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Lymphoma - Hodgkin - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Hodgkin Lymphoma. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the lymphatic system

The lymphatic system is made up lymph nodes, lymphatic organs, and lymphatic vessels. Its job is to fight infection and disease. Lymphatic vessels are thin tubes that branch out to all parts of the body. The lymphatic system carries lymph, a colorless fluid that contains lymphocytes. Lymphocytes are a type of white blood cell that make up part of the immune system.

There are several types of lymphocytes, including:

  • B-lymphocytes, or B cells, that make antibodies to fight bacteria and other infections

  • T-lymphocytes, or T cells, that kill viruses and abnormal cells and trigger the B cells to make antibodies.

In a routine complete blood count (CBC) test, lymphocytes are measured in the blood as part of the white blood cell count.

Groups of bean-shaped organs called lymph nodes are located throughout the body at different areas in the lymphatic system. The largest groups of lymph nodes are found in the abdomen, groin, pelvis, underarms, and neck.

Other parts of the lymphatic system include the:

  • Spleen, which makes lymphocytes and filters the blood

  • Thymus, which is an organ located behind the breastbone

  • Tonsils, which are located in the throat.

About Hodgkin lymphoma

Hodgkin lymphoma, which used to be called Hodgkin’s disease, is 1 of many types of cancer that develops in the lymphatic system. Lymphoma begins when healthy cells in the lymphatic system change and grow out of control. This uncontrolled growth may form a tumor, involve many parts of the lymphatic system, or spread to other parts of the body.

Hodgkin lymphoma most commonly affects lymph nodes in the neck or the area between the lungs and behind the breastbone. It can also begin in groups of lymph nodes under an arm, in the groin, or in the abdomen or pelvis.

If Hodgkin lymphoma spreads, it may spread to the spleen, liver, bone marrow, or bone. Hodgkin lymphoma can spread to other parts of the body, but this is unusual.

This section covers Hodgkin lymphoma in adults. Learn more about childhood Hodgkin lymphoma or non-Hodgkin lymphoma in adults.

Types of Hodgkin lymphoma

There are different types of Hodgkin lymphoma. It is important to know the type because this may affect how the cancer is treated. Doctors determine the type of Hodgkin lymphoma based on how the cells in a tissue biopsy (see the Diagnosis section) look under a microscope and whether the cells contain certain abnormal proteins.

The American Joint Committee on Cancer (AJCC) recognizes 2 major categories of Hodgkin lymphoma: classical Hodgkin lymphoma, which is divided into 4 subtypes based on the appearance of the lymph node structure and cells, and nodular lymphocyte-predominant Hodgkin lymphoma.

Classical Hodgkin lymphoma (cHL)

cHL is the most common type of Hodgkin lymphoma. About 95% of cases of Hodgkin lymphoma fall into the cHL category. cHL is diagnosed when characteristic abnormal lymphocytes, known as Reed-Sternberg cells, are found. cHL is divided into 4 subtypes:

  • Nodular sclerosis Hodgkin lymphoma. Nodular sclerosis Hodgkin lymphoma is the most common type of cHL. It affects up to 80% of people diagnosed with cHL. Nodular sclerosis Hodgkin lymphoma is most common in young adults, especially women. In addition to Reed-Sternberg cells, there are bands of connective tissue (called fibrosis) found in the lymph node. The presence of these bands can help diagnose this type of Hodgkin lymphoma. This type of lymphoma often affects the lymph nodes in the central part of the chest, called the mediastinum.

  • Lymphocyte-rich classical Hodgkin lymphoma. About 6% of people with cHL are diagnosed with lymphocyte-rich classical Hodgkin lymphoma. It is more common in men and usually affects areas other than the mediastinum. In addition to Reed-Sternberg cells, the lymph node tissue contains many normal lymphocytes.

  • Mixed cellularity Hodgkin lymphoma. This subtype of cHL occurs in older adults. It commonly develops in the abdomen and carries many different cell types, including large numbers of Reed-Sternberg cells.

  • Lymphocyte-depleted Hodgkin lymphoma. Lymphocyte-depleted Hodgkin lymphoma is the least common subtype of cHL. Only about 1% of people with cHL have this subtype. It is most common in older adults; people with the human immunodeficiency virus (HIV), the virus that causes autoimmune deficiency syndrome (AIDS); and people in non-industrialized countries. The lymph node contains almost all Reed-Sternberg cells.

Nodular lymphocyte-predominant Hodgkin lymphoma

About 5% of people with Hodgkin lymphoma have nodular lymphocyte-predominant Hodgkin lymphoma. It often develops in the lymph nodes in the neck, groin, or armpit. It is most common in younger patients.

