Hodgkin Lymphoma

Overview

Hodgkin lymphoma is a type of cancer that starts in white blood cells called lymphocytes. Lymphocytes are part of the immune system, the body's defence against infection. In Hodgkin lymphoma, some lymphocytes grow out of control and can build up in lymph nodes and other parts of the body. It is not contagious, so you cannot catch it from someone or pass it to others.

It is uncommon. It makes up a small share of all cancers. It is much less common than non-Hodgkin lymphoma.

It can affect anyone, but there are two main age peaks: young adults in their 20s and 30s, and older adults over 55. It is slightly more common in men.

Symptoms

Common symptoms

• Painless swelling of lymph nodes, usually in the neck, armpit, or groin
• Drenching night sweats
• Fevers that come and go
• Unexplained weight loss
• Tiredness that does not improve with rest
• Itchy skin, sometimes severe
• Cough or breathlessness if lymph nodes in the chest are affected
• Pain in a lymph node after drinking alcohol (rare)

Symptoms in children

• Children often have the same signs as adults
• A painless lump in the neck, armpit, or groin that a parent may notice
• Ongoing fever, night sweats, or weight loss
• Tiredness, poor appetite, or low energy
• Cough or breathlessness
• Itchy skin

Symptoms in older adults

• Older adults may have more tiredness, weight loss, fever, or night sweats
• A painless lump may be the first sign
• Symptoms can be mistaken for ageing or a minor infection, so lasting changes should be checked
• Breathlessness or cough may be more noticeable

Causes

Main causes

• The exact cause is not known.
• It starts when B lymphocytes, a type of white blood cell, develop changes in their DNA and grow out of control.
• Infection with Epstein-Barr virus (EBV), the virus that causes glandular fever, is linked to some cases, but most people who have had EBV do not get Hodgkin lymphoma.

Risk factors

• Age: two peaks, in young adults and in older adults
• Sex: slightly more common in men
• Previous infection with Epstein-Barr virus (glandular fever)
• A weakened immune system, including from some medical conditions or immune-suppressing medicines
• A family history of Hodgkin lymphoma, though this is uncommon

When to see a doctor

See a doctor urgently if:

• A painless lump that is growing or has been there for a few weeks
• Fevers, drenching night sweats, or weight loss that cannot be explained
• A cough or breathlessness that is getting worse
• Swelling in the neck or face

Book a routine appointment if:

• Tiredness that does not improve with rest
• Unexplained itching
• Lumps that come and go, or swollen glands that keep returning
• Any symptom that worries you or is not settling

Diagnosis

Your doctor will ask about your symptoms and examine you, including feeling for swollen lymph nodes and checking your abdomen. If lymphoma is possible, you will be referred to a specialist. The only way to confirm Hodgkin lymphoma is with a biopsy, which means taking a small sample of lymph node tissue to look at under a microscope.

Tests that may be done

• Physical examination
• Blood tests
• Chest X-ray
• CT scan or PET scan
• Lymph node biopsy
• Bone marrow biopsy, sometimes
• Heart and lung tests before some treatments
• Fertility discussion and tests before treatment if this matters to you

What to expect at your appointment

You may have several tests over a few weeks. Waiting for results can feel hard. Ask your healthcare team who to contact if you are worried, and ask a specialist nurse to explain each step. Bring someone with you to appointments if that helps.

Treatment

Treatment depends on the stage of the lymphoma, your age, your general health, and your plans for fertility. The main treatments are chemotherapy, radiotherapy, targeted therapy, and sometimes a stem cell transplant. Many people respond very well to treatment.

Self-care at home

• Rest when you are tired, but stay gently active if you can
• Eat small meals if your appetite is low, and drink enough fluids
• Keep your hands clean and avoid people with infections when your immune system is low
• Tell your team about side effects early so they can help
• Ask about fertility and preserving fertility before treatment starts if this is important to you
• Keep vaccinations up to date as advised by your team

Medical treatments

Treatment may include chemotherapy, which uses strong medicine to kill cancer cells; radiotherapy, which uses high-energy rays; targeted therapy, which attacks cancer cells in a more focused way; and sometimes a stem cell transplant, which uses healthy stem cells to help the body recover. Your specialist team will explain the choices, the likely benefits, and the possible side effects. They will not recommend a treatment until they know your full test results.

When is surgery considered?

Surgery is not usually the main treatment for Hodgkin lymphoma. It is most often used to remove a lymph node for biopsy. In rare cases, surgery may help with a swollen area or to get a tissue sample.

Living with this condition

You may need time off work or school for tests and treatment. Plan around appointments, accept offers of help, and keep a notebook of symptoms and questions. Ask your team about practical support, such as financial advice or help with travel to appointments.

Lifestyle tips

• Do not smoke, and avoid second-hand smoke
• Limit alcohol
• Try to keep a regular sleep routine
• Stay gently active, such as short walks, when you feel able
• Avoid crowded places during periods when your immune system is low
• Ask your team before travelling or starting new activities

Diet and exercise

There is no special diet that treats Hodgkin lymphoma. Aim for balanced meals with enough protein, fruit, and vegetables, and drink enough fluids. Gentle exercise like walking or yoga can help with tiredness and mood. Ask your team before doing intense exercise or if you have new symptoms.

Mental health and emotional wellbeing

It is common to feel anxious, sad, angry, or overwhelmed. You may worry about treatment, fertility, body changes, or the cancer coming back. If you have thoughts of harming yourself, call your local emergency number or a crisis service right away. You are not alone, and help is available.

Prevention

There is no sure way to prevent Hodgkin lymphoma. Most cases happen in people with no clear risk factors. Living a healthy lifestyle is good for general health, but it does not guarantee protection.

Vaccines

There is no vaccine to prevent Hodgkin lymphoma. Vaccines for other infections may be recommended based on your health and treatment plan. Ask your healthcare team.

Screening programmes

There is no routine screening test for Hodgkin lymphoma. See your doctor if you have lasting symptoms such as a lump, fever, night sweats, or weight loss.

Complications

If left untreated

• The cancer can spread to other lymph nodes and organs
• Swollen lymph nodes can press on the airways, blood vessels, or other structures
• The immune system can be weakened, making infections more likely
• Severe tiredness and weight loss can affect daily life

Long-term outlook

Hodgkin lymphoma is often very treatable. Many people, especially younger people with early disease, are cured. Even more advanced disease can often be controlled. Long-term follow-up is important to check for late effects of treatment and to support your health.

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