Hodgkin's lymphoma (also called Hodgkin's disease) is one of the two main types of lymphoma.  A lymphoma is a cancer of the lymph system.  Hodgkin lymphoma affects more than 8000 people annually in the United States.

There are five main types of Hodgkin Lymphoma.  They differ in whom it affects, the parts of the body more likely to be affected, and in what stage it is usually diagnosed.

• Nodular Sclerosing Hodgkin Lymphoma (NSHL):  This is the most common type of Hodgkin Lymphoma. In the developed countries 60 to 80 percent of the people affected by Hodgkin disease have the Nodular Sclerosing subtype. It is commoner in females and mostly affects younger people — adolescents and young adults. The disease mainly affects nodes in the neck or armpits, or within the chest.
• Mixed Cellularity Hodgkin Lymphoma (MCHL):  This is another common type of Hodgkin Lymphoma. 15 to 30 percent of those affected have mixed cellularity disease. This type is more common in developing countries.  People of any age may be affected. Males and females are equally affected. This type of disease is more likely to involve the abdomen than the more common nodular sclerosing variety, and less likely to involve nodes within the chest.
• Lymphocyte Depleted Hodgkin Lymphoma (LDHL):  The Lymphocyte depletion subtype is a very rare form of Hodgkin Lymphoma that makes up only about 1 percent of those affected by the disease. It affects older people and is often diagnosed in an advanced stage when the lymphoma has affected different organs of the body. It is also more common in those who are HIV affected.
• Lymphocyte-rich Classic Hodgkin Lymphoma (LRCHL):  This is another uncommon subtype that makes up about 5 to 6 patients of Hodgkin patients. It is more common in males and affects people most commonly in their 30s or 40s. Most individuals are diagnosed in early stages and response to treatment is excellent.
• Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL):   Now considered to be a special type of Hodgkin disease that is different from the other types mentioned above, this variant accounts for 4 to 5 percent of all cases of Hodgkin disease.  According to pathologists this type has many similarities with Non-Hodgkin Lymphoma (NHL).  In all clinical aspects, however, the features are similar to the lymphocyte-rich type of Hodgkin lymphoma. Most individuals are diagnosed early and do very well after treatment. 

The following are risk factors for Hodgkin's lymphoma:

• Age:  People between the ages of 15 and 40, as well as those older than 55, are most at risk of Hodgkin's lymphoma.
• Family history:  Anyone with a brother or a sister who has the disease faces an increased risk of developing Hodgkin's lymphoma, though this may be due to similar environmental exposures rather than genetic factors.
• Sex:  Males are slightly more likely to develop Hodgkin's lymphoma.
• Past Epstein-Barr infection:  People who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin's lymphoma than are people who haven't had these Epstein-Barr infections.
• Compromised immune system:  Having a compromised immune system, such as from HIV/AIDS or from having an organ transplant requiring medications to suppress your immune response, also appears to put you at a greater risk of Hodgkin's lymphoma.
• Geography:  Hodgkin's lymphoma is most prevalent in the U.S., Canada and northern Europe. It's least common in Asian countries.
• Socioeconomic Status:  Hodgkin's lymphoma is more common in people with higher socioeconomic background.  

Hodgkin's lymphoma commonly affects young people.  The commonest symptom is enlarged lymph nodes.  Lymph nodes are enlarged in the neck, armpits, groin or within the chest. Apart from enlarged nodes, those with lymphoma may have weight loss, fever, itching and drenchin sweats at night.

Hodgkin's lymphoma is identified from a lymph node biopsy.  What helps the pathologist looking at the node under the microscope to identify Hodgkin disease is the presence of the Reed-Sternberg cell.  This is the cancer cell of Hodgkin disease and it looks rather like an owl under the microscope.  When these cells are present, the pathologist can differentiate Hodgkin from Non-Hodgkin lymphoma and other benign conditions.

The pathologist also identifies the type of this lymphoma.  There are 4 types of Hodgkin's lymphoma, and they are often quite different in terms of prognosis and treatment options. 

The treatment of Hodgkin disease depends mainly on the extent of involvement (the stage) and not on the type of disease.  In certain circumstances however, the type of disease may predict the chances of certain areas of the body being affected, and may influence the doctors’ choice of treatment modality.

Hodgkin Lymphoma can be treated with chemotherapy, radiotherapy or a combination of both.  The decision on the exact course of treatment is usually decided on a number of factors.  The most important is the stage of your disease.  Other factors are also important.  The number of nodes involved, the size of the tumor in your chest, the presence of lymphoma in other organs, some blood test reports, and even your age are related to the type of treatment which works best.

Chemotherapy is one of the main treatment options for Hodgkin disease.  A combination of three or more drugs are generally used.  All or most of the drugs are administered either as quick injections or as slow infusions into your veins.  Some drugs may be taken as pills.  There are a number of effective drug combinations. The most common is called ABVD.  The choice of the exact schedule depends on your doctor.  Chemotherapy is typically administered every 2-3 weeks for a number of ‘cycles’.

Radiation therapy is also very effective in Hodgkin disease.  Radiation can be used as the only treatment, or added after chemotherapy.  Taking radiation treatment is much like getting an X-ray taken.  You lie flat on a couch, and a machine delivers X-rays to a part of your body from a distance.  Radiation treatments are usually given 5 days a week for 3-5 weeks.  Hodgkin lymphoma responds well to radiation and very high doses are not required.

When you have Stage I or Stage II disease and no other bad risk factors, you may be offered:

• Radiotherapy alone to a large area (extended field radiation)
• Combination chemotherapy for a few cycles followed by radiation to a small area (involved field radiation)

Both forms of treatment are very successful and most patients are cured.

If you have some poor risk factors that are mentioned above, you will probably be treated with combination chemotherapy followed by radiation.

Treatment for Stage III and IV disease mainly involves chemotherapy.  Chemotherapy can reach the disease in all parts of your body through your blood.  Radiotherapy may be added later to some parts where the disease was bulky, or if chemotherapy is unable to take care of the disease completely in a particular area.  Since there is some scope to improve the results of advanced stage Hodgkin lymphoma, you may be asked to participate in a clinical trial using a new combination of drugs.

If your disease has relapsed after having disappeared following initial treatment, you may be treated with a different set of chemotherapy drugs.  You can also be offered 'high-dose chemotherapy with autologous stem cell rescue'.  This involves treatment with a high dose combination of drugs to destroy all cancer cells.  The damage to your bone marrow is reversed by transplanting some marrow that has been stored in advance.  This treatment has shown the best results in relapsed disease.