Hodgkin’s Lymphoma

What is Hodgkin’s lymphoma?

Lymphoma means a cancer of the lymphatic system. There are two main types of lymphoma. These are Hodgkin’s lymphoma and non– Hodgkin’s lymphoma (NHL). They are different diseases. If you are looking for information  about ‘non Hodgkin’s lymphoma’, this is not the right information for you.

The lymphatic system.

In Hodgkin’s lymphoma, cells in the lymph nodes become cancerous. Lymph nodes are bean shaped glands found all over the body that are part of the lymphatic system. They are connected by very fine tubes called lymph vessels. Tissue fluid circulates around the body in these vessels and flows through the lymph glands. The lymph glands filter germs out of the fluid and contains specialised white blood cells, which kill bacteria and viruses.

Where in the body do you get Hodgkin’s lymphoma?

The commonest place for Hodgkin’s lymphoma to be noticed is in the lymph nodes in the neck. But you may notice it first in lymph nodes anywhere in the body, for example, in the chest, groin or abdomen or under the arm. You can also get Hodgkin’s lymphoma in body organs. The organ most commonly affected is the spleen. It can also affect the liver, bone or lung.

Remember —  It is very common for other types of cancer to spread to lymph nodes. This is not lymphoma. For information on spread to the lymph nodes you will need to look at the information for the type of primary caner you have.

Risks and causes of Hodgkin’s lymphoma

We don’t know exactly what causes Hodgkin’s lymphoma. Most people who develop Hodgkin’s lymphoma do not have any particular risk factors. But there are a few thinks that may make some people more likely to get it.

Age and gender

The peak age for Hodgkin’s lymphoma is 15 to 29. it is the 3rd most common cancer in this age group. It then becomes less common until older age, when the number of cases increases again. It is slightly more common in men than in women.

Lowered immunity

Anyone whose immune system is not working properly may be more likely to develop a lymphoma. This includes people who are taking drugs to stop organ rejection after a transplant, people who have HIV or AIDS, people born with rare medical syndromes that affects immunity, and people who develop ‘autoimmune’ conditions, such as rheumatoid arthritis or lupus (SLE)

Other risk factors have been investigated, but there is no strong evidence for any of them.

Symptoms of Hodgkin’s lymphoma.

The most common symptom is one or more painless swellings in the neck, armpit or groin. Theses swellings are enlarged lymph nodes. About (70%) diagnosed with Hodgkin’s lymphoma have a swollen lymph node in their neck. Usually, the swollen nodes don’t hurt. But some people say their lumps ache. A very enlarged node in the neck can give you a stiff neck.

Other general symptoms

About 1 in 4 people have other more general symptoms. These are called ‘B symptoms’. They can include heavy sweating (especially at night), temperatures that come an go, and losing a lot of weight. Some people experience itching, which may be worse after drinking alcohol. If the disease affects nodes in the chest or lungs it can cause a cough or breathlessness.

Hodgkin’s lymphoma in the bone marrow

If you have Hodgkin’s lymphoma in your bone marrow, you may  have symptoms cause by low blood cell counts. These include breathlessness and tiredness, and bleeding problems such as nosebleeds.

Other possible symptoms

There can be other odd symptom, depending on where in your body the Hodgkin’s lymphoma is. Enlarged lymph nodes can press on nerves and cause pain, or swelling in arms and legs. Some people get yellowing of the skin and eyes (jaundice) or small lumps (nodules) on the skin.

Screening for Hodgkin’s lymphoma

Screening means testing people for the early stages of a disease before they have any symptoms. Before screening for any type of cancer can be carried out, doctors must have a test that will reliably detect early disease.

The screening test must be accurate and reliable in picking up cancers that are there. And must not give false positive results in people who do not have cancer.

At the moment there is no reliable screening test for Hodgkin’s lymphoma. It  is unlikely that there will be screening in the near future. There are only about 1,400 cases of Hodgkin’s lymphoma diagnosed in the UK each year. So, even if a reliable screening test  was available, screening for this cancer would be very expensive in relation to the number of cancers diagnosed. Because Hodgkin’s lymphoma is relatively rare, screening everyone would mean that most people would have unnecessary tests.

Should I see a Hodgkin’s lymphoma specialist

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much less serious. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines to help GPs decide which patients need to be seen urgently by a specialist.

Guide lines for urgent referral

You should have an urgent referral to see a specialist (usually a haematologist) within 2 weeks if you have an enlarged spleen that is not getting better and your doctor can’t explain the cause. You might also need further investigations or a referral if you have a swollen lymph node that is larger than 2cm , has been there for more than 6 weeks, is increasing in size, accompanied by night sweats, weight loss and an enlarged spleen, or is one of several swollen lymph nodes.

The guidelines also say that a GP should investigate anyone with combinations of symptoms including fatigue, night sweats, itching, being short of breath, bruising easily or bleeding, infections that keep coming back, bone pain or nerve pain, abdominal pain, or an enlarged spleen or lymph nodes.

What to do if you are still worried

If you are concerned that your GP is not taking your symptoms as seriously as you think he or she should, you can take this booklet along to your appointment.

Questions for your doctor about Hodgkin’s Lymphoma

  • I have swollen glands in my neck could I have Hodgkin’s lymphoma?
  • How can you tell if I have an infection, or if I have Hodgkin’s lymphoma?
  • Am I more likely to get Hodgkin’s lymphoma than anyone else?
  • How common is Hodgkin’s lymphoma?
  • My sister had Hodgkin’s lymphoma. Does that make me more likely to get it?
  • A member of my family had Hodgkin’s lymphoma and I’m worried about it. Is there any screening available?