What Is Hodgkin Lymphoma?

Hodgkin lymphoma is a type of lymphoma, which is a cancer that affects the immune system. Lymphoma is cancer that starts in the lymphocytes—white blood cells in the immune system. Hodgkin lymphoma makes up about 10% of lymphoma cases. The exact cause of Hodgkin lymphoma is unknown. Risk factors include age, assigned sex at birth, a family history of lymphoma, and a personal history of a compromised immune system or certain infections.

Hodgkin lymphoma does not usually cause symptoms in the early stages, so it can be challenging to recognize. Possible symptoms of Hodgkin lymphoma may include swollen lymph nodes, fever, fatigue, night sweats, and unintended weight loss. Fortunately, Hodgkin lymphoma is treatable. There are several treatment options available, and your treatment plan will depend on the extent of the disease, as well as your overall health. It is important to see your healthcare provider if you develop Hodgkin lymphoma symptoms. 

Types of Hodgkin Lymphoma

There are different types of Hodgkin lymphoma, and the most common one is classic Hodgkin lymphoma. Classic Hodgkin lymphoma makes up about 90% of all Hodgkin lymphoma cases. 

There are four subtypes of classic Hodgkin lymphomas, which include:

• Nodular sclerosis Hodgkin lymphoma: This is the most common type and makes up about 70% of Hodgkin lymphoma cases. It tends to affect adolescents and young adults but can occur at any age.
• Mixed cellularity Hodgkin lymphoma: This is the second most common type and is most common in people with human immunodeficiency virus (HIV). 
• Lymphocyte-rich Hodgkin lymphoma: This uncommon type of cancer is usually found in the upper part of the body. 
• Lymphocyte-depleted Hodgkin lymphoma: This rare and aggressive form of Hodgkin lymphoma is usually seen in people with HIV.

In addition to classic Hodgkin lymphoma, another type is nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) which makes up about 5% of all cases. This type is usually slow-growing and requires different treatment than the other subtypes. 

Hodgkin Lymphoma Symptoms 

It is common to not experience any symptoms of Hodgkin lymphoma in the early stages. This can make early diagnosis and treatment a challenge. Fortunately, Hodgkin lymphoma is one of the most curable cancers. Recognizing the symptoms as soon as possible can contribute to a better prognosis.

The first symptom of Hodgkin lymphoma is usually a swollen lymph node. A swollen lymph node feels like a painless lump right below the skin. As cancer spreads, you may notice additional lumps. Swollen lymph nodes are usually painless, but may cause pain after you drink alcohol.

It’s helpful to remember that many health conditions, such as an infection, cause swollen lymph nodes. It is common to feel distressed when you notice a new lump under your skin but the cause is usually benign. Always see your healthcare provider when you notice any symptoms of Hodgkin lymphoma.

Other common symptoms of Hodgkin lymphoma include:

• Night sweats: You may wake up drenched whether or not you actually feel warm
• Weight loss: Losing 10% of your body weight over 6 months without meaning to or trying 
• Fatigue: Feeling tired or having low energy levels, despite getting good rest 

Other Hodgkin lymphoma symptoms vary depending on which areas of the body are affected. If cancer cells developed in your chest, you may experience coughing, shortness of breath, and chest pain. Other possible symptoms include abdominal pain, a loss of appetite, and skin itching.

Causes

Hodgkin lymphoma occurs when cancer cells develop and spread in an area of the lymphatic system. This usually occurs in the lymph nodes but may also happen in the bone marrow or spleen. The exact cause of Hodgkin lymphoma is unknown, but there are known risk factors that can raise your chances of developing it. 

Researchers believe there is a possible link between Hodgkin lymphoma and Epstein-Barr virus (EBV). EBV is the virus that causes mononucleosis (mono) and may cause DNA changes that affect your risk of lymphoma. EBV may cause mutations in B lymphocytes (a type of white blood cell) that lead to the development of cancer cells. This possible connection is still being studied.

Risk Factors

Risk factors include any factor that affects your odds of developing a certain disease like Hodgkin lymphoma. Having a risk factor does not mean that you will definitely develop the disease. It means that your risk is higher than someone with no risk factors. 

Many of the risk factors for Hodgkin lymphoma cannot be changed. They include:

• Epstein Barr virus (EBV): EBV may lead to genetic mutations that raise the risk of developing lymphoma.
• Age: Hodgkin lymphoma is most common in older adults over age 55 and younger adults in their twenties. 
• Sex: More men develop Hodgkin lymphoma than women.
• Family history: There is a higher risk of developing Hodgkin lymphoma if your sibling has it. The risk is very high for an identical twin. 
• Weakened immune system: People with a compromised immune system, such as from HIV or taking certain medications, are more likely to develop Hodgkin lymphoma.

