Adult Hodgkin Lymphoma: Symptoms, Stages & Treatment

A swollen lymph node that arises for no apparent reason is generally the initial symptom of Hodgkin lymphoma. The disease can spread to neighboring lymph nodes, later extending to the spleen, liver, bone marrow, or other organs.

Not everyone with Hodgkin lymphoma experiences symptoms. If symptoms do occur, they may include:

• Swollen lymph nodes: The most common symptom of Hodgkin lymphoma is a swollen lymph node under the skin. This commonly manifests as a lump in the neck, armpit, or groin. When a lymph node swells for no apparent reason and the swelling persists, it could be an indication of cancer. The lump may hurt even more after consuming alcohol.
• B symptoms: Part of the staging process for Hodgkin lymphoma involves determining whether certain B symptoms are present, which may be signs of a more advanced disease. B signs include:
  • Extreme night sweats
  • Persistent fever
  • Unexplainable weight loss of more than 10% over the last 6 months

With Hodgkin lymphoma, swollen lymph nodes in the chest can cause the following symptoms:

• Cough
• Shortness of breath
• Loss of appetite
• Generalized itchy skin
• Fatigue

Other signs and symptoms of adult Hodgkin lymphoma include:

• Extreme tiredness
• Chest discomfort
• Decreased appetite
• Abdominal pain or swelling
• Feeling of fullness
• Rash or itchy skin
• Unusual bleeding, such as chronic nosebleeds

Occasionally, people can present with symptoms that reflect the involvement of certain organs, such as:

• Jaundice and itching due to liver involvement
• Tetany (muscular spasms) due to high levels of calcium
• Tiredness due to anemia
• Edema due to kidney involvement

Symptoms of Hodgkin lymphoma are typically nonspecific and share many similarities with other diseases. However, if you have any symptoms that do not go away, you should see your doctor so that you may be properly examined and treated. 

Hodgkin lymphoma is caused by a mutation in the DNA of a B-cell lymphocyte. This mutation causes a significant number of abnormal and enlarged B cells to grow in the lymphatic system and spread to other organs over time. It is unknown what causes the DNA mutation.

Although the actual etiology of Hodgkin lymphoma is unknown, various risk factors enhance the likelihood of developing the disease:

• Family history: A family history of a certain subtype of Hodgkin lymphoma is most significantly related to the development of the condition, indicating the possibility of a genetic predisposition.
• Age: Hodgkin lymphoma is most common in early adulthood (15 to 40 years) and late adulthood (after 55 years) with high prevalence in their 20s.
• Gender: Hodgkin lymphoma is more common in men.
• Geographical region: Hodgkin lymphoma is most common in North America and northern Europe. 
• Chronic infections and autoimmune diseases: People with persistent infections (human immunodeficiency virus or Epstein-Barr virus) or autoimmune disorders (rheumatoid arthritis, lupus, Sjögren syndrome, or celiac disease) have a slightly increased risk of developing Hodgkin lymphoma. 
• Suppressed immunity: People with immune suppression, such as those who have had prolonged cycles of chemotherapy for other diseases, are more likely to acquire this type of lymphoma. Others include people with a weakened immune system due to an inherited immune deficiency disease. People who take drugs to prevent the rejection of transplanted organs are also vulnerable.

Hodgkin lymphoma is classified into several stages and subtypes. Hodgkin lymphoma is classified into four stages based on how far cancer has spread from a single lymph node area to the rest of the body. 

Stages

• Stage I
  • Cancer has only affected one lymph node area or lymphoid organ.
  • When Hodgkin lymphoma affects an organ other than the lymphoid system, it is referred to as stage IE, commonly known as extranodal lymphoma.
  • Chemotherapy is typically administered in 2-4 cycles. Radiation therapy may be recommended as well.
• Stage II
  • Cancer has affected two or more lymph node sites on the same side of the body. 
  • Cancer may be found above or below the diaphragm, which is a muscle that separates your abdomen from the chest.
  • Cancer has spread to one organ and a surrounding lymph node. This is called stage IIE Hodgkin lymphoma.
  • 2-4 cycles of chemotherapy and sometimes radiation may be recommended.
• Stage III
  • Cancer has spread to both sides of the diaphragm. It is also possible that cancer has spread to the lymph nodes above the diaphragm in addition to the spleen.
  • This stage of Hodgkin lymphoma is commonly treated with 6-8 cycles of chemotherapy. Steroids and radiation treatment may be prescribed as well.
• Stage IV or the most advanced stage
  • Cancer has progressed to at least one organ other than the lymphatic system, such as the liver, lungs, or bone marrow. 
  • 6-8 rounds of chemotherapy are routinely administered, and steroids and radiation treatment are recommended.

