What is Hodgkin lymphoma?
Hodgkin lymphoma—formerly Hodgkin’s disease—is a type of cancer that starts in immune cells of the lymphatic system, or lymphoid system. This system includes the lymph nodes, lymph vessels, lymphatic fluid, tonsils, thymus, and spleen, as well as lymphoid tissue of the digestive tract. Hodgkin’s disease can occur nearly anywhere in the body, but it is most often discovered in the neck, chest and underarms. This type of lymphoma was named after Thomas Hodgkin, the physician who first described it in 1832.
The cause of Hodgkin lymphoma is not known, but infection with certain viruses seems to increase the risk of developing it, as does having a weakened immune system. Having a family history of Hodgkin’s disease also increases the risk.
Symptoms of Hodgkin lymphoma often resemble those of a cold or flu and include enlarged lymph nodes, fevers, chills, night sweats, fatigue, and a general ill feeling. To diagnose Hodgkin’s, either a biopsy or surgical removal of an enlarged lymph node can determine if cancer is present. With appropriate treatment, Hodgkin lymphoma is often curable or controllable for many years.
The other type of lymphoma, non-Hodgkin lymphoma (NHL), is more common than Hodgkin lymphoma and has a less favorable prognosis.
People who have Hodgkin lymphoma can develop serious infections. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:
- Bluish or pale lips
- Fast heart rate (tachycardia)
- High fever (higher than 101°F)
- Loss or change in level of consciousness
- Severe difficulty breathing
- Severe sweating
Seek prompt medical care if you have experienced unexpected weight loss, persistent fever, frequent infections, night sweats, tiredness, bone pain, enlarged lymph nodes, or flu-like symptoms that last longer than two weeks.
What are the symptoms of Hodgkin lymphoma?
Many of the symptoms of Hodgkin lymphoma resemble those of a cold or flu, although the disease may not lead to any symptoms.
Common symptoms of Hodgkin lymphoma
Symptoms of Hodgkin’s disease include:
- Abdominal pain or fullness, especially in the upper abdomen
- Enlarged liver and glands, such as the spleen and lymph nodes
- Fever and chills
- Frequent infections
- Itching feeling
- Increased sensitivity to the effects of alcohol, potentially including pain in the lymph nodes after drinking
- Night sweats
Serious symptoms that might indicate a life-threatening condition
In some cases, Hodgkin’s disease can be life-threatening, especially if severe infections occur or if enlarged lymph nodes or collections of fluid interfere with the function of vital organs. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following life-threatening symptoms:
- Bluish coloration of the lips or fingernails
- Change in level of consciousness or alertness, such as passing out or unresponsiveness
- Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
- High fever (higher than 101°F)
- Rapid heart rate (tachycardia)
- Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, choking
- Severe abdominal pain
What are the stages of Hodgkin lymphoma?
The stage of cancer is a way to describe how advanced it is or how much it has grown. Hodgkin lymphoma starts in a lymph node. From there, it can spread to additional lymph nodes, either near the original site or farther away. Hodgkin lymphoma can also grow into organs.
Hodgkin lymphoma staging system has four stages: I, II, III and IV. Stage I and II are limited stages, but if the lymphoma affects an organ outside of the lymph system, the letter E follows the stage, such as stage IIE.
- Stage I (1) is limited to one lymph node or lymphoid organ, such as the thymus gland. Stage IE is cancer in one part of an organ outside of the lymph system.
- Stage II (2) is limited to two lymph node areas, both of which must be above or below the diaphragm. Stage IIE Hodgkin lymphoma extends from one lymph node into an organ near it.
- Stage III (3) is present in lymph node areas above and below the diaphragm or it is in lymph nodes above the diaphragm and in the spleen.
- Stage IV (4) cancer has spread to one or more organs outside the lymphatic system, such as the bone marrow.
Hodgkin lymphoma may go into remission with treatment, when there are no signs of cancer present. Recurrent or relapsed Hodgkin lymphoma is when it comes back after being in remission. Resistant or progressive Hodgkin lymphoma is when it continues to grow during treatment, or does not go into remission with treatment.
What causes Hodgkin lymphoma?
Hodgkin lymphoma begins in a type of white blood cell called a B lymphocyte. There is some evidence that infection of B cells by Epstein-Barr virus (EBV) somehow triggers the development of cancer cells, called Reed-Sternberg cells, possibly by changing the cell’s DNA (genes). Reed-Sternberg cells have many changes in key genes that allow the cells to grow and multiply uncontrollably—the hallmark feature of cancer cells. The immune system also plays a role in Hodgkin lymphoma cancer cell growth.
Since EBV infection is vastly more common than Hodgkin lymphoma (some estimate 90% of the world’s population would test positive for EBV), there are likely additional factors involved in causing Hodgkin lymphoma.
What are the risk factors for Hodgkin lymphoma?
An estimated 8,500 people were diagnosed with Hodgkin lymphoma in 2020 (in the United States). The rate of Hodgkin lymphoma diagnosis has declined by 1.5% per year from 2007-2016. About a quarter of Hodgkin lymphoma cases are in people ages 20 to 29; the second-most common age group is older than 55. Hodgkin lymphoma is the most common type of cancer in adolescents ages 15 to 19.