Nodular lymphocyte-predominant Hodgkin lymphoma is more similar at the protein and genetic level to B-cell non-Hodgkin lymphoma. People with this type of Hodgkin lymphoma have large cells in the affected area called “popcorn cells” or “LP cells” that have a marker called CD20 on their surface. CD20 is a protein that is usually found in people diagnosed with B-cell non-Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma is often treated differently from cHL. Some people with nodular lymphocyte-predominant Hodgkin lymphoma do not need treatment right away, while others may benefit from a treatment plan that includes radiation therapy, chemotherapy, or the monoclonal antibody rituximab (Rituxan).

People with nodular lymphocyte-predominant Hodgkin lymphoma tend to have a very good prognosis. This means the treatment, if needed, has a very good chance of being successful and helps the patient recover. However, a small number of patients with nodular lymphocyte-predominant Hodgkin lymphoma may develop a more aggressive type of non-Hodgkin lymphoma called diffuse large B-cell lymphoma through a process called transformation.

Looking for More of an Introduction?

If you would like more of an introduction, explore the following items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics, and it helps explain how many people are diagnosed with Hodgkin lymphoma and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find information about the number of people who are diagnosed with Hodgkin lymphoma each year. You will read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 8,260 people (4,650 men and 3,610 women) in the United States will be diagnosed with Hodgkin lymphoma.

It is estimated that 1,070 deaths (630 men and 440 women) from this disease will occur this year. The survival rate has been going up the past 40 years thanks to treatment improvements.

Hodgkin lymphoma affects both children and adults. It is most common in 2 age-groups: ages 15 to 40 (particularly young adults in their 20s) and after age 55.

The 1-year survival rate tells you what percent of people live at least 1 year after the cancer is found. Percent means how many out of 100. The 1-year survival rate for all people with Hodgkin lymphoma is 92%.

The 5-year survival rate for all people with Hodgkin lymphoma is 86%. For men and women, the 5-year survival rates are 85% and 87% respectively. The 10-year survival rate for all people with the disease is 80%. However, these survival rates vary depending on the stage and subtype of the disease.

The 5-year survival rate for stage I and stage II Hodgkin lymphoma is 90%. For stage III, the 5-year survival rate is 80% and for stage IV it’s 65%.

It is important to remember that statistics on the survival rates for people with Hodgkin lymphoma are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 1 or 5 years. People should talk with their doctor if they have questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s (ACS) publication, Cancer Facts & Figures 2017, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by Hodgkin lymphoma. Or, use the menu to choose another section to continue reading this guide.  

Lymphoma - Hodgkin - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of lymphoma. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The exact cause of Hodgkin lymphoma is not known, but the following factors may raise a person’s risk of developing Hodgkin lymphoma:

  • Age. People between the ages of 15 and 40 and people older than 55 are more likely to develop Hodgkin lymphoma.

  • Gender. In general, men are slightly more likely to develop Hodgkin lymphoma than women, although the nodular sclerosis subtype is more common for women.

  • Family history. Brothers and sisters of people with Hodgkin lymphoma have a higher chance of developing the disease, although the increase in risk is small.

  • Virus exposure. The Epstein-Barr virus (EBV) causes infectious mononucleosis or "mono." Nearly all adult Americans and many others around the world have been infected with EBV. About 20% to 25% of people with cHL in the United States have lymphoma cells that test positive for EBV. However, the role of EBV in the development of Hodgkin lymphoma is not yet clear. Although a person’s immune system response to an infection with EBV may be important in the development of Hodgkin lymphoma, doctors still don’t understand why when so many people have been infected with EBV, relatively very few people ever develop Hodgkin lymphoma. People with HIV infection also have a higher risk of developing Hodgkin lymphoma, particularly lymphocyte-depleted Hodgkin lymphoma (see the Introduction).

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

People with Hodgkin lymphoma may experience the following symptoms or signs. Sometimes, people with Hodgkin lymphoma do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer. Common symptoms caused by Hodgkin lymphoma include:

  • Painless swelling of lymph nodes in the neck, underarm, or groin area that does not go away within a few weeks

  • Unexplained fever that does not go away

  • Unexplained weight loss

  • Night sweats, usually drenching

  • Pruritus, a generalized itching that may be severe

  • Fatigue

  • Pain in the lymph nodes triggered by drinking alcohol

If the lymph nodes in the chest are affected, they may press on structures in the lung and cause shortness of breath, cough, or chest discomfort.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

Use of symptoms in staging

If the diagnosis is Hodgkin lymphoma, the doctor may also use certain symptoms to help describe the disease in a process known as staging. Each stage may be subdivided into "A" and "B" categories.

