Hodgkin lymphoma

Hodgkin lymphoma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Hodgkin lymphoma Hodgkin lymphoma About Hodgkin lymphoma Symptoms of Hodgkin lymphoma Causes of Hodgkin lymphoma Diagnosing Hodgkin lymphoma Treating Hodgkin lymphoma Complications of Hodgkin lymphoma About Hodgkin lymphoma Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body. The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes. In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection. The most common symptom of Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. Read more about the symptoms of Hodgkin lymphoma . Whos affected? Hodgkin lymphomacan develop at any age, but it mostly affects young adults in their early 20s and older adults over the age of 70. Slightly more men than women are affected. What causes Hodgkin lymphoma? The exact cause of Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if: youhave a medical condition that weakens your immune system you take immunosuppressant medication youve previously been exposed toa common virus called the Epstein-Barr virus  which causes glandular fever You also have an increased risk of developing Hodgkin lymphoma if a first-degree relative (parent, sibling or child) has had the condition. Read more about the causes of Hodgkin lymphoma . How Hodgkin lymphoma is diagnosed The only way to confirm a diagnosis of Hodgkin lymphoma is by carrying out a biopsy . This is a minor surgical procedure wherea sample of affected lymph node tissue is removed and studied in a laboratory. Read more about diagnosing Hodgkin lymphoma . Treatment Hodgkin lymphoma is a relatively aggressive cancer and can quickly spread through the body. Despite this, its also one of the most easily treated types of cancer. Your recommended treatment plan will depend on your general health and age, because many of the treatments can put a tremendous strain on the body.How far the cancer has spread is also an important factor in determining the best treatment. The main treatments used are chemotherapy , followed by radiotherapy or chemotherapy alone. Surgery isnt generally used as a treatment for the condition. Read more about: treatment for Hodgkin lymphoma complications of Hodgkin lymphoma Symptoms of Hodgkin lymphoma The most common symptom of Hodgkin lymphoma is a swelling in the neck, armpit or groin. The swelling is usually painless, although some people find that it aches. The swelling is caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph node (also called lymph glands). Lymph nodes are pea-sized lumps of tissue found throughout the body. They contain white blood cells that help to fight infection. However, its highly unlikely that you have Hodgkin lymphoma if you have swollen lymph nodes , as these glands often swellas a response to infection. Other symptoms Some people with Hodgkin lymphoma also have other more general symptoms. These can include: night sweats unintentional weight loss a high temperature (fever) a persistent cough or feeling of breathlessness persistent itching of the skin all over the body Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion A few people with lymphoma have abnormal cells in their bone marrow when theyre diagnosed. Thismay lead to: persistent tiredness or fatigue an increased risk of infections excessive bleeding  such as nosebleeds ,heavy periods and spots of blood under the skin Insome cases, people with Hodgkin lymphoma experience pain in theirlymph glands when they drink alcohol. When to seek medical advice Speak to your GP if youhave any of these symptoms, particularly if you have persistently swollen glands with no other signs of infection. While the symptoms are unlikely to be caused by Hodgkin lymphoma, it is best to get them checked out. Causes of Hodgkin lymphoma Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called B lymphocytes, although the exact reason why this happens isnt known. The DNA gives the cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions so the cells keep growing, causing them to multiply uncontrollably. The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, its possible for the abnormal lymphocytes to spread into other parts of your body, such as your: bone marrow spleen liver skin lungs Whos most at risk? While thecause of the initial mutation that triggers Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition. These include: having a medical condition that weakens your immune system, such as HIV having medical treatment that weakens your immune system  for example, taking medication to suppress your immune system afteran organ transplant being previously exposed to the Epstein-Barr virus (EBV) a common virus that causes glandular fever having previously had non-Hodgkin lymphoma , possibly because of treatment with chemotherapy or radiotherapy being very overweight ( obese )this may be more of a risk factor in women than men Hodgkin lymphoma isnt infectious andisnt thought torun in families. Although yourrisk isincreased if a first-degree relative (parent, sibling or child) has had lymphoma, its not clear if this is because of an inherited genetic faultorlifestyle factors. Hodgkin lymphoma can occur at any age, although most cases are diagnosed in people in their early 20s or 70s. The condition is slightly more common in men than women. Diagnosing Hodgkin lymphoma If you