Hodgkin Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma, once known as Hodgkin disease, is a group of blood cancers that usually develops in your lymphatic system. They’re acquired genetic disorders. You’re not born with these disorders. Instead, they happen when genes inside certain cells mutate or change.

While Hodgkin lymphomas are relatively rare, they’re the most common cancers in young adults. Every year, more people are living longer after treatment. Most of the time, people are cured of Hodgkin lymphoma because treatment eliminates all signs and symptoms. That said, this condition sometimes comes back (recurring Hodgkin lymphoma). Medical researchers are investigating treatments for this condition.

How common are Hodgkin lymphomas?

Hodgkin lymphomas are relatively rare, each year affecting about 3 in 100,000 people.

Who’s affected by these conditions?

Hodgkin lymphomas typically affect people in two age groups. The first group is people age 20 to 39. This age group has the highest rate of diagnosis. The second group includes people age 65 and older. Sometimes, people with a Hodgkin lymphoma also have viruses such as mononucleosis (Epstein-Barr virus) or less commonly, human immunodeficiency virus (HIV/AIDS). It may also affect children and teenagers. This article focuses on Hodgkin lymphomas in adults.

How do these conditions affect my body?

Hodgkin lymphomas most commonly affect the lymph nodes in your neck or your mediastinum (chest cavity). They may also develop in groups of lymph nodes under your arms, in your groin, your belly (abdomen) or pelvis.

A Hodgkin lymphoma happens when your B-cells mutate, or develop genetic changes. B-cells are white blood cells that help fight infection. When these cells mutate, they create abnormal cancerous cells called Reed-Sternberg cells.

Reed-Sternberg cells are larger-than-normal cells. They multiply faster and live longer than normal cells. They also make cytokines, substances that attract normal cells to lymph nodes carrying the abnormal cells.

The normal cells, like innocent bystanders in a crowd, get caught up in the action and release substances that make the Reed-Sternberg cells grow. The result is swollen lymph nodes that expanded to accommodate the crowd.

There are two main types of Hodgkin lymphoma: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL).

Classic Hodgkin lymphoma

This is the most common form of Hodgkin lymphoma, representing 95% of cases. Medical specialists called pathologists identify Hodgkin lymphoma by examining lymph nodes or other tissue and blood cells under a microscope for signs of Reed-Sternberg cells. There are four classic Hodgkin lymphoma subtypes:

• Nodular sclerosing Hodgkin lymphoma: This is the most common classic Hodgkin lymphoma subtype. It often affects young adults, especially women and people designated female at birth (DFAB). This subtype 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 people’s bellies (abdomen). People with this subtype have lymph nodes carrying a mixture of many different cell types, including many Reed-Sternberg cells.
• Lymphocyte-rich classic Hodgkin lymphoma: This Hodgkin lymphoma subtype affects about 6% of people with Hodgkin lymphoma. It’s more common in men and people designated male at birth (DMAB) than in women and people DFAB. It’s called lymphocyte-rich because affected lymph nodes carry many normal lymphocytes along with Reed-Sternberg cells.
• Lymphocyte depleted Hodgkin lymphoma: This subtype only affects about 1% of people with Hodgkin lymphoma. It’s most common in people age 60 and older and people who have HIV/AIDS. As the name implies, the condition depletes or replaces normal cells in lymph nodes with abnormal cells.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)

This is a rare form of Hodgkin lymphoma. It affects about 5% of people who have Hodgkin lymphoma. It’s more common in people in their 20s than people in their 60s. It grows more slowly than classic Hodgkin lymphoma, so people may not need treatment right away.

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

There are several differences between non-Hodgkin lymphoma and Hodgkin lymphoma:

• Non-Hodgkin lymphoma typically affects people age 65 and older, while Hodgkin lymphoma may affect people in their 20s and 30s, as well as people age 65 and older.
• Hodgkin lymphoma is relatively rare. Non-Hodgkin lymphoma is the sixth most common cancer type.
• There are more than 70 different types of non-Hodgkin lymphoma. Hodgkin lymphoma has six different types.
• People with non-Hodgkin lymphoma don’t have Reed-Sternberg lymphocytes, the oversized white blood cells that healthcare providers look for when diagnosing Hodgkin lymphoma.
• In Hodgkin lymphoma, biopsy results show the Reed-Sternberg cells along with noncancerous lymphocytes and other immune cells. In contrast, biopsy results for non-Hodgkin lymphoma usually show cancerous lymphoma cells and very few, if any, noncancerous cells.

What are Hodgkin lymphoma symptoms?

