Cancer from A to Z

Types of cancer, how to prevent them, diagnosis and treatment.


Hodgkin's Lymphoma

Hodgkin's lymphoma, also known as Hodgkin's disease, usually develops in the lymphatic system (a part of the body's immune system). The lymphatic system carries disease-fighting white blood cells throughout the body. Lymph tissue, which makes up the lymphatic system, is located throughout the body (neck, armpits, chest and groin). Because of this, the disease can start in almost any part of the body. It can also spread to almost any organ or tissue, including the liver, bone marrow and spleen.


Hodgkin's lymphoma is a very treatable type of cancer. It occurs mainly in young adults, with more cases occurring between the ages of 16 and 34 years. Older patients, especially those over age 55, may also develop Hodgkin's lymphoma. Hodgkin's is very treatable even for patients with advanced disease. The survival rate is high.


Hodgkin's lymphoma has been divided into subtypes according to how the lymph nodes look under the microscope. The type of tumor provides important information that may affect treatment choices.

Nodular Sclerosing Hodgkin's Lymphoma: The affected lymph nodes have mixed areas of normal cells, Reed-Stemberg cells and prominent scar tissue. This is the most common type, making up 60% to 80% of all cases. It is more common in adolescents and young adults, but can occur at any age.

Lymphocyte-Rich Classical Hodgkin's Lymphoma: A newly created subtype that was sometimes confused with some lymphocyte predominant cases. It behaves more like mixed cellularity Hodgkin's lymphoma.

Mixed Cellularity Hodgkin's Lymphoma: The affected lymph nodes contain many Reed-Stemberg cells in addition to several other cell types. Mixed cellularity accounts for about 5% to 30% of all cases of Hodgkin's lymphoma. It primarily affects older adults.

Lymphocyte Depletion Hodgkin's Lymphoma: There are large numbers of Reed-Stemberg cells, but very few other cell types are found in the lymph nodes. It is the least common form of Hodgkin's lymphoma and found in less than 5% of the cases. It is seen more often in elderly or in patients with AIDS.

Nodular Lymphocyte Predominance Hodgkin's Lymphoma: This is not considered a classic Hodgkin's lymphoma, because it lacks some of the features that identify Hodgkin's lymphoma and also Non-Hodgkin's lymphoma. Most of the lymphocytes found in the lymph nodes are normal. Abnormal cells, known as "popcorn cells" are a special type of B-cell found in the nodular variety. NLPHL accounts for about 5% or 6% of the cases of Hodgkin's lymphomas. It affects more men than women. The average age of patients is in their mid-30s. This type of Hodgkin's lymphoma is usually diagnosed at an early stage and the prognosis is excellent.

Common symptoms of Hodgkin's lymphoma may include:

  • Painless swelling of lymph nodes (often occurring in the neck or under the arm)
  • Fever or chills
  • Night sweats
  • Unexplained weight loss
  • Lack of energy or fatigue
  • Itching

A cough and shortness of breath or chest discomfort may be early signs of Hodgkin's lymphoma in the chest. Enlargement of the liver and spleen may also occur.

Having one or more of the symptoms listed above does not necessarily mean you have Hodgkin’s lymphoma. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.

Campaña de concienciación en prevención y diagnóstico precoz del linfoma.
Linfomas y aspectos relacionados con los tratamientos médicos del cáncer. Conoce más sobre el Linfome no Hodgkin. Ponente: Dra. Raquel Oña. Servicio de Hematología. MD Anderson Madrid Avances en la investigación en Linfomas. Ponente: Dr. José Luis Solorzano. Servicio de Anatomía Patológica. MD Anderson Madrid Soluciones capilares oncológicas: pelucas y turbantes. Ponente: Óscar Maceda. Director Natura Hair System
Campaña de concienciación en prevención y diagnóstico precoz.
La formación, concienciación y prevención son aspectos fundamentales para nuestra salud y calidad de vida. Este programa es un espacio donde compartir experiencias, adquirir conocimientos y tener un contacto más cercano con los profesionales
El próximo 26 de abril se celebra la LXXXVIII Reunión del Club de Linfomas de la Sociedad Española de Anatomía Patológica (SEAP) en el Auditorio de la Fundación MD Anderson España  que se centrará en los avances en la patología linfoide.

At the moment there are no courses of Hodgkin's Lymphoma

Clinical trials
Un ensayo clinico fase 2 analizando la factibilidad y actividad de claritromicina más lenalidomida en combinación: Un tratamiento completamente oral para pacientes con linfoma asociado a tejido linfoide de las mucosas (MALT) refractario o en recaída.
Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
Estudio Fase II de Plitidepsin en Pacientes con Linfoma Angioinmunoblástico de células T en Recaída o Refractario.
Estudio fase IIIB, prospectivo, randomizado, abierto que evalúa la eficacia y seguridad de Heparina/Edoxaban versus Dalteparina en tromboembolismo venoso asociado con cáncer.
Ensayo clínico fase III, aleatorizado, observador-ciego, controlado con placebo, multicéntrico, para evaluar la eficacia profiláctica, seguridad e inmunogenicidad de la vacuna candidata frente a Herpes Zóster g E/ AS01b de GSK Biologicals cuando se administra por vía intramuscular en una pauta de dosis a adultos receptores de trasplante autólogo de progenitores hematopoyéticos (TPH). Estudio de eficacia clínica de la vacuna frente a Herpes Zoster (Ge/AS01B) en adultos mayores de 18 años receptores de trasplante autólogo de progenitores hematopoyéticos

Since the causes of Hodgkin’s lymphoma are unknown at this time, it is not possible to prevent the disease. There are a few risk factors that may make a person more susceptible to develop Hodgkin’s lymphoma, but most cases of this disease occur in people without any identifiable risk factors. 