speak to your GP because youre concerned about symptoms of Hodgkin lymphoma, theyll ask about your health and carry out a simple physical examination. If necessary, your GPwill refer you to hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of Hodgkin lymphoma and refer people for the right tests faster. To find out if you should be referred for further tests for suspected Hodgkin lymphoma, read the NICE 2015 guidelines on Suspected cancer: recognition and referral . If youre referred to hospital, a biopsy will usually be carried out, as this is the only way to confirm a diagnosis of Hodgkin lymphoma. Biopsy A biopsy involves removing some or all of an affected lymph node, which is then studied in a laboratory. Biopsies are small operations that can often be carried out under a local anaesthetic (where the area is numbed). In some cases, the affected lymph node isnt easily accessible and a general anaesthetic may be required (where youre asleep). A pathologist (an expert in the study of diseased tissue) will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of Hodgkin lymphoma you have, which is an important factor in planning your treatment. Further testing If a biopsy confirms a diagnosis ofHodgkin lymphoma, further testing will be needed to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma. Further tests may include: blood tests  samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidneys are working bone marrow sample  another biopsy may be carried out to see if thecancer has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic chest X-ray  this can check whether the cancer has spread to your chest or lungs computerised tomography (CT) scan  this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread of the cancer magnetic resonance imaging (MRI) scan  this scanuses strong magnetic fields to build up a detailed picture of areas of your body, to check the spread of the cancer positron emission tomography (PET) scan this scan measures the activity of cells in different parts of the body andcan check the spread of the cancer and the impact of treatment;its usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working Stages of Hodgkin lymphoma When testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far its spread. The main stages of Hodgkin lymphoma are: stage 1 thecancer is limited to one group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs) stage 2 2 or more lymph node groups are affected, either above or below the diaphragm stage 3 thecancer has spread to lymph node groups above and below the diaphragm stage 4 thecancer has spread through the lymphatic system and is now present in organs or bone marrow Health professionals alsoadd the letters A or B to your stage, toindicate whether or not you have certain symptoms. A is put after your stage if youhave no additional symptoms other than swollen lymph nodes. B is put after your stage if you haveadditional symptoms of weight loss, fever or night sweats. Treating Hodgkin lymphoma Hodgkin lymphoma can usually be treated successfully with chemotherapy alone, or chemotherapy followed by radiotherapy. Your treatment plan Your specific treatment plan will depend on your general health and your age, asmany of the treatments can put a tremendous strain on the body. How far the cancer has spread is also an important factor in determining the best treatment. Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT). Your MDT will recommend the best treatment optionsfor you. However, you shouldnt be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner. Treatment options The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. In a few cases, chemotherapy may be combined with steroid medication. Surgery isnt generally usedto treat the condition, except for the biopsy used to diagnose it. Overall, treatment for Hodgkin lymphoma is highly effective and most people with the condition are eventually cured. Chemotherapy Chemotherapy is a type of cancer treatment where medicine is used to kill cancer cells. This medication can be given in a number of different ways, depending onthe stage of your cancer. If doctors think your cancer is curable, youll normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy).If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms. Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you shouldnt have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome and a longer hospital stay may be needed. Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems: fatigue breathlessness increased vulnerability to infection bleeding and bruising more easily If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells. Other possible side effects of chemotherapy include: nausea and vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes hair loss infertility , which may be temporary or permanent Mostside effects should pass once your treatment has finished.Tell your care team if the side effects become particularly troublesome, as there are treatmentsthat can help. Read more about the side effects of chemotherapy . High-dose chemotherapy If regular chemotherapy is unsuccessful or Hodgkin lymphoma returns after treatment, you may have a course of chemotherapy at a higher dose. However, this intensive chemotherapy destroys your bone marrow, leading to the problems mentioned above. Youllneed a stem