Hodgkin's lymphoma treatment at GenesisCare

Hodgkin lymphoma, also known as Hodgkin disease, is a type of blood cancer that affects the lymphatic system. It is named after Thomas Hodgkin, who first discovered the disease.

The lymphatic system is made up of organs, vessels and tissues. Three of its functions are:

• removal of cellular waste
• absorbing digestive fat
• production of immune cells to help fight infections.

The lymphatic system contains white blood cells called lymphocytes. Hodgkin lymphoma starts in these lymphocytes and causes abnormal lymphocytes, which typically reside in the lymph glands. The abnormal cells grow and multiply, leading to lymph node swelling.

The lymph nodes are the most common part of the body to be affected. But Hodgkin lymphoma can also involve the spleen and other extra-nodal sites such as bone and lungs. Hodgkin lymphoma can also cause systemic symptoms such as fevers, drenching night sweats, lethargy and weight loss.

Hodgkin lymphoma is less common than non-Hodgkin lymphoma and accounts for around 10% of all lymphoma cases.¹ It is diagnosed when a certain type of abnormal cell, called a Reed-Stenberg cell, is detected on a biopsy of an abnormal lymph node. 

There are two main types of Hodgkin lymphoma:

• Classical Hodgkin lymphoma – features large abnormal cells called Reed-Stenberg cells that are found on lymph node biopsy. There are four subcategories of classical Hodgkin lymphoma:
  • Nodular sclerosis Hodgkin lymphoma – occurs in lymph nodes in the chest or neck
  • Mixed cellularity Hodgkin lymphoma – usually occurs in the lymph nodes of the upper body
  • Lymphocyte-rich classic Hodgkin lymphoma – typically diagnosed at an early stage
  • Lymphocyte-depleted Hodgkin lymphoma – a rare type usually found in lymph nodes in the liver, stomach, spleen and bone marrow. 
• Nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) – features abnormal cells called “popcorn cells” which look like popcorn when viewed under a microscope. It often grows more slowly than classical Hodgkin lymphoma and is treated differently.

Many people with Hodgkin lymphoma have mild or minimal signs and symptoms. The most common is a painless swelling in the lymph nodes, particularly on the side of the neck or groin or in the armpit.

Other symptoms may include:

• fever
  
• night sweats
• weight loss
• fatigue
• persistent coughing
• shortness of breath
• itching or skin rashes

Some symptoms of Hodgkin lymphoma are referred to as ‘B symptoms’. These symptoms can help doctors predict the severity of the disease. They include:

• frequent, unexplained fevers
• regular night sweats that leave you drenched
• losing large amounts of weight very quickly

Having any of these symptoms doesn’t mean you have Hodgkin lymphoma, but you should see your doctor for a check-up.

It’s not known what causes Hodgkin lymphoma. However, some factors appear to increase the risk of getting the disease. These include:

• Genetics Certain genes are believed to play a role in the development of the disease²
• Family history Having a first-degree relative who has had Hodgkin lymphoma slightly increases the risk of developing it
• Certain viruses The Epstein-Barr virus which causes glandular fever, and HIV are associated with a minority of Hodgkin lymphoma cases
• Weakened immune system Autoimmune diseases such as rheumatoid arthritis or a weakened autoimmune system from taking certain medications can slightly increase the risk of developing Hodgkin lymphoma

Having any of these symptoms doesn’t necessarily mean you have testicular cancer, but you should see your doctor for a check-up.

Your GP will probably refer you to a specialist if they are concerned about your symptoms and risk factors for Hodgkin lymphoma. They may arrange a lymph node biopsy, which involves removing samples of cells and tissue from an enlarged lymph node to be examined. Two types of biopsy can be used:

• Excision biopsy The lymph node, or part of it, is removed with surgery. This is the preferred way to take a biopsy for Hodgkin lymphoma as it provides a large sample for analysis
• Core biopsy A needle is inserted into a lymph node to remove cells and tissue. This approach is usedwhen it would be difficult to remove the entire lymph node with surgery

If a biopsy confirms Hodgkin lymphoma, you will need further tests to see if the cancer has spread. These might include:

• Blood tests You will likely have a Full Blood Count (FBC), which assesses the number of red cells, white cells and platelets in the blood. Blood tests may also help determine if your kidneys and liver are working well
  
• Imaging tests These might include an ultrasound to find other swollen lymph nodes, and a PET-CT scan of your neck, chest, abdomen and pelvis to work out how far the Hodgkin lymphoma has spread. This helps create a detailed picture of your body
• Bone marrow biopsy A sample of bone marrow is taken from the pelvic bone and examined under a microscope
• Cardiac testing An echocardiogram (ultrasound of the heart) or gated heart pool test (nuclear medicine scan of the heart) is usually performed to appraise your baseline cardiac function, prior to chemotherapy
• Lung function tests Lung function tests are sometimes performed to check your respiratory function prior to chemotherapy
• Fertility preservation Depending on your age and personal wishes, referral to a fertility specialist to arrange urgent semen cryopreservation (sperm freezing), oocyte cryopreservation (egg freezing) or in vitro fertilization (IVF) to facilitate embryo collection and storage may be warranted, as many types of chemotherapy for lymphoma can cause temporary (or permanent) infertility

If you are found to have lymphoma, your doctor will explain which of the four stages you have and how far your cancer has progressed. Stage 1 is the least advanced stage, with Stage 4 being the most advanced stage. 

Treatment for Hodgkin lymphoma is most commonly chemotherapy and radiation therapy. These are often used together to improve the results. Your doctor will discuss treatment options with you.

Other treatments may include:

• immunotherapy
• stem cell or bone marrow transplant
• steroids
• targeted therapy

We understand that a cancer diagnosis can be emotional and life changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.

Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re at GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Whether you experience side effects and how severe they are depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short term and can be managed. These may include:

• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• reduced immunity which can lead to infection
• weight changes
• skin changes
• mood changes
• sores and pain around the mouth

These symptoms tend to improve gradually once treatment stops and the normal, healthy cells recover. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
  
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for skin if you are getting irritation or pain
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

These may include:

• fatigue
• bowel issues
• headaches
• fever or chills
• nausea or vomiting
• weight loss
• itching or localised rashes

General side effects of radiation therapy include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated) include:

• digestive issues – reduced appetite, pain, discomfort or bloating
• change in bowel habits
• nausea or vomiting
• radiation therapy in the neck can increase the risk of an underactive thyroid gland

Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you, depending on the tumour type.

Side effects from a stem cell transplant can also include the side effects of chemotherapy or radiation therapy that may be performed before the transplant. These may include:

• nausea and vomiting
• stomach cramps
• infection

These may include:

• problems sleeping
• mood changes
• weight gain
• heartburn

The side effects may vary depending on the type of targeted therapy you receive and how your body reacts. These may include:

• diarrhoea
• fatigue
• nausea
• numbness or tingling
• headaches
• skin rashes

References

1. Lymphoma: Ayesha Jamil; Shiva Kumar R. Mukkamalla. https://www.ncbi.nlm.nih.gov/books/NBK560826/
2. Highly recurrent mutations of SGK1, DUSP2 and JUNB in nodular lymphocyte predominant Hodgkin lymphoma; https://www.nature.com/articles/leu2015328?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=CONR_PF018_ECOM_GL_PHSS_ALWYS_PRODUCT&utm_content=productdatafeed&utm_term=PID100090071&CJEVENT=bbd89866a4de11ec81a900d40a1c0e12