Hodgkin lymphoma is a type of lymphoma. Lymphoma is cancer that affects the lymphatic system. The lymphatic system is made up of organs, glands, tubelike vessels and clusters of cells called lymph nodes. It's part of the body's germ-fighting immune system. The lymphatic system also includes the spleen, thymus, tonsils, adenoids and bone marrow. Hodgkin lymphoma, which used to be called Hodgkin disease, can affect all these areas and other organs in the body.

There are many types of lymphoma. Lymphoma types are often divided into two categories: Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma starts in germ-fighting white blood cells called B lymphocytes.

Hodgkin lymphoma is highly treatable and often curable. Treatments for Hodgkin lymphoma may include chemotherapy, radiation, targeted therapy, immunotherapy, bone marrow transplant, also called bone marrow stem cell transplant, and clinical trials.

Types

Classic Hodgkin lymphoma

Classic Hodgkin lymphoma is the most common type of Hodgkin lymphoma. People diagnosed with this type have large lymphoma cells called Reed-Sternberg cells in their lymph nodes.

Subtypes of classic Hodgkin lymphoma include:

• Nodular sclerosing Hodgkin lymphoma.
• Mixed cellularity Hodgkin lymphoma.
• Lymphocyte-depleted classic Hodgkin lymphoma.
• Lymphocyte-rich classic Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma is much rarer. It involves lymphoma cells sometimes called popcorn cells because of how they look. Usually, it is diagnosed early and may need less intensive treatments than the classic type of Hodgkin lymphoma.

Symptoms

Signs and symptoms of Hodgkin lymphoma may include:

• Swollen lymph nodes, which might feel like a lump under the skin. They happen most often in the neck, armpit and groin.
• Fever.
• Fatigue.
• Drenching night sweats.
• Weight loss that happens without trying.
• Itchy skin.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Causes

It's not clear what causes Hodgkin lymphoma. Cancer happens when cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. In Hodgkin lymphoma, the cancer cells can build up in the lymph nodes, bone marrow, spleen and other tissues throughout the body.

Hodgkin lymphoma starts in germ-fighting white blood cells called B lymphocytes.

Risk factors

Factors that can increase the risk of Hodgkin lymphoma include:

• Age. Hodgkin lymphoma is most often diagnosed in people in their 20s and 30s and those over age 65.
• A family history of lymphoma. Having a blood relative, such as a parent or sibling, with lymphoma may increase your risk of Hodgkin lymphoma.
• Some infections. Certain infections have been linked to Hodgkin lymphoma. These infections include human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV).
• A weakened immune system or an autoimmune condition. Having a condition that affects the immune system can increase the risk of Hodgkin lymphoma. Conditions may include rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis and others. The immune system also may be weakened after organ transplant.

Complications

A potential complication of Hodgkin lymphoma is that the cancer may come back after treatment. This is called a relapse. Relapse is more common in people with advanced cancer.

Diagnosis

Hodgkin lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen or liver. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for lab testing.

Blood tests

Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test for viruses, including HIV, EBV, hepatitis B virus and hepatitis C virus. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma.

Imaging tests

Imaging tests make pictures of the body. They can show the location and extent of Hodgkin lymphoma. Tests might include CT and positron emission tomography (PET) scans.

Biopsy

Your healthcare professional may suggest a lymph node biopsy or a biopsy of other tissue to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. A sample may be taken from other parts of the body depending on symptoms and imaging test results. In the lab, tests may show whether you have Hodgkin lymphoma.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. Bone marrow has a solid part and a liquid part.

In a bone marrow aspiration, a needle is used to collect a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. Most often, the samples are taken from the hip bone. The samples go to a lab for testing. For Hodgkin lymphoma, a healthcare professional may recommend this test only if blood counts are low and there isn't a clear reason for the low count.

Testing Hodgkin lymphoma cells in the lab

Lymphoma cells collected from a biopsy or a bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to find out the type of lymphoma that you have.

