Hodgkin lymphoma

Hodgkin lymphoma is a type of cancer that originates in the lymphatic system, specifically affecting a subset of white blood cells known as lymphocytes. Its hallmark is the presence of multinucleated Reed–Sternberg cells within the lymph nodes. The condition was first identified in 1832 by English physician Thomas Hodgkin.

Common symptoms include fever, night sweats, and weight loss—collectively referred to as B symptoms—along with fatigue and itchy skin. Painless swelling of lymph nodes often occurs in the neck, under the arms, or in the groin. Enlargement of the spleen is also frequent, while liver enlargement is less common. Some individuals experience back pain, and a small number report pain in affected nodes after drinking alcohol, a rare but distinctive sign. Cyclical fevers, known as Pel–Ebstein fever, may also appear, though their existence is debated. In some cases, the disease can lead to airway obstruction, fluid buildup around the lungs or heart, liver dysfunction, or bone marrow infiltration.

The two main types are classical Hodgkin lymphoma, which accounts for about 90% of cases, and nodular lymphocyte-predominant Hodgkin lymphoma, making up the remaining 10%. These types differ in their cell structure, appearance, molecular features, and clinical behavior. Classical Hodgkin lymphoma is further divided into four subtypes based on the shape of Reed–Sternberg cells and the surrounding cell environment. Epstein–Barr virus (EBV) is linked to about half of all Hodgkin lymphoma cases, most often in the classical form, and these are considered a type of EBV-associated lymphoproliferative disease. Other risk factors include a family history of the condition and HIV/AIDS.

Diagnosis requires a lymph node biopsy to confirm the presence of cancer and identify Reed–Sternberg cells. Blood tests assess organ function and readiness for chemotherapy. Imaging techniques like PET scans help detect small deposits not visible on CT scans, and gallium scans may be used as an alternative.

Treatment options include chemotherapy, radiation therapy, and stem-cell transplantation. The approach depends on the cancer’s stage and whether it has favorable features. Early detection often leads to a cure. In the United States, the five-year survival rate is 89% overall, rising to 97% for those under 20. However, radiation and certain chemotherapy drugs raise the long-term risk of other cancers, heart disease, and lung disease.

Globally, about 574,000 people had Hodgkin lymphoma in 2015, with 23,900 deaths (4.2%). In the U.S., 0.2% of people are affected at some point in their lives, and most diagnoses occur between ages 20 and 34.