Hodgkin lymphoma is a cancer that originates in the lymphatic system, an extensive network of tissues and organs that helps rid the body of toxins and waste. An essential part of the immune system, the lymphatic system transports lymph, a fluid containing infection-fighting white blood cells, throughout the body. As lymph drains from bodily tissues, it is filtered through lymph nodes and lymphoid organs, which detect and destroy foreign invaders such as viruses and bacteria.
Hodgkin lymphoma occurs when the infection-fighting cells in a lymph node or lymphoid organ grow uncontrollably. The excess cells may spread throughout the body via lymphatic circulation or form a mass that presses on nearby tissues. In many cases, the cancer originates in a lymph node in the neck or between the lungs and breastbone. It can also begin in a group of lymph nodes under an arm or in the groin area.
After Hodgkin lymphoma is diagnosed, a numeric stage and letter category may be assigned to describe the extent of the cancer, the parts of the body affected and the associated symptoms. Physicians utilize this important information when evaluating treatment options.
How staging is determined
When staging Hodgkin lymphoma, a physician will typically review the patient’s medical history and symptoms and evaluate the results of one or more diagnostic tests, such as a:
- Physical examination, including an assessment of the lymph nodes, spleen and liver
- Chest X-ray
- Computed tomography (CT) scan of the chest, stomach or pelvic area
- Positron emission tomography (PET) scan
- Blood test
- Excisional or incisional biopsy of an enlarged lymph node
- Bone marrow aspiration and biopsy
The staging system used for Hodgkin lymphoma is the Lugano classification, which consists of four numeric stages. After determining how far the cancer has spread from the lymphatic tissue where it originated, a physician may assign:
- Stage 1 – The cancer is confined to one lymph node or lymphoid organ, such as the thymus, or one organ outside the lymphatic system.
- Stage 2 – The cancer affects two or more lymph nodes on one side of the diaphragm or has spread locally from one lymph node to one nearby organ outside the lymphatic system.
- Stage 3 – The cancer affects two or more lymph nodes on both sides of the diaphragm or one lymph node above the diaphragm and the spleen.
- Stage 4 – The cancer has spread widely to tissues and organs outside the lymphatic system, such as the liver, lungs or bones.
If stage 1 or 2 is assigned and the cancer has spread to an organ outside the lymphatic system, the letter “E,” may be added to the numeric stage to indicate that the cancer is extranodal.
Hodgkin lymphoma may be described as bulky disease if:
- A tumor in the chest spans at least a third of the entire chest width
- A tumor elsewhere in the body is 10 centimeters in diameter or larger
If bulky disease is diagnosed, the letter “X” may be added to the numeric stage.
Other letter classifications
In total, there are five letter categories of Hodgkin lymphoma. In addition to the letters “E” and “X,” the letters “A” or “B” may be assigned based on the presence or absence of certain symptoms:
- Category A – No symptoms.
- Category B – Symptoms include unexplained weight loss, drenching night sweats or fever.
Additionally, the letter "S" may be added to the numeric stage if the cancer has spread to the spleen.
Resistant or recurrent
While not part of the formal staging system, the terms “resistant” and “recurrent” are sometimes used to describe Hodgkin lymphoma as follows:
- Resistant – The cancer persists or progresses during treatment.
- Recurrent – The cancer went away with treatment, but later returned to the same tissue or organ where it started or another part of the body. This can happen shortly after treatment or many years later.
Hodgkin lymphoma treatment at Moffitt
In the Malignant Hematology Program at Moffitt Cancer Center, we take an individualized approach to Hodgkin lymphoma treatment. We offer a full range of options, including chemotherapy, immunotherapy, radiation therapy, radioimmunotherapy, stem cell transplantation and photopheresis, as well as a robust portfolio of clinical trials. After evaluating multiple patient-specific factors and taking into account evidence-based best practices, we develop a customized treatment plan for each patient.