Risk Factors

Doctors can't always explain why one person gets lymphoma and another doesn't. However, certain risk factors make a person more likely than others to develop Hodgkin's lymphoma. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a person will get Hodgkin's lymphoma. Many people who get lymphoma have none of these risk factors, and many people who have known risk factors never get cancer. A person with one or more of these risk factors should talk with his or her doctor about cancer risk.

These are risk factors for Hodgkin's lymphoma:

• Infection with certain viruses: Having an infection with the Epstein-Barr virus (EBV) or the human immunodeficiency virus (HIV) may increase the risk of developing Hodgkin's lymphoma. However, lymphoma is not contagious. A person can't catch lymphoma from another person.
• Weakened immune system: The risk of developing Hodgkin's lymphoma may be increased by having a weakened immune system (such as from an inherited condition or certain drugs used after an organ transplant).
• Age: Hodgkin's lymphoma is most common among teens, young adults, and adults over the age of 55.
• Family history: Family members, especially brothers and sisters, of a person with Hodgkin's lymphoma or other lymphomas may have an increased chance of developing this disease.

Symptoms

Hodgkin's lymphoma can cause many symptoms:

• A fever that does not go away
• Becoming more sensitive to the effects of alcohol, or having painful lymph nodes after drinking alcohol
• Coughing, trouble breathing, or chest pain
• Itchy skin
• Soaking night sweats
• Swollen lymph nodes (that do not hurt) in the neck, underarms, or groin
• Weakness and tiredness that don't go away
• Weight loss

Most often, these symptoms do not mean cancer. A person with these symptoms should tell his or her doctor so any health problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Currently, there are no screening methods for Hodgkin's lymphoma.

If symptoms suggest Hodgkin's lymphoma, the doctor will try to find out what's causing the problem. The doctor may ask about the patient's personal and family medical history, and may order some of the following exams and tests:

• Physical exam: The doctor checks for swollen lymph nodes in the neck, underarms, and groin. The doctor also checks for a swollen spleen or liver.
• Blood tests: Tests are done to check the number of white blood cells and other cells and substances in the blood.
• Chest x-rays: X-ray pictures may show swollen lymph nodes or other signs of disease in the chest.
• Biopsy: A biopsy is the only sure way to diagnose Hodgkin's lymphoma. The doctor may remove an entire lymph node (called an excisional biopsy) or only part of a lymph node (incisional biopsy). The lymph node is sent to a lab, where a doctor will look at it under a microscope to check for Hodgkin's lymphoma cells.

Staging

If Hodgkin's lymphoma is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment. Staging is a careful attempt to find out if the cancer has spread, and if so, to what parts of the body. The doctor considers these factors to determine the stage of Hodgkin's lymphoma:

• The number of lymph nodes that have Hodgkin's lymphoma cells
• Whether these lymph nodes are on one or both sides of the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen)
• Whether the disease has spread to the bone marrow, spleen, liver, or lungs

The doctor may order one or more of these staging tests:

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the chest, abdomen, and pelvis. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas.
• MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of the inside of the body. Sometimes contrast material is given by injection into the blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.
• PET scan: The patient receives an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes pictures of the sugar used by cells in the body. Lymphoma cells use sugar faster than normal cells, so areas with lymphoma look brighter on the pictures.
• Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from the hipbone or another large bone. Local anesthesia can help control pain. A doctor in the lab looks for Hodgkin's lymphoma cells in the sample.
• Additional biopsies: The doctor may do biopsies of other lymph nodes, the liver, or other tissue.

Stages of Hodgkin's Lymphoma

Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm) or in only one part of a tissue or an organ (such as the lung).

Stage II: The lymphoma cells are in at least two lymph node groups on the same side of the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen.

Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes.

In addition to these stage numbers, the doctor may also describe the stage as A or B:

• A: The patient has not had weight loss, drenching night sweats, or fevers.
• B: The patient has had weight loss, drenching night sweats, or fevers.

Treatment

At Huntsman Cancer Institute, Hodgkin's lymphoma is treated by a team of specialists, including hematologists (doctors who specialize in treating blood disorders), medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

These are common treatment options for Hodgkin's lymphoma:

• Chemotherapy
• Radiation therapy
• Bone marrow/Blood stem cell transplant
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The type of Hodgkin's lymphoma (Most people have classical Hodgkin's lymphoma.)
• Where the lymphoma is found
• Whether the patient has a tumor more than 4 inches (10 centimeters) wide
• Whether the patient has had weight loss, drenching night sweats, or fevers
• The patient's age and general health

The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Patients are encouraged to discuss treatment side effects with their health care team.

Chemotherapy

Chemotherapy uses drugs to kill and control lymphoma cells throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Radiation therapy

Radiation therapy uses high-energy rays to kill lymphoma cells. This is local therapy because it affects cells in the treated area only. A large machine aims the rays at the lymph node areas affected by lymphoma. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue.

Bone marrow/Blood stem cell transplant

If Hodgkin's lymphoma returns after treatment, a patient may receive bone marrow/blood stem cell transplantation. A transplant of a patient's own blood-forming stem cells allows him or her to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.

Transplants take place at the hospital. After the patient receives high-dose treatment, healthy blood-forming stem cells are returned to the patient through a tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells. Learn more in our video about HCI's Blood and Marrow Transplant program.

The stem cells may come from the patient's own body or from a donor:

• Autologous stem cell transplantation: This type of transplant uses the patient's own stem cells. The stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After the patient receives high-dose treatment, the stored stem cells are thawed and returned to the patient.
• Allogeneic stem cell transplantation: This type of transplant uses stem cells from a donor. A patient's brother, sister, or parent may be the donor, or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor's cells will match the patient's cells.
• Syngeneic stem cell transplantation: This type of transplant uses stem cells from the patient's identical twin.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or to ask any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.