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What You Need To Know About Hodgkin Lymphoma: Symptoms, Treatment, and Prognosis

Posted on March 17, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Kristopher Bunting, M.D.

Hodgkin lymphoma, sometimes called “Hodgkin disease,” is a type of blood cancer called a “lymphoma.” Lymphomas form in the lymphatic system, which is part of both the immune system and the circulatory system. The lymphatic system includes lymph nodes and organs including the spleen and thymus gland. The lymphatic system’s purpose is to remove waste, bacteria, and extra fluid from the body.

There are two main types of lymphoma, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). There are many subtypes of each.

Hodgkin lymphoma is less common than non-Hodgkin lymphoma. It is a very treatable cancer with an excellent survival rate after treatment. A hallmark of Hodgkin lymphoma is that it spreads through the body in a predictable pattern. NHL spreads less predictably.

What Causes Hodgkin Lymphoma?

The causes of Hodgkin lymphoma are not fully understood. It can occur due to DNA mutations in lymphocytes, a type of immune cell. Mutations of oncogenes (genes that help cells grow) or tumor suppressor genes (genes that slow cell division) also can cause cancer.

Some of the main risk factors for developing Hodgkin lymphoma include being previously infected with the Epstein-Barr virus (the virus that causes mononucleosis), having a compromised immune system, and being infected with HIV.

Learn more about what causes Hodgkin lymphoma.

Signs and Symptoms of Hodgkin Lymphoma

Both Hodgkin and non-Hodgkin lymphomas have many of the same symptoms. Three of these symptoms — fever, night sweats, and unexplained weight loss — are called “B symptoms.” B symptoms are used to help determine the stage of Hodgkin lymphoma, as well as its prognosis.

Common signs and symptoms of Hodgkin lymphoma include:

  • Swollen lymph nodes — New or persistent painless lumps in the neck, armpits, or groin
  • Fever — An unexplained fever without infection that lasts for weeks or months
  • Night sweats — Excessive sweating that occurs while sleeping, sometimes soaking sheets or clothes
  • Weight loss — Sudden weight loss that occurs without a change in diet, exercise, or medication, especially over the course of weeks or months
  • Fatigue — Persistent physical or mental tiredness or exhaustion that does not improve with rest
  • Coughing or chest pain — Chronic cough and pain or pressure in the chest that is not explained by other medical conditions
  • Shortness of breath — Difficulty breathing, especially when lying down
  • Itching — Localized or widespread unexplained itching (pruritus) that can be severe enough to cause a burning sensation and may happen after being exposed to heat or drinking alcohol

These symptoms can occur in other medical conditions, including other types of cancer. They become a cause for concern when they are unexplained by other causes and last for longer than a few days or weeks.

Read more about the symptoms of Hodgkin lymphoma.

Diagnosis of Hodgkin Lymphoma

Diagnosis of Hodgkin (and non-Hodgkin) lymphoma begins with a thorough medical history to identify symptoms and risk factors for lymphoma, as well as a physical exam to identify any physical signs of disease.

Tests to accurately diagnose and stage Hodgkin lymphoma include biopsies of tumors and bone marrow, imaging tests, and blood tests. A pregnancy test is also very important in women of reproductive age.

Determining the stage of Hodgkin lymphoma involves identifying which organs are affected and how far the disease has spread in the body. Staging helps doctors determine the most appropriate treatments and prognosis.

Physical Exam

A thorough physical exam for lymphoma includes careful palpation (feeling by hand) of the neck, armpits, and groin for swollen lymph nodes. Palpation of the abdomen is also important to check for enlargement of the spleen.

Biopsy

In a biopsy, a small sample of a tumor or tissue is removed from the body for testing. Pathologists analyze the sample under a microscope to look for abnormalities in cells. They can determine whether the sample is cancer and, if so, what kind of cancer it is. Doctors may also use genetic testing to look for specific proteins and DNA mutations to diagnose lymphoma. Genetic testing is more common in non-Hodgkin lymphoma.

