Hodgkin lymphoma, also called Hodgkin’s disease, is one category of lymphoma, a cancer of the lymph system. Lymphoma begins when cells in the lymph system change and grow uncontrollably, which may form a tumor.

The lymph system is made up of thin tubes that branch out to all parts of the body. Its job is to fight infection and disease. The lymph system carries lymph, a colorless fluid containing lymphocytes (white blood cells). Lymphocytes fight germs in the body. B-lymphocytes (also called B cells) make antibodies to fight bacteria, and T-lymphocytes (also called T cells) kill viruses and foreign cells and trigger the B cells to make antibodies.

Groups of bean-shaped organs called lymph nodes are located throughout the body at different sites in the lymph system. Lymph nodes are found in clusters in the abdomen, groin, pelvis, underarms, and neck. Other parts of the lymph system include the spleen, which makes lymphocytes and filters blood; the thymus, an organ under the breastbone; and the tonsils, located in the throat.

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

If Hodgkin lymphoma spreads, involvement of the spleen, liver, bone marrow, and bone is fairly common. Spread to other parts of the body can also occur, but it is unusual.

This section covers Hodgkin lymphoma in adults. For more information on childhood Hodgkin lymphoma, please visit Lymphoma, Hodgkin, Childhood Cancer.

Types of Hodgkin Lymphoma

There are different types of Hodgkin lymphoma. It is important to know the type, as this may affect the choice of treatment. Doctors determine the type of Hodgkin lymphoma by how the cells in a tissue sample look under a microscope and whether the cells contain abnormal patterns of certain proteins.

The American Joint Committee on Cancer (AJCC) recognizes these major categories of Hodgkin lymphoma:

Classical Hodgkin lymphoma. Classical Hodgkin lymphoma (CHL) is diagnosed when characteristic Reed-Sternberg cells are found. About 20% to 25% of cases of CHL in the United States and Western Europe are associated with the Epstein-Barr virus (EBV, the virus that causes infectious mononucleosis, also known as "mono").

The following list describes the different CHL subtypes.

Statistics

In 2009, an estimated 8,510  people (4,640 men and 3,870 women) in the United States will be diagnosed with Hodgkin lymphoma. It is estimated that 1,290 deaths (800 men and 490 women) from this disease will occur this year. Hodgkin lymphoma affects both children and adults. It is most common in two age groups: ages 15 to 40 (ages 25 to 30 are most common) and after 55.

The one-year relative survival rate (the percentage of people who survive at least one year after the cancer is detected, excluding those who die from other diseases) of people with Hodgkin lymphoma is 92%. The five-year and ten-year relative survival rates are 85% and 81%, respectively.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with Hodgkin lymphoma. Because survival statistics are often measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2009.

Find out more about basic cancer terms used in this section.

A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to 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 age 15 and 40 and people over age 55 are more likely to develop Hodgkin lymphoma.

Gender. Men are slightly more likely to develop Hodgkin lymphoma than women overall, 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 likelihood is still remote).

Virus exposure. People who are infected with EBV (see Overview) may be at increased risk for developing some types of Hodgkin lymphoma. However, there are probably several other factors involved. Mono is a very common disease, but Hodgkin lymphoma is very uncommon. For those cases not associated with EBV, other viruses may be involved.

It is important to note that although viruses may be involved in the development of Hodgkin lymphoma, there is no evidence that this type of cancer is contagious. Close contact with someone with Hodgkin lymphoma does not increase a person’s risk of developing the disease.

People with Hodgkin lymphoma may experience the following symptoms. Sometimes, people with Hodgkin lymphoma do not show any of these symptoms, or these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor. Common symptoms associated with Hodgkin lymphoma may include:

• Painless swelling of lymph nodes in the neck, underarm, or groin area that does not go away in a few weeks
  
  
• Unexplained fever that does not go away
  
  
• Unintended weight loss
  
  
• Night sweats (usually drenching)
  
  
• Pruritus (generalized itching) is another occasional symptom of Hodgkin lymphoma
  
  
• Tiredness
  
  
• Pain in the lymph nodes associated with alcohol intake

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

Doctors use many tests to diagnose cancer and determine the extent of the disease. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• The type of cancer suspected
• Severity of symptoms
• Previous test results

The following tests may be used to 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 and fevers, and affected or 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 the diagnosis of Hodgkin lymphoma can only be made after a biopsy of an affected piece of tissue. Most commonly, this will be a lymph node 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 obtain a biopsy using a needle under local anesthesia, while the patient is undergoing a scan (most commonly a computed tomography [CT or CAT] scan, see below). The CT scan is used to help make sure the biopsy is taken from the appropriate place.

The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). As described in the Overview, a biopsy of CHL usually has Reed-Sternberg cells. Reed Sternberg cells are often absent in the nodular lymphocyte predominant Hodgkin lymphoma, which usually has a different type of cancerous cell, called the L & H or popcorn cell.