Hodgkin lymphoma risk factors include:
- Age between 15 and 35 years and over 55 years
- Compromised immune system due to such conditions as HIV/AIDS or other immunodeficiencies, taking corticosteroids, antirejection medications for organ transplant, or cancer and cancer treatment
- Family history of Hodgkin’s disease (siblings of those with Hodgkin lymphoma have a higher-than-average-chance of developing this disease)
- History of infectious mononucleosis (mono), which is caused by the Epstein-Barr virus (EBV)
- Male sex (the disease is more common in men than women)
How do doctors diagnose Hodgkin lymphoma?
In addition to a complete medical history and physical exam—especially of the lymph nodes—diagnostic procedures for Hodgkin lymphoma may include:
- Blood tests: Tests include complete blood count, liver function test, and tests to diagnose infectious causes of your symptoms. (Having lymphoma increases the risk of infections.)
- X-ray of the chest: This common test can show enlarged lymph nodes in the chest area or uncover other possible reasons for your symptoms.
- CT (computed tomography): An imaging procedure with X-rays that produces detailed images of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
- MRI (magnetic resonance imaging): A diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
- PET (positron emission tomography): A type of nuclear medicine procedure. A tiny amount of a radioactive substance, called a radionuclide, is used to help examine the tissue under study. PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process (like cancer) before anatomical changes related to the disease can be seen with CT or MRI alone.
- Lymph node biopsy: A procedure to remove tissue or cells from the body for examination under a microscope. There are several types of biopsies.
How is Hodgkin lymphoma treated?
The goal of Hodgkin lymphoma treatment is to permanently cure the cancer or to bring about a complete remission of the disease. Remission means there is no longer any sign of the disease in the body, although it may recur or relapse later. The specific treatment(s) for Hodgkin lymphoma depend on the stage of cancer and prognosis.
Regular visits with your medical care team are important so that progression or relapse can be identified early and to watch for and treat any complications that might result from the disease or its treatments.
Common treatments for Hodgkin lymphoma
Therapies available to treat Hodgkin lymphoma include:
- Chemotherapy to attack cancer cells
- Radiation therapy to attack cancer cells
- Stem cell transplant to provide healthy stem cells that can make healthy new blood cells
- Targeted monoclonal antibody-chemotherapy and immunotherapy
Other treatments for Hodgkin lymphoma
Other therapies that may be added to help with your overall health and any complications of the cancer or its treatment include:
- Antinausea medications
- Blood transfusions to temporarily replace blood components (such as red blood cells or platelets) that have been reduced or lost
- Dietary counseling to help maintain strength and nutritional status
- Experimental new treatments or regimens in a clinical trial
- Pain medications if needed to increase comfort
- Vaccinations to prevent diseases like the flu and pneumonia
Alternative and complementary treatments for Hodgkin lymphoma
Some complementary treatments may help some people to better deal with Hodgkin lymphoma and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments.
Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are taking nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.
Complementary treatments may include:
- Massage therapy
- Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
In cases in which Hodgkin lymphoma has progressed to an advanced stage and anticancer treatments are no longer controlling the spread, the goal of treatment may shift away from curing the disease and focus on measures to keep a person comfortable and maximize the quality of life.
Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family.
What are the potential complications of Hodgkin lymphoma?
With proper treatment, Hodgkin lymphoma can often be cured or controlled for many years. However, complications of untreated or poorly controlled disease can be serious, even life-threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you.
Complications of Hodgkin lymphoma include:
- Adverse effects of anticancer therapy
- Airway obstruction (blockage of the airways, which can make it difficult to breathe normally)
- Compression of the spinal cord
- Immune deficiency and frequent infections
- Obstruction of blood return to the heart
- Pericardial tamponade (accumulation of fluid in the sac that surrounds the heart, making it difficult for the heart to function normally)
- Peripheral neuropathy (disorder that causes dysfunction of nerves that lie outside your brain and spinal cord)
- Spread of cancer
What is the survival rate and prognosis for Hodgkin lymphoma?
The prognosis and survival rate for Hodgkin lymphoma is very good, relative to other cancers. It is one of the most curable of cancers if caught early enough.
Survival rates for cancer are estimates of how long a person may live from the time of diagnosis. They are usually in five-year increments. The value is based on a large number of people who have had Hodgkin lymphoma and how many were still alive at least five years after diagnosis. A survival rate is an estimate. Actual survival depends on how advanced the cancer is at diagnosis, your overall health, how well you respond to treatment, and other factors.
For Hodgkin lymphoma, the data here are based on people who were diagnosed between 2010 and 2016. The overall 5-year survival rate for Hodgkin lymphoma is 87%. For Hodgkin lymphoma diagnosed at an early stage, the 5-year survival rate is 91%; for HL that has spread to adjacent lymph nodes, the 5-year survival rate is 94%; when HL has spread distantly, 5-year survival is 81%. In children ages 0 to 14, the survival rate is 98%.
In 2020, an estimated 970 people died of Hodgkin lymphoma; the rate of people dying from the disease has been declining by about 4% per year since 2008.