Hodgkin lymphoma
Lymphoma - Hodgkin; Hodgkin disease; Hodgkin lymphoma; Hodgkin's lymphoma
Hodgkin lymphoma is a cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, liver, bone marrow, and other sites.
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Hodgkin's disease (lymphoma) is a malignant cancer that can affect many organs. A whitish, irregular tumor mass of lymphoma cells is seen on the left side of this cross-section of the liver.
This abdominal CT scan shows tumor masses (malignant lymphomas) in the area behind the peritoneal cavity (retroperitoneal space).
The immune system protects the body from potentially harmful substances. The inflammatory response (inflammation) is part of innate immunity. It occurs when tissues are injured by bacteria, trauma, toxins, heat or any other cause.
Causes
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.
Did you ever touch your neck and feel a bump on one or both sides? Usually, it's just a swollen gland or lymph node that's caused by a cold or other infection. But occasionally, swollen lymph nodes can be a sign of cancer, perhaps a cancer called Hodgkin's lymphoma. These are your lymph nodes. You'll find them not only on your neck, but in your armpits and groin too. They're a part of your body's normal defense system, which protects you against invading viruses and bacteria. Hodgkin's lymphoma is a type of cancer that starts inside the lymph nodes. What causes Hodgkin's lymphoma isn't known, but having the Epstein-Barr virus or HIV may increase your risk. So, what are the signs of Hodgkin's lymphoma? In addition to having swollen lymph nodes, you may feel tired and have no appetite. Some people wake up in the middle of the night soaked in sweat. That's called night sweats. Remember, though, that these symptoms can occur with many different conditions. So if you have them, don't panic. But do see your doctor, who can tell you for sure what's causing your symptoms. If your doctor suspects that you have Hodgkin's lymphoma, your doctor will probably cut and remove a small piece of tissue from your lymph node, called a biopsy, and the samples will be sent to a lab to look for cancer cells. If cancer is diagnosed, other tests are used to stage it, in other words, to see whether the disease has spread, and if so, how far it's spread. That helps your doctor find the right treatment. If you have Hodgkin's lymphoma, most often the treatment involves radiation therapy, chemotherapy, or a combination of both. People who don't respond to these treatments sometimes need a bone marrow transplant. While you're being treated for Hodgkin's lymphoma, you may need other therapies to help you feel better. That might include antibiotics to fight an infection or a blood transfusion to add red blood cells when they're low. Getting diagnosed with any type of cancer can be difficult to hear. But you should know that Hodgkin's lymphoma is one of the most curable types of cancer. Even if the disease has spread, your chances of survival are very high. You can improve your odds by following the entire treatment plan. Once your lymphoma has been treated, you'll need to see your doctor regularly for check-ups to make sure the cancer hasn't returned, and to monitor for any side effects your treatment may have caused.
Symptoms
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.
Exams and Tests
The provider will perform a physical exam and check body areas with lymph nodes to feel if they are swollen.
The disease is often diagnosed after a biopsy of suspected 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)
- Sed rate or 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
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 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.
Support Groups
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.
Outlook (Prognosis)
Hodgkin lymphoma is one of the most curable cancers. Cure is even more likely if it is diagnosed and treated early. Unlike 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.
Possible Complications
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.
When to Contact a Medical Professional
Contact your provider if:
- You have symptoms of Hodgkin lymphoma
- You have Hodgkin lymphoma and you have side effects from the treatment
References
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. Adult Hodgkin lymphoma treatment (PDQ) - health professional version.
National Cancer Institute website. Childhood Hodgkin lymphoma treatment (PDQ) - health professional version.
National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: Hodgkin lymphoma. Version 2.2023.
Version Info
Last reviewed on: 2/2/2023
Reviewed by: Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 06/05/2023.
