Hodgkin Lymphoma (Hodgkin Disease)

Diagnosis

Hodgkin lymphoma is diagnosed through a combination of physical examinations, imaging studies, and laboratory tests. The process often begins with a physical exam to check for swollen lymph nodes in the neck, underarms, or groin, as well as an enlarged spleen or liver. Your healthcare professional may also order blood tests, imaging scans, and tissue biopsies to confirm the diagnosis.

Blood tests
Blood tests help detect abnormalities that may suggest lymphoma. They can:

• Check for the presence of viruses such as HIV, EBV, hepatitis B, and hepatitis C

• Measure lactate dehydrogenase (LDH) levels, which may be elevated in people with lymphoma

• Identify other blood-related irregularities that could support the diagnosis

Imaging tests
Imaging tests create detailed pictures of the body to show the location and spread of the disease. Common scans include:

• Computed tomography (CT) scans

• Positron emission tomography (PET) scans

These tests help determine the stage of Hodgkin lymphoma and guide treatment planning.

Biopsy
A biopsy involves removing all or part of a lymph node or other tissue for laboratory testing. This procedure helps confirm whether lymphoma cells are present and what type they are.

Bone marrow aspiration and biopsy
A bone marrow test involves collecting samples from the hip bone using a needle.

• Bone marrow aspiration removes liquid marrow.

• Bone marrow biopsy removes a small piece of solid tissue.

These samples are analyzed to see if the bone marrow contains lymphoma cells. This test is usually done if blood counts are low without an obvious cause.

Testing lymphoma cells in the lab
Lymphoma cells collected from a biopsy are examined in a lab for specific markers, which help identify the exact type of Hodgkin lymphoma. Specialized tests determine how the cancer behaves and guide the best course of treatment.

Treatment

Treatment for Hodgkin lymphoma depends on several factors, including the type and stage of the disease, how quickly it is progressing, overall health, and patient preference. The main treatments include chemotherapy, radiation therapy, targeted therapy, immunotherapy, bone marrow transplant, and clinical trials.

Chemotherapy

Chemotherapy uses strong medicines to kill cancer cells. Most drugs are given intravenously, but some are taken orally. It is often the first treatment for classic Hodgkin lymphoma and may be combined with radiation, targeted therapy, or immunotherapy. For nodular lymphocyte-predominant Hodgkin lymphoma, chemotherapy may be used with immunotherapy.

Common side effects include nausea, fatigue, and hair loss. Long-term risks may include heart or lung damage, infertility, and secondary cancers.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to destroy cancer cells. It is often combined with chemotherapy and may be used alone in early-stage cases. For advanced or relapsed Hodgkin lymphoma, it can help relieve symptoms and improve quality of life.

Possible side effects include fatigue, skin irritation, thyroid damage, and organ injury depending on the treatment area.

Targeted therapy

Targeted therapy attacks specific molecules in cancer cells that control their growth and survival. It is often used in combination with chemotherapy or for relapsed or refractory lymphoma.

Side effects can include fatigue, high blood pressure, diarrhea, and liver issues, but these usually improve after treatment ends.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer cells. It may be used alongside chemotherapy or as a treatment for relapsed cases.

Possible side effects include fever, fatigue, nausea, and rare allergic reactions.

Bone marrow transplant
Also called a stem cell transplant, this treatment replaces diseased bone marrow with healthy stem cells from either the patient (autologous) or a donor (allogeneic). It is usually recommended for relapsed or treatment-resistant Hodgkin lymphoma.

Short-term side effects include nausea, mouth sores, fatigue, and skin changes. Long-term risks can include infertility, secondary cancers, and organ damage.

Clinical trials
Clinical trials test new therapies or drug combinations and may be an option for people seeking the latest treatments. Risks and benefits vary, so discuss participation with your healthcare team.

Monitoring after treatment

After treatment, regular follow-up appointments are essential to monitor recovery and detect any recurrence. These visits may include:

• Physical exams

• Blood and imaging tests

• Biopsies if new symptoms appear

Side effects of treatment

Treatments for Hodgkin lymphoma can cause mild to serious side effects. Common effects include fatigue, nausea, vomiting, and increased infection risk. More serious complications may involve:

• Bone marrow suppression, leading to reduced blood cell production and increased infection risk

• Febrile neutropenia, a dangerous fever caused by low white blood cell count

• Medicine toxicity, which can damage organs depending on the type and dosage of drugs used

• Viral reactivation, such as hepatitis B or C becoming active again, which can lead to liver damage

Close monitoring by your healthcare team helps manage these side effects and ensures safe, effective treatment.