The most common symptoms are painless swollen lymph nodes in your neck, underarm or groin. Here are some other symptoms:

• Persistent fatigue: This is feeling much more tired than usual for at least several days.
• Unexplained fever: A fever that stays above 103 degrees Fahrenheit (39.5 degrees Celsius) for two or more hours after home treatment or lasts longer than two days may be a sign of a serious problem.
• Drenching night sweats: This is sweating that’s so intense it drenches your sheets.
• Unexplained weight loss: This is losing body weight without trying. Losing 10% of 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 cavity.

Healthcare providers may call some symptoms B symptoms. B symptoms include fatigue, unintended weight loss and drenching night sweats. Providers consider B symptoms as they make treatment plans and develop prognoses.

What causes the condition?

Hodgkin lymphomas happen when your body produces too many leukocytes or white blood cells. Healthcare providers don’t know all the reasons why this happens. Acquired genetic mutations that affect white blood cell growth play a part. (Acquired genetic mutations are mutations you develop during your lifetime instead of being born with them.) Healthcare providers also know people who have certain infections or problems with their immune system are more likely to develop Hodgkin lymphoma. Healthcare providers have identified factors that may increase your risk of developing Hodgkin lymphoma, including:

• Your age: People age 20 to 40 and people older than 65 are more likely to develop Hodgkin lymphoma.
• Your gender: Men and people DMAB are more likely to develop this condition than women and people DFAB. The exception is nodular sclerosis, a classic Hodgkin lymphoma sub-type that’s more common in women and people DFAB than in men and people DMAB.
• Your family medical history: If you have biological siblings with Hodgkin lymphoma, there’s a slight chance you’re at increased risk of developing the condition.
• You had an organ transplant: If you had an organ transplant, such as a heart, lung or kidney transplant, you need to take antirejection medications that suppress your immune system. That increases your risk of developing lymphoma.
• Having certain viruses: Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS) and Human T-lymphotropic virus Type 1 or Epstein-Barr virus may increase your risk of developing Hodgkin lymphoma.

How do healthcare providers diagnose Hodgkin lymphoma?

A healthcare provider will do a physical examination to look for symptoms that may be signs of Hodgkin lymphoma, such as swollen lymph nodes. They’ll ask you about any changes in your body that you’ve noticed, like a fever that doesn’t go away or if you’ve lost weight without trying. They may do the following tests:

Blood tests

Blood tests give your provider a view of your overall health. They may test your blood for viruses linked to Hodgkin lymphoma, for substances or other characteristics that may be signs of disease. Here’s more information:

• Complete blood count (CBC): This test measures and counts your blood cells.
• Blood chemistry study: This test measures substances that your organs and tissues release into your bloodstream.
• Erythrocyte sedimentation rate (ESR): In this test, providers place erythrocytes (red blood cells) in a test tube and measure how long it takes the cells to settle on the tube’s bottom. Sedimentation rate measures inflammation. High sedimentation rates may be signs of lymphoma.

Imaging tests

• Computed tomography (CT) scan: CT scans make a series of detailed pictures of areas inside the body.
• Positron emission tomography (PET) scan: This test uses a small amount of radioactive tracer to detect tissues that are likely to contain cancer.
• Magnetic resonance imaging (MRI) scan:This test uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside of your body.
• Ultrasound: A procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Other tests

• Lymph node biopsy: Providers may remove all or part of a lymph node to examine the tissue under a microscope for signs of Reed- Sternberg cells. 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.
• Hepatitis B and hepatitis C: Providers may test for hepatitis B and C markers to help plan Hodgkin lymphoma treatment. Markers are virus-specific antigens and/or antibodies. Different markers or combinations of markers show if you’ve been exposed to these viruses.
• Human immunodeficiency virus (HIV):Providers may test for HIV to help them plan Hodgkin lymphoma treatment.

What are the stages of Hodgkin lymphoma?

Once your provider has diagnosed a Hodgkin lymphoma, they use test results to stage the condition. Cancer staging lays the foundation for cancer treatment.

Stage I

• There’s lymphoma in one lymph node area or one lymphoid organ. Your thymus, spleen and bone marrow are lymphoid organs.
• Stage IE: There’s lymphoma in just one area of a single organ outside of the lymph system.

Stage II

• There’s lymphoma in two or more groups of lymph nodes on the same side of (above or below) your diaphragm (the band of muscle separating your chest and belly).
• The lymphoma is part of a group of lymph nodes and is in one area of a nearby organ. In this stage, the lymphoma may also affect other lymph nodes near your diaphragm.

Stage III

• There’s lymphoma in lymph node areas on both sides of (above and below) your diaphragm OR...
• There’s lymphoma 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 bone marrow, liver or lung.