  • A means that a person has not experienced B symptoms, which are listed below.

  • B means that a person has experienced 1 or more of the following symptoms:

    • Unexplained weight loss of more than 10% of original body weight during the 6 months before diagnosis

    • Unexplained fever, with temperatures above 100.4ºF (38ºC)

    • Drenching night sweats. Many patients with Hodgkin lymphoma say their nightclothes or the sheets on the bed were so wet they needed to be changed during the night. Sometimes, heavy sweating occurs during the day.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The following tests may be used to help diagnose Hodgkin lymphoma:

  • Medical history and physical examination. A thorough medical history and physical examination can show evidence of typical symptoms, such as night sweats, fevers, and enlarged lymph nodes or spleen.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but Hodgkin lymphoma can only be diagnosed after a biopsy of an affected tissue, preferably by removal (or excision) of a lymph node. Most commonly, this will be a lymph node affected in the neck, under the arm, or in the groin. If there are no lymph nodes in these areas, a biopsy of other lymph nodes, such as those in the center of the chest, may be necessary. This type of biopsy usually requires minor surgery, although occasionally it is possible to do a biopsy using a core needle during a scan or ultrasound using local anesthesia. Anesthesia is medication to block the awareness of pain. Doctors most commonly use ultrasound or a computed tomography (CT or CAT) scan (see below) to help guide the needle to the correct location.

    A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A hematopathologist is a doctor who has received additional training in blood diseases and blood cancer diagnosis.

    It is important that the biopsy sample is large enough to allow the pathologist to make an accurate diagnosis and determine the subtype of Hodgkin lymphoma. As described in the Introduction, a biopsy of cHL usually has Reed-Sternberg cells. For people with nodular lymphocyte-predominant Hodgkin lymphoma, the Reed-Sternberg cells often look different and are called “LP” cells. In contrast to classic Reed-Sternberg cells, LP cancer cells have a protein on their surface called CD20.

Once Hodgkin lymphoma is diagnosed, other tests can help find out the extent of the disease, the stage, and other information to help the doctors plan treatment. These tests include:

  • Laboratory tests. Blood tests may include a CBC and an analysis of the different types of white blood cells, in addition to the erythrocyte sedimentation rate (ESR or "sed rate") and liver and kidney function tests. Blood tests cannot detect Hodgkin lymphoma.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities, such as enlarged lymph nodes, or tumors. A CT scan of the chest, abdomen, and pelvis can help find cancer that has spread to other parts of the body. A special dye called a contrast medium is usually given before the scan to improve the details of the images. This dye can be injected into a patient’s vein or given as a liquid to swallow. People with a history of kidney disease or poor kidney function should not receive a contrast medium given by IV (vein).

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s vein. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. PET-CT scans may be used to determine the stage of Hodgkin lymphoma. PET scans may also be used to see how the lymphoma is responding to treatment.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow. This test is sometimes used for Hodgkin lymphoma.

  • Lung function tests. Also called pulmonary function tests or PFTs, lung function tests evaluate how much air the lungs can hold, how quickly air can move in and out of the lungs, and how well the lungs add oxygen and remove carbon dioxide from the blood. These tests may be done if a person's treatment plan includes chemotherapy with certain drugs that could affect the lungs.

  • Heart evaluation. A heart evaluation, including an echocardiogram (ECHO) or a multigated acquisition (MUGA) scan, may be used to check the function of the heart if specific types of chemotherapy will be included in a person's treatment plan.

  • Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow is the soft, spongy tissue found inside the center of bones. It has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. A pathologist then analyzes the sample(s). However, bone marrow biopsy is often not necessary if a PET-CT scan has been performed as part of the staging evaluation.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is Hodgkin lymphoma, these results also help the doctor describe the extent of cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn about how doctors describe the extent of a cancer’s growth or spread. This is called the stage. You will also discover what prognostic factors help doctors predict how well treatment will work. To see other pages, use the menu.

