Hodgkin's lymphoma is a rare type of cancer that often first gets noticed when a bruise, lump, or bump arises out of nowhere and doesn’t disappear as you’d normally expect it would.
Lumps associated with Hodgkin's lymphoma are not painful and not associated with an injury. They tend to arise on the chest or neck, under the arms, or in the groin. If such a lump shrinks within a week or two—or grows larger—it might be time to see a doctor for an assessment. The good news is, this type of cancer responds well to treatment.
About 8,500 to 9,000 people in the U.S. are diagnosed with Hodgkin's lymphoma each year. Hodgkin's lymphoma is more prevalent in females than in males. People are most frequently diagnosed between the ages of 15 and 35, but younger children and older adults may be diagnosed as well. It’s also more common among people with human immunodeficiency virus (HIV).
Most people who are diagnosed with Hodgkin's lymphoma should recover after treatment, which typically involves chemotherapy, with or without radiation therapy.
“Hodgkin lymphoma is common in younger adults, and often patients present to their doctors with asymptomatic lymph node swellings,” says Francine Foss, MD, a professor of medicine (medical oncology) at the Yale Cancer Center. “Tremendous progress has been made over the last 10 years in the treatment of Hodgkin lymphomas with novel drugs and immunotherapy and improved radiation techniques, and the goal is to cure all of our patients.”
What is Hodgkin's lymphoma?
Hodgkin's lymphoma is a type of cancer that affects the lymphatic system, which is part of the body’s immune system. The lymphatic system (a series of tiny vessels that connect lymph nodes) contains special white blood cells called lymphocytes, which help to fight infection and keep people healthy.
Hodgkin's lymphoma develops when certain lymphocytes (known as B cells) mutate and multiply uncontrollably. This type of cancer may occur anywhere within the lymphatic system, which contains the bone marrow, spleen, tonsils, and more. However, Hodgkin's lymphoma is most likely to develop within the lymph nodes of the armpits, neck, or chest.
What causes Hodgkin's lymphoma?
Experts aren’t sure what causes Hodgkin lymphoma, but researchers believe there may be a connection to the Epstein-Barr virus (EBV), a virus that belongs to the herpes family.
Most of us are exposed to it during childhood, typically with minor or no symptoms at all. However, some people aren’t exposed to EBV until their teenage years. At that stage of life, EBV may cause infectious mononucleosis (mono). Rare as Hodgkin's lymphoma is, research has shown that it is three times more likely to develop in people who had mono as teens.
What are the symptoms of Hodgkin lymphoma?
People with Hodgkin's lymphoma may experience some or all of the following symptoms:
- Swollen, painless lymph nodes, often in the armpits, chest, or neck
- Night sweats
- Loss of appetite
- Unintended weight loss
- Itchy skin
- Bone pain
Additionally, drinking alcoholic beverages may trigger pain in otherwise painless but swollen lymph nodes in people with this condition.
What are the risk factors for Hodgkin's lymphoma?
Anyone may get Hodgkin's lymphoma, although it’s rare in young children. It’s most common among:
- Adolescents and young adults in their teens, 20s, and 30s
- Adults older than 50 or 60
- People with a family history of Hodgkin lymphoma
- People with autoimmune diseases, such as rheumatoid arthritis, lupus, Sjögren syndrome, or celiac disease
- People who have had EBV, including those who had mono as teens
- People with HIV, many of whom have had EBV
How is Hodgkin's lymphoma diagnosed?
Doctors may suspect Hodgkin's lymphoma after hearing about the patient’s symptoms and doing a physical exam. They can confirm a diagnosis by doing a biopsy.
After learning about symptoms like fever or unintended weight loss, and checking for swollen lymph nodes, a doctor will want to know about their personal and family medical history. It’s helpful to know that a first-degree relative (a parent or sibling) may have had Hodgkin lymphoma.
To diagnose Hodgkin's lymphoma, a doctor surgically removes some or all of an affected lymph node to biopsy it. After a biopsy, doctors look within the sample for abnormal cells known as Reed-Sternberg cells. Their presence confirms a diagnosis of Hodgkin's lymphoma.
Further testing is done to stage the cancer, which helps determine treatment. This may involve a PET scan, a CT scan, blood tests, and/or biopsy of the bone marrow, in some cases.
How is Hodgkin's lymphoma treated?
People with Hodgkin's lymphoma are commonly treated with chemotherapy and sometimes with radiation therapy. The chemotherapy regimen, including which drugs and how often they’re taken, varies depending on the stage of the disease. It’s standard practice for people with Hodgkin's lymphoma to receive combination therapy. This means that they get more than one type of chemotherapy drug at a time, rather than receiving a single drug.
After chemotherapy, doctors can use a PET scan or a CAT scan to see if all of the cancer has disappeared; if it hasn’t, radiation therapy may be given.
For many patients with Hodgkin's lymphoma, a treatment called ABVD chemotherapy (the drugs Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is given intravenously. Some patients—but not all—also are given radiation therapy after chemotherapy ends.
People with late-stage Hodgkin's lymphoma may receive:
- ABVD chemotherapy, with or without radiation therapy
- BEACOPP chemotherapy, in which the medications bleomycin, etoposide, Adriamycin, cyclophosphamide, vincristine, procarbazine and prednisone are given intravenously and orally. Radiation therapy may sometimes be given after chemotherapy, but this isn’t always necessary.
- Immuno-chemotherapy, such as the monoclonal antibody brentuximab vedotin, which is given intravenously and may be combined with the chemotherapy drugs doxorubicin, vinblastine and dacarbazine
- High-dose chemotherapy plus a stem cell transplant, which is recommended for people who have a recurrence of Hodgkin's lymphoma or who have not had a good response to chemotherapy.
Newer drugs have been developed for patients with recurrent Hodgkin's lymphoma, including an immunotherapy called “checkpoint inhibitors.” These drugs are given intravenously and can alter factors around the tumor cells that contribute to the growth of the cells. This allows the body’s own immune system to fight against the tumor cells. These drugs have been highly effective in patients with Hodgkin's lymphoma.
In young children, chemotherapy may be favored over radiation therapy, which can have long-term complications and impair muscle and bone growth in those who have not yet reached their full body size.
What is the outlook for people with Hodgkin's lymphoma?
Hodgkin's lymphoma is treatable. About 90% of people with early-stage Hodgkin's lymphoma are cured. Among people with more advanced disease, the cure rate is lower. Younger people respond to treatment better than older adults, and females tend to respond to treatment more successfully than males.
Sometimes, the treatments that cure Hodgkin's lymphoma may cause health problems later in life, including an underactive thyroid, lung problems, heart disease, or other types of cancer, such as melanoma or breast cancer. Therefore, people who’ve had this type of cancer are advised to continue regular monitoring throughout the rest of their lives.
What makes Yale Medicine unique in its management of Hodgkin's lymphoma?
“The lymphoma program at Yale has extensive experience in the treatment of Hodgkin lymphoma,” says Dr. Foss. “Cutting edge chemotherapy treatments and novel immunotherapies are offered, and the Yale Radiation Oncology physicians and staff have worked with individual patients to lower the doses of radiation to normal tissues and to optimize outcomes with radiation. Our survivorship program is available for patients who have completed therapy to assess and support patients as they recover from treatment and to help them to resume a full and active life.”