What are other ways healthcare providers characterize Hodgkin lymphomas?

Providers may place your condition in specific categories as they plan treatment. For example, they may characterize early-stage cancer as favorable or unfavorable. The categories are based on cancer stages and risk factors that may increase the chance the lymphoma may come back after treatment. The more risk factors, the more likely Hodgkin lymphoma will come back.

Understanding cancer staging

Cancer staging is how healthcare providers plan treatment and share information about your situation. Healthcare providers use stages to plan Hodgkin lymphoma treatment. They also evaluate risk factors to place conditions in certain categories that characterize prognosis or expected outcomes.

Some people who have cancer may be confused and intimidated by a system that describes their illness with a formula of letters and numbers or risk factors that place them in one category or another. They may even feel as if their condition’s stage or category defines who they are. If this is your situation, talk to your provider. They’ll understand why you may feel this way and will be glad to answer your questions about cancer staging systems.

How do healthcare providers treat Hodgkin lymphomas?

There are several types of treatments for Hodgkin lymphomas. These treatments either kill cancer cells or keep them from dividing. Each treatment has different side effects. Here’s more information:

• Chemotherapy: This 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: Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from multiplying.
• Immunotherapy: This treatment, also called biologic therapy or biotherapy, boosts your body’s immune system. Checkpoint inhibitors are an important part of this class of treatment for Hodgkin lymphoma.
• Targeted therapy: Targeted therapy uses medication or other substances to attack cancer cells. Targeted therapy may include treatments such as antibody-drug conjugates. This treatment uses lab-created antibodies to find the Reed-Sternberg (cancer) cells and destroy them by delivering a drug to the inside of the Reed-Sternberg cells.
• Chemotherapy with stem cell transplantation: Stem cells are immature blood cells in your blood or bone marrow. In stem cell transplantation, providers may do autologous stem cell transplantation Less frequently, they may do allogeneic stem cell transplantation

Can I reduce my risk of developing a Hodgkin lymphoma?

Healthcare providers aren’t sure what triggers the genetic mutations that cause Hodgkin lymphomas, so you can’t prevent the condition.

What is the survival rate for Hodgkin lymphomas?

The survival rate continues to improve as healthcare providers use new and different treatments. Experts estimate that 96% to 99% of people diagnosed with early-stage Hodgkin lymphomas were alive five years after diagnosis. Between 56% and 89% of people diagnosed in the condition’s later stages were alive five years after diagnosis.

Can this condition be cured?

Yes, healthcare providers have treatments that can eliminate Hodgkin lymphomas’ signs and symptoms. That said, there are times when treatment doesn’t work or the conditions come back. When that happens, healthcare providers may recommend stem cell transplantation.

I have a Hodgkin lymphoma. How do I take care of myself?

If you have this condition, you may feel relieved to know treatment often eliminates a Hodgkin lymphoma’s signs and symptoms. Even so, you may wonder and worry if the condition will come back. Here are some suggestions that may help you live with a Hodgkin lymphoma:

• Eat a balanced nutritious diet:There’s no clear link between diet and Hodgkin lymphomas but eating well helps protect your immune system and may reduce your risk of catching a virus. Ask to speak to a nutritionist if you’d like more information or ideas about eating well.
• Manage your stress:Hodgkin lymphomas may come back (recur) after treatment. It can be stressful to wonder and worry if you’re going to be sick again. While managing your stress won’t prevent a recurrence, talk to your provider if you’re spending time and 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.
• Get some exercise: Regular exercise helps support your immune system and helps you manage stress.

When should I see my healthcare provider?

If you’re receiving treatment for a Hodgkin lymphoma, you should 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?

You should contact your healthcare provider or go to the emergency room if you have treatment side effects that don’t subside after taking prescribed medication, are stronger than you expect or continue for a long time.

What questions should I ask my doctor?

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 are those treatment side effects?
• Can you cure my condition?
• Can Hodgkin lymphoma come back?

A note from Cleveland Clinic

Hodgkin lymphoma is a group of rare blood cancers that affect your lymphatic system. Newer treatments may eliminate Hodgkin lymphoma signs and symptoms, essentially curing the condition. Studies show more than 90% of people treated for early-stage Hodgkin lymphomas are alive five years after diagnosis. Changes in your body may not be signs you have a serious illness like Hodgkin lymphoma. But any change that doesn’t go away, like swollen lymph nodes or persistent fevers and fatigue, are issues you may want to discuss with a healthcare provider. It’s always better to know what’s going on in your body than to spend time wondering and worrying.