Staging helps to describe where the Hodgkin lymphoma is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

When staging Hodgkin lymphoma, doctors evaluate the following:

  • The number of cancerous lymph node areas

  • Whether the cancerous lymph nodes are localized or generalized. Localized means they are located only in 1 area of the body. Generalized means they are located in many areas of the body

  • Whether the cancerous lymph nodes are on 1 or both sides of the diaphragm, the thin muscle under the lungs and heart that separates the chest from the abdomen

  • Whether the disease has spread to the bone marrow, spleen, or extralymphatic organs (organs outside the lymphatic system; noted using an “E” below), such as the liver, lungs, or bone

Lymphoma stage groupings

The stage of lymphoma describes the extent of the spread of the tumor, using the terms stage I through IV (1 through 4). As explained in the Symptoms and Signs section, each stage may also be further divided into “A” and “B” categories, based on whether or not the patient is experiencing specific symptoms.

Stage I: The cancer is found in 1 lymph node region.

Stage II: Either of the following conditions applies:

  • The cancer is in 2 or more lymph node regions on the same side of the diaphragm (stage II).

  • The cancer involves 1 organ and its regional lymph nodes (lymph nodes located near the site of the lymphoma), with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III: There is cancer in lymph node areas on both sides of the diaphragm, meaning above and below it (stage III). In addition, an extralymphatic organ may be involved (stage IIIE), or the spleen (using the letter “S,” stage IIIS), or both (stage IIIES).

Stage IV: The lymphoma has spread to organs beyond the lymph nodes. Common places that Hodgkin lymphoma usually spreads to include the liver, bone marrow, or lungs.

Recurrent: Recurrent lymphoma is lymphoma that has come back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur at any time, including shortly after the first treatment or years later. If the lymphoma does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Prognostic factors

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how well this treatment will work. For patients with Hodgkin lymphoma, several factors can predict whether the disease will return and which treatments will be successful. A patient may be described as having high-risk disease or low-risk disease based on how many of the following prognostic factors there are.

Factors that are considered less favorable and lead to a poorer prognosis include:

  • Low blood albumin (a type of protein) levels, defined as less than 4 g/L

  • Low hemoglobin (red blood cell count), defined as less than 10.5 g/dL

  • Being male

  • Age 45 and older

  • Stage IV disease

  • White blood cell count that is more than 15,000 per cubic millimeter (mm3)

  • Lymphocyte count that is less than 600 per mm3, less than 8% of the total white blood cell count, or both

Other prognostic factors that are considered, especially for early-stage Hodgkin lymphoma, include:

  • A higher ESR (described in the Diagnosis section) is associated with a poorer prognosis.

  • People with lymphocyte-predominant Hodgkin lymphoma, nodular sclerosis Hodgkin lymphoma, and lymphocyte-rich classical Hodgkin lymphoma have a better prognosis, compared with other subtypes of Hodgkin lymphoma.

  • A large mediastinal mass is a large lymph node mass in the center of the chest that is larger than 10 centimeters (cm). It is associated with a poorer prognosis. Small mediastinal masses are not associated with a poorer prognosis.

  • Having a high number of lymph node sites involved is associated with a poorer prognosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org

Information about the lymphoma’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of lymphoma. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of lymphoma. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors and other health care professionals often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called an multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, nurse practitioners, social workers, pharmacists, counselors, dietitians, and others.

The original treatments for Hodgkin lymphoma, developed in the 1960s and 1970s, were very effective at treating the disease. However, some people who received these treatments developed serious side effects later in life, including infertility (the inability to have children), heart problems (such as heart failure, leaky heart valves, and heart attacks), and secondary cancers, such as lung cancer and breast cancer. These long-term problems were partly caused by the types of chemotherapy used at that time and partly caused by the use of high doses of radiation therapy delivered to large areas of the body. Learn more about the late effects of treatment for Hodgkin lymphoma.

To avoid or reduce the risk of these problems, current treatment plans for Hodgkin lymphoma are aimed at the best chance of curing the Hodgkin lymphoma while avoiding causing long-term side effects as much as possible. This has led doctors to choose newer types and doses of chemotherapy and directing radiation therapy, if used, at smaller areas of the body.

Most people with cHL, even stage I or stage II, often receive chemotherapy. In some patients, this is followed by radiation therapy to the affected lymph node areas. It may be possible to treat some people with early-stage disease (stage I or II) with a relatively short course of chemotherapy with or without radiation therapy. Patients should discuss with their doctor whether chemotherapy can be limited and/or whether radiation therapy is necessary in the treatment plan. For stage III or stage IV disease, chemotherapy is the primary treatment, although additional radiation therapy may be recommended, especially to areas of large lymph nodes.

