Hodgkin Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma, once known as Hodgkin disease, is a group of blood cancers that develop in your lymphatic system. It’s one of two main types of lymphoma. The other type is non-Hodgkin lymphoma. These cancers affect important white blood cells in your immune system called lymphocytes.

Hodgkin lymphomas form when genes inside B lymphocytes (B cells) mutate, or change, at some point in your life. Hodgkin lymphomas typically start in the lymph nodes in your neck or chest cavity. They may also develop in groups of lymph nodes under your arms or in your groin, belly (abdomen) or pelvis.

Every year, more people are living longer after receiving treatment for Hodgkin lymphoma. Treatment can often cure Hodgkin lymphoma, eliminating all signs and symptoms. That said, this condition sometimes comes back (recurs). Medical researchers are investigating new treatments for when this happens.

Types of Hodgkin lymphoma

There are four classic Hodgkin lymphoma subtypes:

• Nodular sclerosis Hodgkin lymphoma. This is the most common classic Hodgkin lymphoma subtype. It often affects young adults, especially females. It typically affects lymph nodes in the central part of your chest.
• Mixed cellularity Hodgkin lymphoma. This subtype typically affects people in their 60s. It sometimes develops in your belly (abdomen).
• Lymphocyte-rich classic Hodgkin lymphoma. This Hodgkin lymphoma subtype affects about 6% of people with Hodgkin lymphoma. It’s more common in males.
• Lymphocyte-depleted Hodgkin lymphoma. This subtype only affects about 1% of people with Hodgkin lymphoma. It’s most common in people who are older than 60 years and people who have HIV/AIDS.

How common is Hodgkin lymphoma?

Hodgkin lymphoma is rare, affecting about 3 in 100,000 people each year. However, Hodgkin lymphomas are the most common cancers in teens between 15 and 19 and young adults.

Hodgkin lymphoma is much less common than non-Hodgkin lymphoma.

What are the symptoms of Hodgkin lymphoma?

The most common first sign of Hodgkin lymphoma is painless swollen lymph nodes in your neck, underarm or groin. Other symptoms include:

• Persistent fatigue. This is feeling much more tired than usual for at least several days.
• Unexplained fever. A high fever that remains for two or more hours after home treatment or lasts longer than two days may be a sign of a serious issue.
• Drenching night sweats. This is sweating that’s so intense it drenches your sheets and clothes.
• Unexplained weight loss. This is losing body weight without trying. Losing 10% or more of your total body weight over six months is a sign of unexplained weight loss.
• Itchy skin (pruritus). Some people with Hodgkin lymphoma have very itchy skin after drinking alcohol or taking a bath.
• Belly (abdominal) pain or swelling. Not all belly pain is a sign of serious illness. Contact a healthcare provider if you have severe pain that doesn’t go away.
• Chest pain. This may be a symptom of Hodgkin lymphoma in your lung tissues or lymph nodes inside of your chest.
• Shortness of breath. This could be a sign of Hodgkin lymphoma in your lungs or of a large mass in your chest.

Healthcare providers call fever, unintended weight loss and drenching night sweats associated with lymphoma “B symptoms.” The presence or absence of these symptoms helps your provider determine your prognosis (the likely outcome of your condition) and plan treatments.

What causes Hodgkin lymphoma?

Hodgkin lymphomas form when your B cells develop genetic changes. These changes are acquired. This means you develop them during your lifetime instead of being born with them.

When B cells mutate, they create larger-than-normal cancerous cells called Reed-Sternberg cells. Reed-Sternberg cells make cytokines, substances that attract normal cells to lymph nodes that contain the abnormal cells. The normal cells release substances that make the Reed-Sternberg cells grow. The result is swollen lymph nodes.

The cancer can spread through your lymphatic system to other lymph organs, like your thymus and spleen. It can spread to lymph tissue throughout your body. Rarely, it can involve other organs like your lungs, liver and bone marrow (which makes your blood cells).