To learn whether the cells are Hodgkin lymphoma cells, the healthcare professionals in the lab look for proteins on the surface of the cancer cells. These proteins, known as markers, can help identify the type of Hodgkin lymphoma.

Treatment

Treatments for Hodgkin lymphoma may include chemotherapy, radiation therapy, targeted therapy, immunotherapy, bone marrow transplant, also called bone marrow stem cell transplant, and clinical trials. Which treatment is best for you depends on the type of lymphoma you have and the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy is often the first treatment for classic Hodgkin lymphoma. You may take a combination of chemotherapy medicines. Chemotherapy also may be combined with radiation therapy, targeted therapy or immunotherapy. Chemotherapy may be an option when other treatments haven't worked, known as refractory lymphoma, or for cancer that comes back after treatment, called relapsed lymphoma.

For nodular lymphocyte-predominant Hodgkin lymphoma, chemotherapy may be combined with immunotherapy.

Side effects of chemotherapy depend on the medicines you're given. Common side effects are nausea and hair loss. Serious long-term complications can happen, such as heart disease, lung damage, infertility and secondary cancers.

Radiation therapy

Radiation therapy for cancer is a treatment that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.

For Hodgkin lymphoma, radiation therapy is often combined with chemotherapy or other medicines. Radiation therapy may be the only treatment needed for early-stage nodular lymphocyte-predominant Hodgkin lymphoma. This treatment also may be used for relapsed or refractory Hodgkin lymphoma. For advanced cancer, radiation therapy may be used to ease symptoms and improve quality of life.

Radiation therapy side effects include fatigue and a sunburnlike reaction on the skin at the site where the radiation is aimed. Other side effects depend on where the radiation is aimed. Radiation to the neck can cause dry mouth and damage the thyroid. Radiation to the chest can damage the heart and lungs.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy may be a treatment for Hodgkin lymphoma. It's often combined with chemotherapy or other treatments. It also may be an option for refractory or relapsed Hodgkin lymphoma.

Targeted therapy side effects may include diarrhea, liver issues, high blood pressure, issues with blood clotting and wound healing, fatigue, mouth sores, and nail changes. Most side effects go away after treatment is done.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be combined with chemotherapy or other medicines to treat Hodgkin lymphoma. Immunotherapy also may be used for refractory or relapsed Hodgkin lymphoma.

Side effects of immunotherapy may include fever, chills, weakness, dizziness, aches, nausea and vomiting. Rarely, some immunotherapy treatments can cause an allergic reaction.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. Stem cells can come from your own body, called an autologous transplant. Stem cells also can come from a donor, called an allogeneic transplant.

A bone marrow transplant may be done for relapsed or refractory Hodgkin lymphoma. Chemotherapy is typically done before the transplant to suppress the immune system and bone marrow.

Short-term side effects of a bone marrow transplant may include nausea, vomiting, fatigue, not feeling hungry, mouth sores, hair loss and skin reactions. Long-term side effects may include infertility, secondary cancers, organ damage, weakness in the bones or muscles, and cataracts.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be able to be in a clinical trial.

Monitoring after treatment

After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. You may have repeat blood and imaging tests and, if needed, biopsies, to check for a relapse.

Side effects of treatment

Treatments for lymphoma may have side effects. These may include nausea, vomiting, fatigue, fever, rash, diarrhea, infection and more.

More serious side effects from treatments may include:

• Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections. With a lower amount of white blood cells, you are at a higher risk of infections.
• Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, a type of white blood cell that helps fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough neutrophils.
• Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you receive. There are many different medicine options. Your healthcare team can work with you to find the best medicines for you.
• Reactivating viruses. If you have had a viral infection in the past, such as hepatitis B or hepatitis C, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.

Coping and support

With time, you'll likely find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find that it helps to:

Learn enough about Hodgkin lymphoma to make decisions about your care

Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about Hodgkin lymphoma, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you deal with your Hodgkin lymphoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.

