Hodgkin lymphoma

Here at Children’s Hospital Boston, we focus on providing innovative family centered care. From your first visit, our team of professionals will be there to support your family’s physical and psychosocial needs. We understand you want to know more about Hodgkin lymphoma, and will have many questions including:

• What is it?
• What can we do about it?
• How will it affect my child long-term?

We’ve provided some answers to these questions here, and when you meet with our experts, we can talk with you more about your child’s diagnosis and treatment.

What is the lymphatic system?

Hodgkin lymphoma arises from the body’s lymphatic tissue. This tissue is found in parts of the body that are part of the lymph system, including:

• lymph
• fluid that carries lymphocytes, also known as white blood cells
• lymphocytes
• white blood cells that fight infections and tumor growth
• lymph vessels
• vessels that carry the lymph through the body, and back into the bloodstream
• lymph nodes
• small, bean-shaped structures that can be found anywhere in the body, such as in the groin, abdomen, neck, pelvis and underarm
• filters the lymph and store lymphocytes
• spleen
• located on the left side of the abdomen near the stomach
• makes lymphocytes, filters blood, stores blood cells, and destroys old blood cells
• gastrointestinal system
• stores lymphocytes that help protect the body against infection
• includes the stomach, colon, small intestine, appendix, cecum and anus
• thymus
• located in the behind the breastbone of the chest
• grows lymphocytes
• tonsils
• two small masses of lymph tissue located behind the back of the throat
• makes lymphocytes
• bone marrow
• located in the center of large bones
• makes platelets, white blood cells and red blood cells

Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce causing swelling in the lymph nodes or other lymph tissue.

Hodgkin lymphoma cells can spread to other organs and tissue. A cancer cell that has spread to other organs and tissue is said to have "metastasized." With different treatment options available, the cure rate is not changed if the Hodgkin lymphoma does metasize.

How does Hodgkin lymphoma differ from other lymphomas?

Hodgkin lymphoma is distinguished from other types of lymphomas by:

• the presence of a particular type of abnormal cell,called the Reed-Sternberg cell (named for the scientists who discovered and studied this type of cell)
• the way it progresses—Hodgkin lymphoma usually begins in the lymph nodes of one part of your child’s body, usually in the head, neck or chest. It then tends to spread in a predictable manner from one part of the lymph system to the next, and, in advanced stages, to the lungs, liver, bone marrow, bones or other organs.

What is the difference between Hodgkin and non-Hodgkin lymphoma?

  There are different kinds of lymph cells in the lymph system and each can give rise to specific lymphomas.  The Reed-Sternberg  is a malignant cell that is always seen in Hodgkin lymphoma but rarely in non-Hodgkin lymphoma  There are more non-Hodgkin lymphoma subtypes than Hodgkin lymphoma subtypes. Each kind of lymphoma tends to present and spread in different ways.

What are the factors that separate the different subtypes of Hodgkin lymphoma?

• appearance of cells under a microscope. 
• In addition, pathologists can do special testing on the tissue to help them distinguish different subtypes of Hodgkin lymphoma.

What is the difference between classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma?

Nodular lymphocyte predominant Hodgkin lymphoma is a very rare form, rarely it can be treated just with surgery. Generally, children with this kind may need less intensive treatment than classical Hodgkin lymphoma. Children with the nodular lymphocyte predominant form usually don’t have noticeable symptoms such as fever, night sweats and weight loss. With classical Hodgkin, B symptoms are more common.

What are the different subtypes of classical Hodgkin lymphoma?

Physicians categorize Hodgkin lymphoma based on how the individual cells look under a microscope and other characteristics of the cells. Diagnosis and treatment are similar for all of the following subtypes, although the stage (how far the cancer has progressed) may influence the specifics of your child's treatment:

Nodular sclerosing

• The most common subtype of Hodgkin lymphoma, it tends to occur in adolescents and young adults.
• It accounts for more than half of all Hodgkin lymphoma cases.
• This subtype typically begins in the lymph nodes of the chest and other places above the diaphragm.
• Bulky tumors may arise in the mediastinum (the space in the chest between the lungs) and spread to lung tissue.

Lymphocyte depleted

• An extremely rare subtype accounting for less than 5 percent of people with Hodgkin lymphoma.
• It usually begins in the lymph nodes of the abdomen and pelvis.

Mixed cellularity

• This subtype accounts for 15 to 30 percent of people with Hodgkin lymphoma.
• It tends to arise in the lymph nodes of the abdomen and the spleen but can also arise in lymph nodes anywhere in the body.

Causes

What causes Hodgkin lymphoma?

The specific cause of Hodgkin lymphoma is unknown. The risk of developing this condition may be associated with:

• exposure to viral infections
• a very slight risk of genetic predisposition (there is a slightly increased chance for Hodgkin lymphoma to occur in siblings and cousins)

There has been much investigation into the association of Hodgkin’s lymphoma with:

• the Epstein-Barr virus (EBV), which causes the infection mononucleosis (mono)
• human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS)
• immune suppressing medications
  • used prior to organ transplant

Both of these viruses have been correlated with Hodgkin lymphoma, although the direct link is unknown. It’s important to note, however, that the vast majority of people who have infections related to EBV and HIV do not develop Hodgkin lymphoma.

Signs and Symptoms

What are the symptoms of Hodgkin lymphoma?

Childhood Hodgkin lymphoma most commonly occurs in children age 15 or older. While each child may experience symptoms of Hodgkin lymphoma differently, some of the most common include:

• painless swelling of the lymph nodes in neck, underarm, groin and chest
• dyspnea (difficulty breathing) due to enlarged nodes in the chest
• fever
• night sweats
• fatigue (tiring easily)
• weight loss
• pruritus (itching skin)

The symptoms of Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.

FAQ

We understand that you are an expert on your child, and can play an important role in the care of your child. Our team of professionals use your knowledge about your own child to help your child through treatment and on through recovery. By asking questions of your child’s doctor, you can help facilitate a conversation between you and your child’s care team. Sometimes, it’s helpful to write your questions down, so you can remember them for the appointment. There are several questions you can ask your child’s doctor, such as:

• How do you decide treatment recommendations?
• How long will treatment last?
• What are the possible short and long-term complications of treatment? How will they be addressed?
• How can I get my child eased back into normal social and school activities after treatment?
• How could my child benefit from being part of a research study?