Risk factors

Healthcare providers have identified factors that may increase your risk of developing Hodgkin lymphoma, including:

• Your age. You’re more likely to develop this condition if you’re between 20 and 39 years old or older than 65.
• Your sex. Males are more likely to develop Hodgkin lymphoma. The exception is nodular sclerosis, a classic Hodgkin lymphoma subtype that’s more common in females.
• Your family medical history. You have a slightly increased chance of developing the condition if you have biological siblings or parents with Hodgkin lymphoma.
• Having an organ transplant. If you had an organ transplant, you need to take antirejection medications that suppress your immune system. That increases your risk of developing lymphoma.
• Having certain viruses. Having HIV, human T-lymphotropic virus type 1 or Epstein-Barr virus may increase your risk of developing Hodgkin lymphoma.

How is Hodgkin lymphoma diagnosed?

A healthcare provider will do a physical exam to look for signs of Hodgkin lymphoma, like swollen lymph nodes. They’ll ask about any changes you’ve noticed, like a fever that doesn’t go away or losing weight without trying. You may need several tests to diagnose Hodgkin lymphoma, including blood tests, imaging tests or biopsies.

Blood tests

Blood tests give your provider a view of your overall health. They can also detect signs of cancer. Tests you may need include:

• Complete blood count (CBC). This test shows if you have low blood cell counts, which may be a sign of lymphoma in your blood or bone marrow.
• Blood chemistry study. This test measures your electrolyte levels, and liver and kidney function. It measures substances that your organs and tissues release into your bloodstream that may be a sign of tissue damage.
• Erythrocyte sedimentation rate (ESR). This test measures inflammation. High sedimentation rates can be seen in Hodgkin lymphoma.
• Lactate dehydrogenase (LDH) test. This test measures a protein that cells release if they’re damaged. Sometimes, a high LDH rate occurs with lymphoma.
• Tests for viruses. These tests can detect present or past infections associated with Hodgkin lymphoma, like HIV, hepatitis B and hepatitis C. Test results can help your provider plan treatments.

Imaging tests

Imaging tests can show signs of cancer inside your body. The type of imaging test you’ll need depends on where the cancer is located and whether you’re pregnant. (Imaging tests that use X-rays may harm the fetus). Tests include:

• Chest X-ray
• Computed tomography (CT) scan
• Positron emission tomography (PET) scan
• Magnetic resonance imaging (MRI) scan (safe during pregnancy)
• Ultrasound (safe during pregnancy)

Biopsy

Healthcare providers usually diagnose Hodgkin lymphoma using a lymph node biopsy. For this procedure, a provider removes all or part of a lymph node. A pathologist examines the tissue under a microscope for signs of Reed-Sternberg cells. (The presence of Reed-Sternberg cells lets providers know that you have Hodgkin instead of non-Hodgkin lymphoma.)

Sometimes, healthcare providers diagnose Hodgkin lymphoma after analyzing biopsy results of tissue taken from another area of your body, such as your lung, liver, spleen or bone marrow.

What are the stages of Hodgkin lymphoma?

Once your healthcare provider diagnoses a Hodgkin lymphoma, they use test results to stage your condition. Cancer staging helps providers determine how advanced the cancer is, how quickly it may spread and what treatments may work best. Here are the stages for Hodgkin lymphoma:

• Stage I. There are cancer cells in one lymph node area or lymphoid organ (like your thymus, spleen or bone marrow). Or there’s lymphoma in just one area of a single organ outside of your lymph system.
• Stage II. There are cancer cells in two or more groups of lymph nodes on the same side of your diaphragm (may also affect other lymph nodes near your diaphragm).
• Stage III. Lymph node areas on both sides of your diaphragm contain lymphoma cells, or there are cancer cells in lymph nodes above your diaphragm and in your spleen.
• Stage IV. There’s lymphoma in at least one organ outside of your lymph system, such as your liver, lung or bone marrow.

Providers also use labels like “favorable” and “unfavorable” to classify Hodgkin lymphomas based on whether they’re likely to respond well to treatment and stay in remission (no signs or symptoms of cancer).

How is Hodgkin lymphoma treated?

