Hodgkin Lymphoma: Overview

What is Hodgkin lymphoma?

Cancer starts when cells change (mutate) and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. They can spread to other parts of the body, too. This is called metastasis.

Hodgkin lymphoma (HL) is also called Hodgkin disease (HD). It's cancer that starts in the lymphatic system. The lymphatic system is part of the immune system. It helps the body fight infection. 

With HL, cells in the lymphatic system grow out of control. They often cause swelling in the lymph nodes. These cancer cells can spread to other parts of the body, too, like the bone marrow, liver, or spleen.

HL is different from other types of lymphoma. The other types of lymphoma are grouped together and called non-Hodgkin lymphomas (NHL). 

There are two main types of HL. Each grows in slightly different ways. They are:

• Classic Hodgkin lymphoma, or cHL. It is, by far, the most common type. There are four subtypes of cHL:

• • Nodular sclerosis Hodgkin lymphoma (most common)

  • Mixed cellularity Hodgkin lymphoma

  • Lymphocyte-rich Hodgkin lymphoma (rare)

  • Lymphocyte-depleted Hodgkin lymphoma (very rare)

• Nodular lymphocyte-predominant Hodgkin lymphoma

Who is at risk for Hodgkin lymphoma?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.

Risk factors for HL include:

• Age. (It most often occurs in people in their 20s and 30s or in those older than age 65.)

• Being a man

• Family history of HL

• History of Epstein-Barr virus infection

• HIV infection

• A weakened immune system

Talk with your healthcare provider about your risk factors for HL and what you can do about them.

What are the symptoms of Hodgkin lymphoma?

HL can cause many different symptoms. These are the most common:

• Swollen lymph nodes that don’t hurt and don’t go away

• Tiredness or weakness

• Cough, trouble breathing, or chest pain (if lymph nodes in your chest are enlarged)

• Itchy skin

• Pain in your lymph nodes when drinking alcohol

These symptoms may also occur. They’re known as B symptoms:

• Unexplained weight loss

• Unexplained fever

• Drenching night sweats

Many of these may be caused by other health problems. Still, it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is Hodgkin lymphoma diagnosed?

Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. A physical exam will be done. You may also have some tests done, such as blood tests and an X-ray or other imaging tests.

A biopsy is the only way to tell for sure if you have HL. Small pieces of tissue are taken out from a swollen lymph node and tested for cancer cells. Your results will come back in about one week.

After a diagnosis of HL, you’ll need more tests. These help your healthcare providers learn more about your overall health and exact type of HL. They're used to find out the stage of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what this means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand.

How is Hodgkin lymphoma treated? 

Your treatment choices depend on the type of HL you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or to help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. 

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Radiation is a local treatment. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and immunotherapy are systemic treatments. 

You may have just one treatment or a combination of treatments. Tests will be done during treatment to see how well it's working.  

HL may be treated with:

• Radiation therapy

• Chemotherapy

• Stem cell transplant

• Immunotherapy

Talk with your healthcare providers about your treatment choices. Make a list of questions. Think about the benefits and possible side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects?

Cancer treatment, like chemotherapy and radiation, can damage normal cells. It can cause side effects like hair loss, mouth sores, and vomiting. 

Talk with your healthcare provider about side effects linked with your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

Coping with Hodgkin lymphoma

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are some tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever

• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Next steps

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.