Descriptions of the most common treatment options for Hodgkin lymphoma are listed below. Treatment options and recommendations depend on several factors, including:

  • The type and stage of lymphoma

  • Possible side effects

  • Results of regular PET-CT scans during treatment

  • The patient’s preferences and overall health

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and ask about anything that is unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment, including any potential side effects. Learn more about making treatment decisions.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or by mouth, in a pill or capsule that is swallowed. Many people with Hodgkin lymphoma receive chemotherapy through a port-a-cath placed under the skin. Learn more about catheters and ports in cancer treatment.

A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.

First-line chemotherapy

Many different types of chemotherapy may be used for Hodgkin lymphoma. The most commonly used combination of drugs in the United States is called ABVD. Another combination of drugs, known as BEACOPP, is now widely used in Europe in patients with advanced Hodgkin lymphoma and is sometimes used in the United States. The drugs that make up these 2 common combinations of chemotherapy are listed below. There are other combinations that are less commonly used and not listed here.

  • ABVD: Doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban, Velsar), and dacarbazine (DTIC-Dome). ABVD chemotherapy is usually given every 2 weeks for 2 to 8 months.

  • BEACOPP: Bleomycin, etoposide (Toposar, VePesid), doxorubicin, cyclophosphamide (Cytoxan, Neosar), vincristine (Vincasar PFS, Oncovin), procarbazine (Matulane), and prednisone (multiple brand names). There are several different treatment schedules, but different drugs are usually given every 2 to 3 weeks.

The type of chemotherapy, number of cycles of chemotherapy, and the additional use of radiation therapy are based on the stage of the Hodgkin lymphoma and the type and number of prognostic factors. Talk with your doctor about the specifics of your treatment plan. Some doctors choose to monitor how well these treatments are working with repeat PET scans after 2 to 3 months of treatment. If the PET scans show that the treatment is not working, the chemotherapy may be changed. If the PET scans show that treatment is working, then the doctor may decide to lower the subsequent number of drugs used or the total number of treatment cycles.

Second-line chemotherapy

If Hodgkin lymphoma comes back after first-line treatment with ABVD or BEACOPP, known as a recurrence, there are several second-line treatments. Many of these treatments are given in preparation for an autologous stem cell transplant (see below), but they can also be given to control the disease and its symptoms.

  • ICE: Ifosfamide (Ifex), carboplatin (Paraplatin), and etoposide. ICE is usually given every 2 or 3 weeks for 2 to 3 cycles.

  • ESHAP or DHAP: Etoposide, methylprednisolone (Solu-Medrol), high-dose cytarabine (Cytosar-U), and cisplatin (Platinol). Dexamethasone (multiple brand names), high-dose cytarabine, and cisplatin. ESHAP or DHAP regimens are given every 3 weeks for 2 to 3 cycles.

  • GVD, Gem-Ox, or GDP: Gemcitabine (Gemzar), vinorelbine (Navelbine), and doxorubicin. Gemcitabine and oxaliplatin (Eloxatin). Gemcitabine, dexamethasone, and cisplatin. Gemcitabine-based regimens are either given 2 weeks in a row followed by an off-week or every other week.

  • Brentuximab vedotin (Adcetris): Brentuximab vedotin (Adcetris) is an antibody drug conjugate. This means it delivers chemotherapy only to cells that have a special protein on the surface called CD30. Brentuximab vedotin is usually given every 3 weeks for up to 16 cycles, although sometimes it is given every 4 weeks. This drug is an important therapy once previous chemotherapy stops working. It is being tested as an adjunct or replacement for chemotherapy before stem cell transplantation for patients with recurrent Hodgkin lymphoma. It was also approved in 2015 by the U.S. Food and Drug Administration (FDA) for use in certain patients after stem cell transplantation who are at a high risk for recurrence.

It is unclear which of these chemotherapy treatments is best for patients with Hodgkin lymphoma. The best treatment may differ depending on the type and stage of the lymphoma. For this reason, many clinical trials are underway to compare these different treatments. These clinical trials are designed to find out which combination works best with the fewest short-term and long-term side effects.

During chemotherapy, your doctors will usually repeat some of the original tests, especially PET-CT scans. These tests are used to watch the lymphoma and see how well treatment is working.