Types of biopsies used for Hodgkin lymphoma include:

  • Excisional or incisional biopsy — Surgical removal of an entire lymph node or a significant portion of it
  • Core needle biopsy — A biopsy using a large needle to remove a core sample of a lymph node that is difficult to reach
  • Fine needle aspiration — A biopsy using a small needle to collect a very small amount of cells
  • Bone marrow biopsy — Removal of a portion of bone and bone marrow, usually from the pelvis

Imaging

Imaging tests can help locate tumors in the body. Tests may include:

  • X-rays — X-rays can help doctors find other explanations for your symptoms or check your chest for swollen lymph nodes.
  • Computed tomography (CT) scans — CT scans create 3D images of the whole body or portions of it. CT scans that use a contrast agent (either taken by mouth or injected into the bloodstream) can highlight blood vessels as well.
  • Positron emission tomography (PET) scans — PET scans use a radioactive tracer injected into the bloodstream to identify tissue and organs with a high metabolism, such as cancer cells.
  • Magnetic resonance imaging (MRI) scans — MRI scans use a very strong magnetic field to produce images of the soft tissues in the body.

Blood Tests

The most important blood tests for Hodgkin lymphoma are complete blood count and erythrocyte sedimentation rate (ESR) tests. Blood tests for liver and kidney function and conditions such as HIV, hepatitis B, and hepatitis C are also needed to determine the best treatments for an individual.

Complete Blood Count

Complete blood count testing measures the amount of red blood cells (erythrocytes), hemoglobin, white blood cells (leukocytes), and platelets in a person’s blood. Further testing can show the different types of white blood cells in a blood sample and whether they appear abnormal.

Erythrocyte Sedimentation Rate

ESR is a measure of inflammation in the body. It is important in the diagnosis of Hodgkin lymphoma.

Learn more about diagnosing Hodgkin lymphoma.

Stages of Hodgkin Lymphoma

Different types of cancer use different systems for staging. Cancer stages are described as stage 1, 2, 3, or 4 with subclassifications. Cancer stages are sometimes noted with Roman numerals, as stages I through IV. Both Hodgkin and non-Hodgkin lymphoma are staged using the Lugano classification system.

Stages are based on whether the lymphoma is localized or widespread. One very important factor in lymphoma staging is whether the lymphoma has spread from one side of the diaphragm (the muscle under the lungs separating the chest from the abdomen) to the other. Stages are defined further by the size of the tumor and whether B symptoms are present.

Lymphoma stages include:

  • Stages 1 and 2 — The lymphoma is limited to one side of the diaphragm and involves lymph nodes and/or one organ outside the lymphatic system.
  • Stages 3 and 4 — The lymphoma has spread to both sides of the diaphragm and may include organs outside of the lymphatic system.

Read more about the stages of Hodgkin lymphoma.

Subtypes of Hodgkin Lymphoma

Hodgkin lymphoma has two main subtypes: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Identifying the subtype of lymphoma helps determine how to best treat it.

Classic Hodgkin Lymphoma

Classic Hodgkin lymphoma is defined by the presence of Reed-Sternberg cells. Subtypes of this type of lymphoma include:

  • Nodular sclerosis Hodgkin lymphoma — The most common form of Hodgkin lymphoma, this type is frequently seen in teens and young adults and often affects lymph nodes in the chest and neck.
  • Mixed cellularity Hodgkin lymphoma — Another common type of Hodgkin lymphoma, this type is most frequently seen in people with HIV, as well as children and older adults.
  • Lymphocyte-rich Hodgkin lymphoma — This type is uncommon and is usually limited to a few lymph nodes.
  • Lymphocyte-depleted Hodgkin lymphoma — A rare form of Hodgkin lymphoma, this subtype is seen mostly in people with HIV and older adults. It’s aggressive, and it’s usually in an advanced stage when diagnosed.

Nodular Lymphocyte-Predominant Hodgkin Lymphoma

This is an uncommon form of Hodgkin lymphoma, accounting for roughly 5 percent of cases. It is highly curable, but it may transform into an aggressive non-Hodgkin lymphoma.

Read more about types of Hodgkin lymphoma.

Treatment of Hodgkin Lymphoma

Treatment of classic Hodgkin lymphoma usually includes a combination of therapies, such as chemotherapy, radiation therapy, targeted therapy, and stem cell transplant. The best course of treatment for Hodgkin lymphoma is determined by the lymphoma’s subtype and stage as well as the person’s age and overall health.

Chemotherapy

Chemotherapy for Hodgkin lymphoma varies by subtype. According to the American Cancer Society, chemotherapy combinations used to treat Hodgkin lymphoma include:

  • ABVD — Adriamycin (doxorubicin), Blenoxane (bleomycin), vinblastine, and DTIC-Dome (dacarbazine)
  • BEACOPP — Blenoxane (bleomycin), VP-16 (etoposide), Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Oncovin (vincristine), Matulane (procarbazine), and prednisone
  • Stanford V — Adriamycin (doxorubicin), Mustargen (mechlorethamine), Oncovin (vincristine), vinblastine, Blenoxane (bleomycin), VP-16 (etoposide), and prednisone

Radiation Therapy

Several types of radiation therapy are used to treat Hodgkin lymphoma. Radiation therapy is usually used in addition to chemotherapy, but sometimes it is used alone. External beam radiation therapy can be used in a small, limited area where the cancer is located.

