Hodgkin lymphoma

The cause of Hodgkin lymphoma is not known. Hodgkin lymphoma is most common among people 15 to 35 years old and 50 to 70 years old. Past infection with the Epstein-Barr virus (EBV) is thought to contribute to some cases. People with HIV infection are at increased risk compared to the general population.

The first sign of Hodgkin lymphoma is often a painless swollen lymph node that appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.

Symptoms may include any of the following:

• Feeling very tired all the time
• Fever and chills that come and go
• Itching all over the body that cannot be explained
• Loss of appetite
• Drenching night sweats
• Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
• Weight loss that cannot be explained

Other symptoms that may occur with this disease:

• Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
• Excessive sweating
• Pain or feeling of fullness below the ribs due to swollen spleen or liver
• Pain in lymph nodes after drinking alcohol
• Skin blushing or flushing

Symptoms caused by Hodgkin lymphoma may occur with other conditions. Talk to your health care provider about the meaning of your specific symptoms.

Your provider will perform a physical exam and check body areas with lymph nodes to feel if they are swollen.

The disease is diagnosed based on a biopsy of abnormal tissue, usually a lymph node.

The following procedures will usually be done:

• Blood chemistry tests including liver function tests, kidney function tests, and lactate dehydrogenase (LDH)
• Erythrocyte sedimentation rate (ESR)
• Bone marrow biopsy
• CT scans of the chest, abdomen, and pelvis
• Complete blood count (CBC) to check for anemia and white blood count
• PET scan

If tests show that you have Hodgkin lymphoma, more tests may be done to see how far the cancer has spread. This is called staging. Staging helps guide treatment and follow-up.

Treatment depends on the following:

• The type of Hodgkin lymphoma
• The stage (where the disease has spread)
• Your age and other medical issues
• Other factors, including whether you have weight loss, night sweats, and fever

You may receive chemotherapy, radiation therapy, or both, or immunotherapy. Your provider can tell you more about your specific treatment.

High-dose chemotherapy may be given when Hodgkin lymphoma returns after treatment or does not respond to the first treatment. This is followed by a stem cell transplant that uses your own stem cells.

Blood transfusions or platelet transfusions may be required if blood counts are low.

You and your provider may need to manage other concerns during your lymphoma treatment, including:

• Having chemotherapy at home
• Managing your pets during chemotherapy
• Bleeding problems
• Dry mouth
• Eating enough calories

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences can help you not feel alone.

Hodgkin lymphoma is one of the most curable cancers. A cure is even more likely if it is diagnosed and treated early. Unlike many other cancers, Hodgkin lymphoma is also very curable in its late stages.

You will need to have regular exams for years after your treatment. This helps your provider check for signs of the cancer returning and for any long-term treatment effects.

Treatments for Hodgkin lymphoma can have complications. Long-term complications of chemotherapy or radiation therapy include:

• Bone marrow diseases (such as leukemia)
• Heart disease
• Inability to have children (infertility)
• Lung problems
• Other cancers
• Thyroid problems

Keep following up with a provider who knows about monitoring and preventing these complications.

Contact your provider if:

• You have symptoms of Hodgkin lymphoma
• You have Hodgkin lymphoma and you have side effects from the treatment

Lymphoma - Hodgkin; Hodgkin disease; Hodgkin lymphoma; Hodgkin's lymphoma

Bartlett N, Triska G. Hodgkin lymphoma. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 102.

National Cancer Institute website. Hodgkin lymphoma treatment (PDQ) - health professional version. www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq. Updated April 18, 2024. Accessed August 2, 2024.

National Cancer Institute website. Childhood Hodgkin lymphoma treatment (PDQ) - health professional version. www.cancer.gov/types/lymphoma/hp/child-hodgkin-treatment-pdq. Updated April 30, 2024. Accessed August 2, 2024.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: Hodgkin lymphoma. Version 2.2024. www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf. Updated February 12, 2024. Accessed February 19, 2024.

Updated by: Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Internal review and update on 02/20/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.