cell orbone marrow transplantto replace the damaged bone marrow. Radiotherapy Radiotherapy is most often used to treat early-stage Hodgkin lymphoma, where the cancer is only in one part of the body. Treatment is normally given in shortdaily sessions, Monday to Friday, over several weeks. You shouldnt have to stay in hospital between appointments. Radiotherapy itself is painless, but it can have some significant side effects. These can vary and will be directly related to thepart of your body being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss. Other common side effectsinclude: tiredness nausea and vomiting dry mouth loss of appetite Most side effects are temporary,but theres a risk of long-term problems, including infertility and permanently darkened skin in the treatment area. Read more about: side effects of radiotherapy complications of Hodgkin lymphoma Steroid medication Steroid medication is sometimes used in combination with chemotherapy as a more intensive treatment for advanced cases of Hodgkin lymphoma, orif initial treatment hasnt worked. The steroid medication is given intravenously, usually at the same time as your chemotherapy. Common side effects of steroid medication include: increased appetite, which can lead to weight gain indigestion problems sleeping feeling agitated The side effects of steroid medication usually start to improve once treatment finishes. Rituximab If youre diagnosed with a rare type of Hodgkin lymphoma called lymphocyte-predominant Hodgkin lymphoma, you may have chemotherapy in combination with a medication called rituximab. Rituximab is a type ofbiological therapycalled a monoclonal antibody. Itattaches itself to the surface of cancerous cells and stimulates the immune system to attack and kill the cell. Its given through a drip directly into a vein over the course of a few hours. Side effects of the drug can include: flu -like symptoms, such as headaches , feverand muscle pain tiredness nausea diarrhoea You may be given additional medication to prevent or reduce side effects. Any side effects should improve over time as your body gets used to the medication. Follow-up After your course of treatment ends, youll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. These appointments start off being every few weeks or months, but will become gradually less frequent over time. Read further information: Cancer Research UK:treating Hodgkin lymphoma Cancer Research UK:living with Hodgkin lymphoma Macmillan: treating Hodgkin lymphoma Macmillan: living with Hodgkin lymphoma Complications of Hodgkin lymphoma Some people treated for Hodgkin lymphoma experience long-term problems, even if theyve been cured. Weakened immune system Having a weakened immune system is a common complication of Hodgkin lymphoma and it can become more severe while youre being treated. If you have a weak immune system, youre more vulnerable to infections and theres an increased risk of developing serious complications from infections. In some cases, you may be advised to take regular doses of antibiotics to prevent infections. Its also important to report any symptoms of an infection to your GP or care team immediately, as prompt treatment may be needed to prevent serious complications. Symptoms of infection include: a high temperature (fever) headache aching muscles diarrhoea tiredness Vaccination You should make sure that all of your vaccinations are up-to-date. However, its important to speak toyour GP or care team about this, as it may not be safe for you to have live vaccines (vaccines containing a weakened form of the virus or organism being vaccinated against) until several months after your treatment finishes. Examples of live vaccines include the: shingles vaccine BCG vaccine (against tuberculosis) MMR vaccine (against measles, mumps and rubella) Infertility Chemotherapy and radiotherapy for Hodgkin lymphoma can cause infertility. This is sometimes temporary, but it can be permanent. Your care team will estimate the risk of infertility in your specific circumstances and let you know your options. In some cases, it may be possible for men to store samples of their sperm and for women to store their eggs before treatment, so these can be used to try for a baby afterwards. Second cancers People who have had Hodgkin lymphoma are more likely to get lymphoma, leukaemia or other cancers in the future. Chemotherapy and radiotherapy further increase this risk. Second cancers, such as breast cancer or lung cancer , usually develop more than 10 years after youre treated for Hodgkin lymphoma. In rare cases, other types of cancer, such as leukaemia or other lymphomas, develop after only a few years. You can help to reduce your risk of a second cancer by adopting a healthy lifestyle by not smoking, maintaining a healthy weight with a balanced diet, and getting regular exercise. You should report any symptoms that might suggest another cancer to your GP at an early stage and attend any cancer screening appointments youre invited to. Other health problems The risk of developing other health conditions in the future, such as cardiovascular disease and lung disease, is also higher in people who have had Hodgkin lymphoma. You should report unexpected symptoms, such as increased shortness of breath, to your GP for further advice. 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