The side effects of chemotherapy depend on the individual and the doses used, but they can include fatigue, risk of infection, nausea and vomiting, peripheral neuropathy (tingling or pain in the fingers and toes), hair loss, loss of appetite, and constipation. These side effects usually go away once treatment is finished. Although the risk of long-term side effects has decreased as treatments have improved, chemotherapy still can cause long-term side effects. People with lymphoma may also have concerns about if or how their treatment may affect their sexual function and fertility. Talk about these topics with the health care team before treatment begins. Learn more about late effects of treatment.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation oncologist is a doctor who specializes in giving radiation therapy to treat cancer. Radiation therapy for Hodgkin lymphoma is always external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Whenever possible, radiation therapy is now directed only at the affected lymph node areas. This helps reduce the risk of damaging healthy tissues. Some patients may be able to receive newer radiation therapy techniques. These include:

  • Involved-site radiotherapy, which focuses the radiation on the lymph nodes that contain cancer

  • Intensity modulated radiotherapy (IMRT), which varies the strength and direction of the radiation beams so less healthy tissue is affected

  • Proton therapy, which uses protons rather than x-rays to treat the cancer, may be used in certain patients.

The immediate side effects from radiation therapy depend on the area of the body that is being treated. These may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Patients who receive radiation to the neck may have a sore mouth and/or throat. Most side effects go away soon after treatment is finished.

Although the risk for long-term side effects has decreased with improvements in treatment, radiation therapy may still cause long-term side effects, also called late effects, including thyroid damage if radiation to the neck is given, secondary cancers, and vascular damage, including damage to blood vessels in the heart if radiation to the chest is given. To reduce the risk of long-term side effects, clinical trials are being done to find out the best doses and smallest possible area to direct the radiation therapy.

Learn more about the basics of radiation therapy.

Stem cell transplantation/bone marrow transplantation

A stem cell transplant is a medical procedure in which a patient’s bone marrow is replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is stem cells that are typically collected from the blood that are being transplanted, not stem cells from the actual bone marrow tissue.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the results of any previous treatment and the patient’s age and general health. It is very important to talk with a doctor at an experienced transplant center about the risks and benefits of stem cell transplantation.

Stem cell transplantation is not used as a first treatment for Hodgkin lymphoma, but it may be recommended for patients who have lymphoma remaining after chemotherapy or if the lymphoma returns following treatment.

There are 2 types of stem cell transplantation, depending on the source of the replacement blood stem cells: autologous (AUTO) and allogeneic (ALLO).

In an AUTO transplant, the patient’s own stem cells are used. The stem cells are collected from the patient when he or she is in remission after previous treatment. The stem cells are then frozen until they are needed. An AUTO transplant allows for more intense chemotherapy doses to destroy leftover lymphoma cells followed by returning the saved stem cells to the body so the bone marrow and blood cells can recover.

In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level. This testing is called HLA typing. Most often, a patient’s brother, sister, or other relative serves as the donor, although an unrelated person can be a donor as well. The patient receives chemotherapy to stop his or her immune system from destroying the donor’s cells. The goal of an ALLO transplant is for the donor’s immune system to destroy the patient’s cancer cells.

For both types, the goal of transplantation is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow. The chemotherapy and/or radiation therapy given before the transplant also suppress the patient’s bone marrow tissue and the patient’s immune system. In an ALLO transplant, this helps prevent the donor cells from being rejected by the body, and in fact, these donor cells can be active in destroying remaining cancer cells.

It is important to talk with the doctor about the potential risks and benefits of both types of transplants to determine the best choice for an individual patient.

Learn more about the basics of stem cell and bone marrow transplantation.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

In 2016, the FDA approved nivolumab (Opdivo) for the treatment of patients with classical Hodgkin lymphoma that has recurred or progressed after AUTO transplantation and post-transplant treatment with brentuximab vedotin (Adcetris). This drug is called a checkpoint inhibitor or PD-1 inhibitor. When nivolumab is used by itself in patients with Hodgkin lymphoma who have had a recurrence after AUTO transplantation, about 2 of every 3 patients show improvement in their scans for an average of 9 months, although it is unlikely that these patients are cured. There are side effects, but they are generally mild. Talk with your doctor for more information.

Learn more about the basics of immunotherapy.

Getting care for symptoms and side effects

Hodgkin lymphoma and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the disease, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the lymphoma and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional support, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible.

Learn more about palliative care.

Progressive Hodgkin lymphoma

Progressive disease occurs when the cancer becomes larger or spreads while the original lymphoma is being treated. However, progressive disease is uncommon for people with Hodgkin lymphoma.

If progression happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. Complete recovery from progressive Hodgkin lymphoma is not always possible.

Often, a doctor will recommend a stem cell transplant (see above). This treatment appears to be more effective for progressive Hodgkin lymphoma than standard chemotherapy. Palliative care is also important to help relieve symptoms and side effects.

For most patients, a diagnosis of progressive Hodgkin lymphoma is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when lymphoma cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the disease returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the lymphoma does return. Learn more about coping with the fear of recurrence.