Categories

Categories A, B, E, S, and X are used to assess whether symptoms are present and where the disease may have spread in the body:

• A: Indicates that no symptoms have developed.
• B: One or more of the following symptoms have appeared: sudden weight loss, intense night sweats, or fever.
• X: Large tumors greater than 10 cm are found across the chest.
• E: Indicates extranodal tumors that have entered other tissues or organs after spreading outside of the lymph nodes.
• S: Indicates that the spleen has been affected by cancer. An enlarged spleen (splenomegaly) will appear in about 30% of people with Hodgkin lymphoma.

Grades

Cancer can also be graded based on its rate of growth and propensity to spread:

• Grade I or low-grade tumor: Cancer cells usually appear slightly abnormal and grow slowly. 
• Grade II or intermediate-grade tumor: Cancer cells present as abnormal and grow comparatively faster.
• Grade III or high-grade tumor: Cancer cells present as very abnormal and grow quickly. 

Blood tests cannot diagnose Hodgkin lymphoma but may help your doctor determine the best course of treatment for you. They may also order a biopsy and/or imaging tests.

Accurately diagnosing the stage and category of Hodgkin lymphoma is crucial when weighing treatment options. Doctors use various diagnostic tests to evaluate Hodgkin lymphoma and create a treatment plan that is unique to each person's needs. 

After the tumor has been staged and graded, genetic testing may be recommended, which analyzes the DNA of your tumor and can help determine which treatment has the best chance of success. Thereafter, they may discuss the best treatment option for you.

Hodgkin lymphoma treatment options are advanced and effective. They can range from supportive therapy to chemotherapy, immunotherapy, and recently, cellular therapy.

Your multidisciplinary team will work with you to create a personalized treatment plan that is tailored to your specific needs and goals. Several factors affect treatment, including age, disease stage, and overall health.

Treatment

• Chemotherapy (chemo)
  • Chemotherapy kills or slows the growth of cancer. There are numerous chemotherapies available to treat lymphomas. Doctors may prescribe a single chemotherapy medication or a combination of several. 
  • Chemotherapies differ in how they attack cancer cells and often have different side effects. Giving several of these chemotherapy medications at once may improve treatment success, but it may also increase the number of side effects.
• Radiation therapy
  • Radiation is a type of energy that is carried by waves or a stream of energy particles. It can be given through a radiation machine or through radioactive substances injected into the bloodstream. 
  • External beam radiation, for example, directs radiation toward tumors or lymphoma-infected areas of the body. It kills the cells in the vicinity of the radiation beam.
• Immunotherapy (biologic therapy or biotherapy)
  • Immunotherapy fights cancer by using the person's own immune system. Monoclonal antibodies are a common type of medication. These are recombinant immune system proteins.
  • Antibodies can be very useful in cancer treatment because they can be programmed to attack a specific part of a cancer cell.
• Autologous or allogeneic stem cell transplants (SCT) and peripheral blood stem cell transplants
  • These replenish normal stem cell supplies that have been depleted by high-dose chemotherapy and/or radiation therapy. 
  • In an autologous SCT, the person’s bone marrow or blood stem cells are harvested. 
  • An allogeneic SCT collects bone marrow or blood stem cells from a matched donor who is related or unrelated (nonfamily).

Recurrence

• After treatment, many people with adult Hodgkin lymphoma go into remission. However, there is a chance that cancer will recur (relapse). In the event of a relapse, another biopsy is performed, followed by additional treatment. 
• Clinical trials and palliative care may also be recommended, depending on the person’s condition.

Survival rates for Hodgkin lymphoma have improved in recent years as a result of more advanced treatments. The American Cancer Society reports the following 5-year relative survival rates:

• 88%: All people with Hodgkin lymphoma
• 92%: Localized Hodgkin lymphoma
• 82%: Advanced Hodgkin lymphoma that has reached distant organs, such as the lungs or bone marrow

The study reports that more than 90% of people with early-stage Hodgkin lymphoma survive for 5 years following diagnosis. Cure rates are lower in people with more advanced diseases. Younger people respond better to treatment than older adults, and women respond more successfully to treatment than men.