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Hodgkin Lymphoma: Causes, Symptoms & Treatment

Hodgkin lymphoma is a malignant cancer of the lymphatic system. It most commonly affects young adults and has high cure rates when diagnosed and treated early.

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Things worth knowing about "Hodgkin lymphoma"

Hodgkin lymphoma is a malignant cancer of the lymphatic system. It most commonly affects young adults and has high cure rates when diagnosed and treated early.

What is Hodgkin Lymphoma?

Hodgkin lymphoma (also known as Hodgkin disease) is a malignant cancer originating in the lymphatic system, the network of tissues and organs responsible for immune defense. It arises from the uncontrolled proliferation of a specific type of white blood cell, namely B-lymphocytes. The hallmark of this disease is the presence of Reed-Sternberg cells, large abnormal cells identifiable under the microscope in lymph node tissue.

Hodgkin lymphoma most commonly affects young adults between the ages of 20 and 35, as well as older adults over the age of 60. Compared to many other cancers, it is considered highly treatable, with excellent cure rates especially when caught at an early stage.

Causes and Risk Factors

The exact causes of Hodgkin lymphoma are not fully understood. The following factors are associated with an increased risk:

Epstein-Barr virus (EBV): A prior infection with EBV, the virus responsible for infectious mononucleosis, is considered a significant risk factor.
Genetic predisposition: Having a sibling with the disease is associated with a slightly elevated risk.
Immune deficiency: People with weakened immune systems, such as those living with HIV or undergoing immunosuppressive therapy after organ transplantation, are at higher risk.
Sex: Males are slightly more frequently affected than females.

Symptoms

Common symptoms of Hodgkin lymphoma include:

Painless swelling of lymph nodes, most often in the neck, armpits, or groin
B symptoms: Fever (above 38 °C), drenching night sweats, and unexplained weight loss of more than 10% of body weight within six months
Persistent cough or shortness of breath when lymph nodes in the chest are affected
Generalized itching all over the body without a visible rash
Persistent fatigue and reduced physical performance
Pain in lymph nodes after alcohol consumption (a rare but characteristic sign)

Diagnosis

The diagnosis of Hodgkin lymphoma involves several steps:

Physical Examination and Blood Tests

An initial physical examination includes palpation of lymph nodes. Blood tests may reveal elevated inflammatory markers and changes in blood cell counts.

Imaging Procedures

Computed tomography (CT) or PET-CT (positron emission tomography combined with CT) scans are used to visualize affected lymph nodes and organs throughout the body. PET-CT is particularly valuable for staging and for monitoring treatment response.

Lymph Node Biopsy

A biopsy of an enlarged lymph node is the definitive diagnostic step. The removed tissue is examined in the laboratory for the presence of Reed-Sternberg cells, which confirm the diagnosis.

Staging

Hodgkin lymphoma is classified using the Ann Arbor staging system into four stages (I to IV), based on the extent of disease spread throughout the body. Staging is critical for guiding treatment decisions.

Treatment

Hodgkin lymphoma responds very well to treatment. Therapy is tailored to the disease stage, the age of the patient, and overall health status.

Chemotherapy

Chemotherapy is the cornerstone of treatment. The most commonly used regimen is the ABVD protocol (Adriamycin, Bleomycin, Vinblastine, Dacarbazine). For advanced or more aggressive cases, the escalated BEACOPP regimen may be applied.

Radiation Therapy

Radiation therapy is frequently used in combination with chemotherapy to target remaining tumor cells, particularly in localized early-stage disease.

Targeted Therapy and Immunotherapy

For relapsed or refractory disease, modern therapies are available:

Brentuximab vedotin: An antibody-drug conjugate that specifically targets CD30-positive tumor cells.
Checkpoint inhibitors (e.g., nivolumab, pembrolizumab): These immunotherapy agents reactivate the immune system to recognize and destroy cancer cells.

Stem Cell Transplantation

In cases of relapse, an autologous stem cell transplantation (using the patient's own stem cells) can represent a curative treatment option.

Prognosis

Hodgkin lymphoma has an excellent prognosis compared to many other cancers. In early stages (Stage I and II), five-year survival rates exceed 90%. Even in advanced stages, cure rates of 70–80% are achievable. Long-term side effects of therapy, such as cardiac complications or secondary cancers, must be monitored during follow-up care.

References

Engert A. et al. - Hodgkin Lymphoma: ESMO Clinical Practice Guidelines. Annals of Oncology, 2018.
World Health Organization (WHO): Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon, 2017.
National Cancer Institute (NCI): Hodgkin Lymphoma Treatment (PDQ) - Patient Version. Available at: https://www.cancer.gov

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