Find someone to talk with

Find someone who is willing to listen to you talk about your hopes and worries. This person may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your healthcare team about support groups in your area, or contact organizations such as the American Cancer Society, Blood Cancer United and the Lymphoma Research Foundation. Find support online through Mayo Clinic Connect, which is a community where you can connect with others for support, practical information and answers to everyday questions.

Preparing for an appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks you might have Hodgkin lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of anything you need to do ahead of time. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you're taking and the doses.
• Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

For Hodgkin lymphoma, some basic questions to ask include:

• Do I have Hodgkin lymphoma?
• What type of Hodgkin lymphoma do I have?
• What is the stage of my Hodgkin lymphoma?
• Has my Hodgkin lymphoma spread to other parts of my body?
• Will I need more tests?
• What are the treatment options?
• How much does each treatment prolong my life or increase my chances of a cure?
• What are the potential side effects of each treatment?
• How will each treatment affect my daily life?
• Is there one treatment option you believe is the best?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist?
• Are there any brochures or other printed materials that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• Do your symptoms happen all the time, or do you have them now and then?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to worsen your symptoms?
• Have you had any fevers, night sweats or weight loss?
• Have you noticed any lumps, swelling or pain anywhere in your body?
• Have you had any chest pain, coughing or trouble breathing?
• Have you had any recent infections?
• Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
• What are your biggest worries about your diagnosis or treatment?

If you're diagnosed with Hodgkin lymphoma, the next step is to determine the cancer's extent, called the stage. Imaging tests, blood tests and biopsies may be used to determine the stage of your Hodgkin lymphoma. Your healthcare team uses the cancer stage to help create your treatment plan.

The stages of Hodgkin lymphoma range from 1 to 4:

• Stage 1 lymphoma. At stage 1, Hodgkin lymphoma affects only one lymph node region.
• Stage 2 lymphoma. A stage 2 Hodgkin lymphoma involves two or more lymph node regions on the same side of the diaphragm.
• Stage 3 lymphoma. At stage 3, Hodgkin lymphoma involves lymph node regions on both sides of the diaphragm.
• Stage 4 lymphoma. At stage 4, Hodgkin lymphoma involves regions outside of the lymph nodes.

Hodgkin lymphoma stages also may include the letters A and B. The letter A means that you don't have worrying symptoms of lymphoma. The letter B means that you have some symptoms, such as drenching night sweats, fever or weight loss.

Hodgkin lymphoma prognosis

The cancer prognosis tells you how likely it is that the cancer can be treated or cured. Your prognosis may depend on:

• Your age.
• Your overall health.
• The type of Hodgkin lymphoma you have.
• The cancer's stage.
• Your blood test results.

For Hodgkin lymphoma, healthcare professionals may classify your prognosis as one of three ways:

• Early stage, favorable risk. This means your cancer is stage 1 or 2, and you have no risk factors that affect your prognosis.
• Early stage, unfavorable risk. This means your cancer is stage 1 or 2, and you have one or more risk factors.
• Advanced stage. This means your cancer is stage 3 or 4.

Risk factors that affect your prognosis include your age, the size of lymph nodes, especially in the chest, if you have any symptoms and how many nodal areas are involved. Another risk factor is how quickly your red blood cells settle in a test tube. This is called erythrocyte sedimentation rate. A rate that is faster than usual may mean a more progressive cancer.

Talk with your healthcare team about your prognosis if you want to know what to expect. Members of your healthcare team can explain what they consider when thinking about your prognosis.

The chance of surviving Hodgkin lymphoma is quite good for most people. To understand lymphoma survival rates, experts study many people with lymphoma to see how many are living five years after their diagnosis.

For stage 1 Hodgkin lymphoma, the chance of surviving at least five years is 92%. As the cancer spreads, the chances get lower. For stage 4 Hodgkin lymphoma, the chance of surviving at least five years is about 82%.

Keep in mind that survival statistics take five years to collect. The most recent survival rates include people who had lymphoma treatment more than five years ago. They may not have had access to the latest treatments. Over the last few decades, lymphoma death rates have been falling, and survival rates have been increasing.