If the lymphoma does return following remission after the original treatment, it is called recurrent lymphoma. Recurrence is uncommon for people with Hodgkin lymphoma. However, if Hodgkin lymphoma does recur, a cycle of testing much like that done at the time of diagnosis will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options.

Most often, the first step is to give a second-line chemotherapy treatment, such as ICE, ESHAP, DHAP, gemcitabine-based treatments, or brentuximab vedotin (see Chemotherapy above).

The goal of chemotherapy is to regain control over the recurrent Hodgkin lymphoma. For most patients, this treatment is used to prepare for a stem cell transplant, which provides the best possible chance of curing the disease. Radiation therapy may be included in the treatment plan, before or after a stem cell transplant, especially if radiation therapy was not used during the initial treatment period. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent lymphoma. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent lymphoma often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope.

Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from lymphoma is not always possible. If the lymphoma cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important. It is also important to discuss newer treatment options that are being tested in clinical trials. Finding a second opinion may be useful, too.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with lymphoma. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with Hodgkin lymphoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating Hodgkin lymphoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with Hodgkin lymphoma.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for Hodgkin lymphoma, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of lymphoma. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of lymphoma and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about Hodgkin lymphoma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Measuring treatment effectiveness. A focus of research for Hodgkin lymphoma is monitoring how well treatment is working. This knowledge can help inform decisions about if and when to change treatment. Some new clinical trials are looking at changing chemotherapy depending on the results of a PET scan early in the treatment period. Based upon recent promising clinical trial results, this may become a standard strategy in Hodgkin lymphoma therapy.

  • New chemotherapy/targeted therapy. New drugs, new combinations of chemotherapy, lower doses, and shorter schedules are being studied in clinical trials to reduce short-term side effects and long-term health risks. Other drugs are being tested for recurrent Hodgkin lymphoma and may be added to the current standard chemotherapy regimens used for progressive disease. Several new types of drugs that work in a way different from chemotherapy, called targeted therapy, are also being studied. Many of these are given as a pill by mouth.

  • Gene profiling. Some researchers are looking at the specific genes and proteins that are found in Hodgkin lymphoma. These genes and proteins provide more information about the behavior of Hodgkin lymphoma, which may help doctors choose which chemotherapy or immunotherapy to use to treat the lymphoma.

  • Other treatments. Stem cell transplantation is being studied in combination with chemotherapy and immunotherapy regimens for new or recurrent Hodgkin lymphoma. Mini-allogeneic, also called non-myeloablative or reduced-intensity transplant, and allogeneic transplantation are being tested in combination with chemotherapy and immunotherapy for new or recurrent Hodgkin lymphoma.

  • Reducing treatment intensity. Some earlier stage Hodgkin lymphoma subtypes have such high cure rates that less intense treatment plans are being tested. These lower intensity plans reduce the use of radiation therapy or decrease the amount of chemotherapy. The goal is to effectively treat the lymphoma and have fewer long-term side effects. Often, patients receive a PET scan after a short course of chemotherapy to help guide these treatment reductions.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current Hodgkin lymphoma treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding Hodgkin lymphoma, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that lymphoma and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Many people with Hodgkin lymphoma are young adults. Being diagnosed with cancer at this point in life can bring unique concerns and challenges. Learn more about being a young adult with cancer.

Coping with physical side effects

Common physical side effects from each treatment option for Hodgkin lymphoma are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the lymphoma’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with Hodgkin lymphoma. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Late Effects of Treatment. It describes side effects that may develop months or years after treatment has ended. Or, use the menu to choose another section to continue reading this guide.  

Lymphoma - Hodgkin - Late Effects of Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find out more about the physical and emotional side effects that can occur long after treatment for this type of lymphoma has ended and how these late effects can be prevented, managed, or both. To see other pages, use the menu.

People who received treatment for Hodgkin lymphoma have an increased risk of developing other diseases or conditions later in life. This is because both chemotherapy and radiation therapy can cause permanent damage. Treatments have improved in the last 30 years, and now patients are less likely to experience late effects; however, there is still some risk. Therefore, it is important that patients see their doctors regularly for follow-up care and watch for any new side effects.

  • Infertility. Radiation therapy to the pelvic area can cause infertility unless the ovaries or testicles are shielded during treatment. Also, teenagers and adults who received chemotherapy may be at higher risk for low sperm counts (for men) or damage to the ovaries (for women). The risk of infertility is low after ABVD chemotherapy for Hodgkin lymphoma but is much higher after BEACOPP. Stem cell transplantation usually causes infertility in men. It is unusual, but not impossible, for women to become pregnant after a stem cell transplant.