Healthcare providers use different treatment approaches for Hodgkin lymphomas depending on the stage of the cancer. These treatments either kill cancer cells or keep them from dividing. Treatment options include:

• Chemotherapy. This common Hodgkin lymphoma treatment uses one or more drugs to kill cancer cells or keep them from multiplying. Providers may use one type or a combination of chemotherapies.
• Radiation therapy. This therapy uses high-powered energy beams to kill cancer cells in affected lymph nodes or areas of cancer spread. It’s often used with chemotherapy in early-stage Hodgkin lymphoma treatment.
• Immunotherapy. This treatment boosts your body’s immune system, so it’s better at identifying and destroying cancer cells. Checkpoint inhibitors are an important immunotherapy treatment for Hodgkin lymphoma.
• Targeted therapy. Targeted therapy uses medication or other substances to attack cancer cells. Examples include antibody-drug conjugates. This treatment uses lab-created antibodies that are attached to a chemotherapy drug. They find and destroy the cancer cells.
• Chemotherapy with stem cell transplantation. Providers commonly use this treatment when Hodgkin lymphoma has relapsed (come back after remission) or isn’t responding to treatment. In this case, you’ll get different chemotherapy treatment than you did initially. If the cancer responds, your provider will do a stem cell transplant.

Side effects of treatment

Each treatment has different side effects. For example, chemotherapy may cause hair loss or nausea, while radiation can cause sunburn-like skin changes at the treatment site. Immunotherapy side effects include skin rash, diarrhea and shortness of breath and cough because of inflammation in your lungs.

Ask your healthcare provider about potential side effects before treatment. They’ll help you weigh the potential benefits of treatment against the possibility of side effects.

What is the outlook of Hodgkin lymphoma?

Healthcare providers consider Hodgkin lymphoma to be a treatable and highly curable cancer. Your outlook will depend on the stage and other factors that your healthcare provider can discuss with you. That said, there are times when treatment doesn’t work or the cancer comes back. Ask your provider what these classifications mean for your prognosis.

What is the survival rate for Hodgkin lymphoma?

The survival rate for Hodgkin Lymphoma continues to improve as healthcare providers develop new and improved treatments. According to the U.S. National Cancer Institute, 88% of people with Hodgkin lymphoma diagnosed between 2014 to 2020 were alive five years after treatment.

Survival rates vary by cancer stage. According to the same statistics, between 92% to 95% of people with early-stage disease were alive five years after diagnosis. Between 81% to 87% of people diagnosed in later stages were alive after five years.

How do I take care of myself?

You may feel relieved to know treatment often eliminates signs and symptoms of Hodgkin lymphoma. Even so, you may wonder and worry if the condition will come back. Here are some suggestions that may make living with a Hodgkin lymphoma feel more manageable:

• Rest. Both cancer and cancer treatments can lead to extreme fatigue. Take time out to rest when your mind and body need it.
• Eat balanced, nutritious meals. There’s no clear link between the foods you eat and Hodgkin lymphomas. Still, eating well helps protect your immune system and may reduce your risk of catching a virus. Talk to a dietitian if you’d like more information about eating well.
• Manage stress. Hodgkin lymphomas may come back after treatment. Worrying over whether you’re going to get sick again can feel stressful. Talk to your provider if you’re spending emotional energy wondering if your condition will come back. They’re your best resource for information about your situation. Knowing what you can expect may help ease your stress.
• Exercise. Regular exercise helps support your immune system and can help you manage stress. It can also combat fatigue, a common cancer treatment side effect.

The important thing to remember is that a Hodgkin lymphoma diagnosis doesn’t have to keep you from living a full life. You may need to make some adjustments to cope with side effects. You may need to plan for more provider visits than someone living without a cancer diagnosis. But eventually, you’ll find both a routine and a pace that works for you.

When should I see my healthcare provider?

If you’re receiving treatment for Hodgkin lymphoma, contact your provider if you notice changes in your body that may be signs your condition is getting worse despite treatment. If you’ve completed treatment, you’ll have regular follow-up appointments so your provider can monitor your overall health and watch for recurrence.

When should I go to the emergency room?

Go to the emergency room if you have treatment side effects that don’t improve after taking prescribed medication, are stronger than you expect or continue for a long time. Your healthcare provider and team can discuss this with you.

What questions should I ask my healthcare provider?

You’ll probably have many questions as you go through diagnosis and treatment for Hodgkin lymphoma. Here are some questions you may want to ask your healthcare provider:

• What kind of Hodgkin lymphoma do I have?
• What stage is my disease?
• What treatments do you recommend?
• What treatment side effects should I expect?
• Can you cure my condition?
• How likely is it that the cancer will come back?

What’s the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

Both Hodgkin lymphoma and non-Hodgkin lymphoma are cancers that affect your lymphocytes. But several differences distinguish one from the other.