses the stage to work out the treatment you will need.

After Hodgkin's lymphoma is diagnosed, a patient will be staged: that is, they will undergo a series of tests and procedures that will determine what areas of the body are affected. These procedures may include documentation of their histology, a physical examination, blood tests, chest X-ray radiographs, computed tomography (CT)/Positron emission tomography (PET)/magnetic resonance imaging (MRI) scans of the chest, abdomen and pelvis, and usually a bone marrow biopsy. Positron emission tomography (PET) scan is now used instead of the gallium scan for staging. In the past, a lymphangiogram or surgical laparotomy (which involves opening the abdominal cavity and visually inspecting for tumors) were performed. Lymphangiograms or laparotomies are very rarely performed, having been supplanted by improvements in imaging with the CT scan and PET scan.

On the basis of this staging, the patient will be classified according to a staging classification (the Ann Arbor staging classification scheme is a common one):

Stage I is involvement of a single lymph node region (I) (mostly the cervical region) or single extralymphatic site (Ie);
Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe);
Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes);
Stage IV is disseminated involvement of one or more extralymphatic organs.

The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage. For localized extranodal extension from mass of nodes that does not advance the stage, subscript 'E' is added. Splenic involvement is signified by adding 'S' to the stage.

The report of the biopsy may indicate the type of Hodgkin Lymphoma that has occurred. There are five main types of Hodgkin Lymphoma. They differ in whom it affects, the parts of the body more likely to be affected, and in what stage it is usually diagnosed.


The Lymphocyte depletion subtype is a very rare form of Hodgkin Lymphoma that makes up only about 1% of those affected by the disease. It affects older people and is often diagnosed in an advanced stage when the lymphoma has affected different organs of the body. It is also more common in those who are HIV affected.


This is another uncommon subtype that makes up about 5-6% of Hodgkin patients. It is more common in males and affects people most commonly in their thirties or forties. Most individuals are diagnosed in early stages and response to treatment is excellent.


This is another common type of Hodgkin Lymphoma. 15-30% of those affected have mixed cellularity disease. This type is more common in developing countries. People of any age may be affected. Males and females are equally affected. This type of disease is more likely to involve the abdomen than the more common nodular sclerosing variety, and less likely to involve nodes within the chest.


Now considered to be a special type of Hodgkin disease that is different from the other types mentioned above, this variant accounts for 4-5% of all cases of Hodgkin disease. According to pathologists this type has many similarities with Non-Hodgkin Lymphoma (NHL). In all clinical aspects, however, the features are similar to the lymphocyte-rich type of Hodgkin lymphoma. Most individuals are diagnosed early and do very well after treatment.


This is the most common type of Hodgkin Lymphoma. In the developed countries 60-80% of the people affected by Hodgkin disease have the Nodular Sclerosing subtype. It is commoner in females and mostly affects younger people – adolescents and young adults. The disease mainly affects nodes in the neck or armpits, or within the chest.

Definition

Hodgkin's disease is a cancer of the lymphatic system, which is part of your immune system.

In Hodgkin's lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.

Hodgkin's lymphoma is one of two common types of cancers of the lymphatic system. The other type, non-Hodgkin's lymphoma, is far more common.

Advances in diagnosis and treatment of Hodgkin's lymphoma have helped to give people with this diagnosis the chance for a full recovery. The prognosis continues to improve for people with Hodgkin's lymphoma.

Description

Hodgkin's disease, or Hodgkin's lymphoma, was first described in 1832 by Thomas Hodgkin, a British physician. Hodgkin clearly differentiated between this disease and the much more common non- Hodgkin's lymphomas. Prior to 1970, few individuals survived Hodgkin's disease. Now, however, the majority of individuals with this cancer can be cured.

The lymphatic system is part of the body's immune system, for fighting disease, and a part of the blood- producing system. It includes the lymph vessels and nodes, and the spleen, bone marrow, and thymus. The narrow lymphatic vessels carry lymphatic fluid from throughout the body. The lymph nodes are small organs that filter the lymphatic fluid and trap foreign substances, including viruses, bacteria, and cancer cells. The spleen, in the upper left abdomen, removes old cells and debris from the blood. The bone marrow, the tissue inside the bones, produces new red and white blood cells.

Lymphocytes are white blood cells that recognize and destroy disease- causing organisms. Lymphocytes are produced in the lymph nodes, spleen, and bone marrow. They circulate throughout the body in the blood and lymphatic fluid. Clusters of immune cells also exist in major organs.

Hodgkin's disease is a type of lymphoma in which antibody- producing cells of the lymphatic system begin to grow abnormally. It usually begins in a lymph node and progresses slowly, in a fairly predictable way, spreading via the lymphatic vessels from one group of lymph nodes to the next. Sometimes it invades organs that are adjacent to the lymph nodes. If the cancer cells spread to the blood, the disease can reach almost any site in the body. Advanced cases of Hodgkin's disease may involve the spleen, liver, bone marrow, and lungs.

There are different subtypes of Hodgkin's disease:

• lymphocyte depleted (less than 5% of cases)
• lymphocyte predominant (5-10% of cases)
• mixed cellularity (20-40% of cases)
• nodular sclerosis (30-60% of cases)
• unclassified