Risk Factors
Age: Hodgkin’s lymphoma is most common in early adulthood (15 to 40 years) and late adulthood (55+ years)

Viruses: The Epstein-Barr virus (EBV) or the human immunodeficiency virus (HIV) may increase the possibility of developing Hodgkin’s lymphoma, although the overall risk is still very small.

Family History: Family members of a person having Hodgkin’s lymphoma, have an increase risk of also developing the disease.

Tests & Procedures
Biopsy: A piece of tissue from an area of suspected cancer is removed from the body for examination under the microscope. Hodgkin's lymphoma is diagnosed by looking at cancer cells and determining how they are growing in the lymph nodes or other tissues.

X-Ray: This procedure uses radiation to take pictures of the area inside the body.

Computerized Axial Tomography (CT Scan): X-rays are taken from different angles around the body. The pictures are then combined using a computer to give a detailed image. The most common CT scans ordered are of the neck, chest, abdomen and/or pelvis.

Positron Emission Tomography (PET) Scan: PET combines the fields of medicine, computer science, chemistry, physics and physiology to study the function of organs such as the heart, brain and bone. It is different from conventional imaging methods such as x-rays, CTs, ultrasounds or MRIs, because PET images provide information about how tissue functions. The other imaging methods show what the tissues look like.

Magnetic Resonance Imaging (MRI): An MRI is similar to a CT scan but uses magnets and radio frequency waves instead of x-rays. A MRI can provide important information about tissues and organs that is not available from other imaging techniques. It is less used in Hodgkin's lymphoma than are CT scans, but it can be useful in evaluation of the bones and brain.

Lymphangiogram: A dye (contrast medium) is injected into the lymphatic vessels in both feet. When the body is X-rayed, the lymph nodes and lymphatic vessels containing the dye are more clearly seen on the film as compared to images obtained with regular X-rays.

Gallium (Radioisotope) Scan: Radioactive gallium is a chemical that collects in some tumors. A small amount of gallium is injected into a blood vessel, and it circulates throughout the body. The body is then scanned from several angles to see if the gallium has collected in a tumor. This test can be very useful in management of Hodgkin's lymphoma.

Blood Tests: These are performed to determine if different types of blood cells are normal in numbers and appearance when viewed under the microscope and if blood chemistry is normal. Other standard tests include liver and kidney function tests, B2 microglobulin and LPH tests and other chemical tests.

Bone Marrow Aspiration and Biopsy: Bone marrow is obtained by numbing the skin, tissue and surface of the bone with a local anesthetic. A thin needle is then inserted into the hip or another large bone and a small sample is collected.

Echocardiogram: This diagnostic test is ordered to evaluate the size and function of the heart.

Pulmonary Function Test: determines how well the lungs function. It is an important test since some drugs used to treat Hodgkin's Lymphoma may affect the lungs.

After diagnosis your doctor will order tests that will help determine the extent of your disease. This is known as "staging". The stage describes the extent to which the tumor has spread in the body. Staging is important since it helps to predict outcome or prognosis and determines the treatment approach.

Stage I (early stage): One lymph node region is involved.

Stage II (locally advanced disease): The cancer is found in two or more lymph regions on one side of the diaphragm or the cancer is found in one lymph node region plus a nearby area or organ, a situation known as "extension," or "E" disease.

Stage III (advanced disease): The disease involves lymph nodes both above and below the diaphragm or one node area and one organ on opposite sides of the diaphragm ("E" disease).

Stage IV (widespread disease): The lymphoma is outside the lymph nodes and spleen and has spread to one or more organs such as bone, bone marrow, skin and other organs.

The treatment for Hodgkin's disease depends on the disease stage. The treatment may consist of chemotherapy, radiation therapy, bone marrow and stem cell transplantation or a combination of these four types of treatments.

Chemotherapy is the use of medications to treat cancer. There are many different types of drugs available to treat lymphomas. Doctors may prescribe a single drug but more often combinations of many drugs are used. Chemotherapy drugs have varying ways to kill cancer cells and different side effects. Giving several drugs at once may increase their effectiveness but also may increase the number of side effects.

Radiation Therapy
Radiation is a special kind of energy carried by waves or a stream of energy particles. It may be delivered by a radiation machine or from radioactive substances injected through the bloodstream. External beam radiation equipment is used to aim the radiation at tumors or areas of the body where there is lymphoma. It kills the cells in the area where the radiation beam was aimed.

The following technological means and types of radiation therapy are used with this disease:

  • Virtual CT simulation
  • Intensity modulated radiartio therapy (IMRT)
  • Total skin electron therapy (TSET)

Bone Marrow & Stem Cell Transplantation
Autologous or allogeneic bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) are procedures that restore the supply of normal stem cells that are destroyed by high-dose chemotherapy and/or radiation therapy. In autologous transplantation, the bone marrow or blood stem cells are collected from the patient. In allogeneic transplantation, the bone marrow or blood stem cells are collected from a matched donor of a related or unrelated (non-family) individual.

In bone marrow transplantation, stem cells are taken from inside the donor or patient's hip bone. In peripheral blood stem cell transplantation, the cells are collected from the blood using a procedure called pheresis, similar to donating blood. Before the transplant procedure, patients receive large doses of anti-cancer drugs, alone or in combination with radiation, in order to destroy as many cancer cells. They then receive the bone marrow or stem cell transplant. Bone marrow collection for transplants is very seldom done. Instead, peripheral stem cellcollection is used most often to collect stem cells.

Clinical Trials
New treatments are always being tested in clinical trials and some patients with Hodgkin’s lymphoma may want to consider participating in one of these research studies. These studies are meant to help improve current cancer treatments or obtain information on new treatments. Search MD Anderson's clinical trials database for a current listing of Hodgkin’s lymphoma clinical trials.