    Patients who are considering having a family should discuss fertility preservation with their doctor before starting treatment. Learn more about fertility concerns and preservation for men and women.

  • Second cancers. Some survivors of Hodgkin lymphoma have a higher risk of developing a secondary cancer, especially acute myeloid leukemia (following certain types of chemotherapy or radiation therapy), non-Hodgkin lymphoma, lung cancer, or breast cancer. The risk of a secondary cancer is likely to decrease in the future because the treatments used now have fewer risks. Patients can lower their risk of developing a secondary cancer by limiting or avoiding other risk factors, such as smoking. It is also important that women who received radiation therapy to the chest begin regular breast cancer screening at age 40 or 8 years after treatment, whichever comes first.

  • Lung and heart damage. Patients who received anthracyclines (doxorubicin) or bleomycin during chemotherapy have a higher risk of both heart and lung damage. Radiation therapy to the chest area also can cause lung damage and increase the risk of heart disease. It is very important that men and women who received radiation to the chest limit other risk factors that may lead to heart damage by not smoking, by getting regular exercise, by monitoring and maintaining healthy blood pressure and cholesterol levels, and by making healthy food choices.

  • Thyroid problems. Radiation therapy to the neck area can cause problems with the thyroid gland, most commonly hypothyroidism. Hypothyroidism is when the body produces too little thyroid hormone, which regulates metabolism. This problem can be checked using a blood test and managed by taking a thyroid hormone supplement pill.

Learn more about possible late effects of cancer treatment.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after cancer treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with lymphoma doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects and late effects of treatment, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. How often a person needs follow-up care and which tests are performed depends on several factors, including the original extent of the Hodgkin lymphoma and the type of treatment. Tests like CT scans and PET scans should be repeated after treatment ends to make sure that the disease is in complete remission, but research has not shown that having routine subsequent (“surveillance”) scans is better than scanning only when there is development of new symptoms or new findings on your physical examination or laboratory tests. Talk with your doctor whether tests such as CT scans and PET scans should be repeated, as well as how often you should have physical examinations.

Patients who have had Hodgkin lymphoma should get a flu shot every year. It may be recommended that some survivors get an immunization against pneumonia, which may be done every 5 to 7 years.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health.

In general, each follow-up visit includes a discussion with the doctor, a physical examination, and blood tests. During some visits, scans may be done. At most cancer centers, follow-up visits are scheduled every 2 to 3 months for the period right after treatment, which is when the risk of recurrence is highest. After that, the time between visits increases over time. Later visits may only be 2 to 3 times per year until 5 years have passed. Then, annual visits should be continued with an oncologist.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them. Special attention should be paid to cancer screening and detection, as well as heart risk factors, throughout the person’s lifetime. For patients who received radiation therapy to the neck or chest, monitoring thyroid gland function is important.

Follow-up care should also address the person’s quality of life, including emotional concerns. In particular, Hodgkin lymphoma survivors are encouraged to be aware of the symptoms of depression and to talk with their doctor immediately if they have such symptoms.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, either to reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from Hodgkin lymphoma are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your health care team. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of Hodgkin lymphoma do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • Has my biopsy been reviewed by a pathologist who is an expert in lymphoma?

  • What is the stage of my Hodgkin lymphoma? What is the subtype?

  • What prognostic factors do I have? Are they good or poor? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • How experienced are you in treating Hodgkin lymphoma?

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of treatment, both in the short term and the long term?

  • Who will be leading my overall treatment?

  • Should I get a second opinion?

  • What symptoms should I be most concerned about during treatment? When and how should I contact the health care team if they appear or get worse?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • How can I stay as healthy as possible during treatment? Will taking supplements or changing my diet help improve my overall health?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins? If I’m a man, should I bank my sperm? How much will that cost?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having chemotherapy

  • Which chemotherapy treatment do you recommend?

  • What is the goal of this treatment?

  • What are the advantages and disadvantages of chemotherapy alone versus chemotherapy plus radiation treatment?

  • How often will I need to have treatment? For how long?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having radiation therapy

  • What, if any, radiation treatment do you recommend? Why?

  • What area(s) do you plan to treat?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about stem cell/bone marrow transplantation

  • What type of transplant is recommended?

  • What is the goal of this treatment?

  • How long will I be in the hospital?

  • Can you describe what my recovery will be like?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • What support services are available to me? To my family?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Lymphoma - Hodgkin - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Hodgkin Lymphoma. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Hodgkin lymphoma. Use the menu to select another section to continue reading this guide.