How Is Hodgkin’s Lymphoma Diagnosed?  

There are several tests available to diagnose Hodgkin lymphoma, and your healthcare provider will recommend specific tests based on your symptoms, history, and overall health. Most people with Hodgkin lymphoma see their provider when they develop symptoms or have a general feeling of being unwell. 

Your provider will start with a thorough physical and history. This will involve a physical exam to look for any signs of swelling in your lymph nodes, spleen, or liver. It will also involve several questions about your symptoms and health history. They may refer you to an oncologist, or a medical doctor who specializes in cancer diagnosis and treatment.

A swollen lymph node is often the first (and sometimes only) symptom of Hodgkin lymphoma. Because several, less serious conditions can cause swollen lymph nodes, your provider may recommend trying a course of antibiotics before moving to more invasive diagnostic tools. If the antibiotics do not improve your swelling, then further testing will likely be recommended. 

The next step in diagnosing Hodgkin lymphoma is usually a lymph node biopsy. There are different types of biopsies available, and your provider will recommend the right one for you based on your exam findings. The different types of tissue biopsies include:

• Excisional biopsy: Removal and examination of the entire lymph node
• Incisional biopsy: Removal and examination of part of the lymph node
• Fine needle aspiration biopsy: Using a thin, hollow needle to remove a small amount of fluid
• Core needle biopsy: Using a larger needle to remove a larger piece of tissue

Once you have been diagnosed with lymphoma, your medical team may recommend a bone marrow aspiration to determine if cancer cells are present in the bone marrow. 

Blood tests are also commonly used in cancer diagnosis. Common blood tests to expect include:

• Complete blood count (CBC): Detects high white blood cell count
• Erythrocyte sedimentation rate (ESR): Measures inflammation in the body
• Liver and kidney function tests: Determine if there is swelling in the liver or kidney

Other types of testing used to diagnose Hodgkin lymphoma include:

• Immunohistochemistry: Detects certain types of proteins on cells that can raise the risk of Hodgkin lymphoma 
• Chest X-ray: Examines enlarged lymph nodes in the chest
• Computed tomography (CT): Inspects signs of lymphoma in the neck, chest, abdomen, or pelvis 
• Magnetic resonance imaging (MRI): Rarely used but might be needed to detect cancer spread to the spinal cord or brain
• Positron emission tomography (PET) scan: Detects cancer cells via imaging 
• Bone scan: Determines if cancer cells have spread to the bone; only recommended if you are experiencing bone pain
  

Treatment

Hodgkin lymphoma is treatable, and remission is possible. Remission refers to a period of time when symptoms of a disease go away. When Hodgkin lymphoma is caught early, the goal of treatment is to reach remission. When caught in the later stages, the goal of treatment is to improve your quality of life by reducing symptoms. 

Hodgkin lymphoma treatment depends on several factors including your subtype of the disease, how advanced it is, your symptoms, and your overall health. 

The treatments most commonly used for Hodgkin lymphoma include:

• Chemotherapy: Anti-cancer drugs that you receive by mouth or through intravenous (IV) infusion.
• Radiation therapy: Treatment that shrinks the presence of any large lymph nodes or tumors.
• Immunotherapy: Drugs that boost your immune system's response to fighting cancer cells; treatment is available as an IV infusion, oral tablets, or topical creams. Examples include monoclonal antibodies, immune checkpoint inhibitors, and immunomodulating drugs.
• Stem cell transplant: Procedure that helps your body rebuild bone marrow; this treatment is typically used only if chemotherapy and radiation have not been effective in treating your condition.
  

Prevention

Hodgkin lymphoma is often not preventable. Many of the risk factors for this type of cancer cannot be changed. You cannot control factors like your age or family history. It is also important to note that many people with Hodgkin lymphoma do not have any of the risk factors. 

If you have risk factors for Hodgkin lymphoma, talk with your healthcare provider about your risk level and if there are any steps you can take to lower your chances of developing cancer. 

Living With Hodgkin Lymphoma  

Living with Hodgkin lymphoma is challenging, and it is normal for this disease to affect every area of your life. Being diagnosed with Hodgkin lymphoma is a life-changing experience. 

Most people with Hodgkin lymphoma feel a wide range of emotions on any given day. It is common to experience anger, sadness, worry, overwhelm, and loneliness. Meeting with a mental health professional may help. In addition, consider making a list of activities you enjoy and schedule them as you are able. Learning stress management techniques, such as deep breathing, may help as well. 

Going through Hodgkin lymphoma treatment is an overwhelming experience, so don’t do it alone. Lean on your friends and family as often as possible. Consider asking for help with food preparation, transportation to medical appointments, babysitting, and more.