Targeted Therapy

Targeted therapy includes immunotherapy with monoclonal antibodies and treatment with small-molecule drugs. Monoclonal antibodies attach to specific proteins found on the surface of cancer cells. Different treatments are used depending on the type of Hodgkin lymphoma.

Some monoclonal antibodies used to treat Hodgkin lymphoma include:

  • Adcetris (brentuximab vedotin), which targets the CD30 antigen
  • Rituxan (rituximab), which targets the CD20 antigen
  • Keytruda (pembrolizumab) and Opdivo (nivolumab), which both target the PD-1 protein on T cells

Stem Cell Transplant

Stem cell transplantation is frequently used with high-dose chemotherapy. Stem cells are collected from a person’s own blood or bone marrow prior to chemotherapy. After the person completes the chemotherapy course, their stem cells are transplanted back into their blood or bone marrow.

Palliative Care

Another important part of any cancer treatment plan is palliative care. Palliative care aims to help people deal with the complications of cancer and cancer treatment. Palliative care focuses on improving quality of life by treating symptoms caused by illness and treatment. It also connects people undergoing cancer treatment — and their caregivers — with emotional and spiritual support.

Learn more about treatments for Hodgkin lymphoma.

Prognosis

A diagnosis of Hodgkin lymphoma usually has an excellent prognosis; the overall five-year survival rate in the United States is 88.3 percent. A diagnosis of stage 1 or stage 2 Hodgkin disease improves the five-year survival rate to over 90 percent. A stage 4 diagnosis still has a 78.5 percent survival rate, which is better than the overall five-year survival rate for all cancers combined (67.7 percent).

Read more about Hodgkin lymphoma survival rate and outlook.

Talk With Others Who Understand

MyLymphomaTeam is the social network for people with lymphoma and their loved ones. On MyLymphomaTeam, more than 10,800 members come together to ask questions, give advice, and share their stories with others who understand life with lymphoma.

Are you or someone you care for living with Hodgkin lymphoma? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. What Is Lymphoma? — Lymphoma Action
  2. Lymphoma — Centers for Disease Control and Prevention
  3. What Causes Hodgkin Lymphoma? — American Cancer Society
  4. Causes: Hodgkin Lymphoma — NHS
  5. Symptoms of Lymphoma — Lymphoma Action
  6. Tests for Hodgkin Lymphoma — American Cancer Society
  7. Biopsies — Johns Hopkins Medicine
  8. Tests, Scans, and Staging for Lymphoma— Lymphoma Action
  9. Computed Tomography (CT) Scan — Johns Hopkins Medicine
  10. Positron Emission Tomography (PET) — Johns Hopkins Medicine
  11. Magnetic Resonance Imaging (MRI) — Johns Hopkins Medicine
  12. Understanding Your Lab Test Results — American Cancer Society
  13. Staging and Response Assessment in Lymphomas: The New Lugano Classification — Chinese Clinical Oncology
  14. Hodgkin Lymphoma — Leukemia & Lymphoma Society
  15. What Is Hodgkin Lymphoma? — American Cancer Society
  16. Treating Classic Hodgkin Lymphoma, by Stage — American Cancer Society
  17. High-Dose Chemotherapy and Stem Cell Transplant for Hodgkin Lymphoma — American Cancer Society
  18. Chemotherapy for Hodgkin Lymphoma — American Cancer Society
  19. Radiation Therapy for Hodgkin Lymphoma — American Cancer Society
  20. External Beam Radiation Therapy for Cancer — National Cancer Institute
  21. Targeted Therapy (Precision Medicine) — MD Anderson Cancer Center
  22. Immunotherapy for Hodgkin Lymphoma — American Cancer Society
  23. Monoclonal Antibodies and Their Side Effects — American Cancer Society
  24. Hodgkin Lymphoma Treatments — Cancer Treatment Centers of America
  25. Palliative Care in Cancer — National Cancer Institute
  26. Cancer Stat Facts: Hodgkin Lymphoma — National Cancer Institute
  27. Cancer Stat Facts: Cancer of Any Site — National Cancer Institute
All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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