Once a diagnosis has been made, other tests can help determine the extent of the disease or stage and other information to help doctors plan treatment. These tests include the following:

Laboratory tests. Blood tests may include a complete blood count and analysis of the different types of white blood cells, in addition to liver function tests. The doctor may also test for the erythrocyte sedimentation rate (ESR), also called the "sed rate."

Imaging tests. To determine where the cancer is located and whether it has spread, the doctor may use the following imaging tests:

Bone marrow biopsy. In a bone marrow biopsy, a needle is inserted through the skin into the back of the pelvic (hip) bone. A small amount of bone and bone marrow are taken, either under local anesthesia to numb the area or with sedation. The small amount of bone and bone marrow are examined under a microscope. The decision regarding the need for a bone marrow biopsy depends on the extent of the disease, and the results of certain laboratory tests.

To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.

Staging helps to define where the Hodgkin lymphoma is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (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
  
  
• The location of the cancerous lymph nodes: regional (in the area where the cancer began) or distant (in other parts of the body)
  
  
• Whether the cancerous lymph nodes are on one 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 lymph system) such as the liver, lungs, or bone

The stage of lymphoma describes the extent of the spread of the tumor, first using the terms stage I through IV (one through four), and then using a letter (A or B).

Stage I: Either one of these conditions:

• The cancer is found in one lymph node region (stage I).
  
  
• The cancer involves one extralymphatic organ (identified using the letter “E”) or site but not any lymph node regions (stage IE).

Stage II: Either one of these conditions:

• The cancer is in two or more lymph node regions on the same side of the diaphragm (stage II).
  
  
• The cancer involves a single organ and its regional 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 (stage III).
  
  
• In addition, there may be involvement of an extralymphatic organ (stage IIIE), involvement of the spleen (using the letter “S,” stage IIIS), or both (stage IIIES).

Stage IV: Lymphoma is called stage IV if there is disseminated (multifocal) involvement, meaning that the lymphoma has spread throughout multiple areas. Common sites for disseminated disease are the liver, bone marrow, or lungs.

Recurrent: Recurrent lymphoma is lymphoma that comes back after treatment. Lymphoma may return in the area where it first started or in another part of the body. Recurrence may occur shortly after the first treatment or years later.

In Hodgkin lymphoma, each stage may be subdivided into "A" and "B" categories:

A means that an individual did not experience B symptoms, listed below.

B means that an individual experienced any one of the following symptoms:

• Unexplained weight loss of more than 10% of original body weight during the six months before diagnosis
  
  
• Unexplained fever with temperatures above 100.4º F (38º C)
  
  
• Drenching night sweats. Most patients report that either their nightclothes or the sheets on the bed are actually wet. Sometimes, heavy sweating occurs during the day.

Prognostic factors. In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how successful treatment will be. In patients with Hodgkin lymphoma, several factors can predict whether the disease will return and which treatments will be successful. Individuals are treated as high risk or low risk based on how many risk factors are present.

Below are poor prognostic factors for patients with advanced Hodgkin lymphoma. In general, the fewer poor prognostic factors a patient has, the longer remission he/she should experience and the more successful treatments should be.

• Low blood albumin (a type of protein) levels (less than 4 g/L)
  
  
• Low hemoglobin (red blood cell count) (less than 10.5 g/dL)
  
  
• Being a male
  
  
• Age 45 and over
  
  
• Stage IV disease
  
  
• White blood cell count of greater than 16,000 per cubic millimeter
  
  
• Lymphocyte count of less than 600 per cubic millimeter, or less than 8% of the total white blood cell count, or both

Below are prognostic factors for patients with early-stage Hodgkin lymphoma. Prognosis depends on several factors, including:

• Age. The effect of age on outcome is also connected with gender and with results of some blood tests, particularly the ESR. Older age, being male, and a higher ESR are associated with a less favorable outcome.
  
  
• Subtype of Hodgkin lymphoma. Lymphocyte predominant Hodgkin lymphoma, nodular sclerosis Hodgkin lymphoma, and lymphocyte rich classical Hodgkin lymphoma have a more favorable outcome.
  
  
• The presence of a large mediastinal mass [a large lymphoma node mass in the center of the chest that is larger than 10 centimeters (cm)] is regarded as a less favorable feature. (Small mediastinal masses are not unfavorable.)
  
  
• The number of lymph node sites involved; the higher the number of sites involved, the less favorable the prognosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.

The treatment of Hodgkin lymphoma depends on the size and location of enlarged lymph nodes, the results of blood tests, the type of Hodgkin lymphoma, and the patient’s age, symptoms, and overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. The most common treatment methods for Hodgkin lymphoma are radiation therapy, chemotherapy, or a combination of both methods.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

The original treatments for Hodgkin lymphoma, developed in the 1960s and 1970s, were very effective. However, long-term follow-up care of people who received these treatments has shown that they are at risk for side effects later in life, including infertility (the inability to have children) and secondary cancers, such as lung cancer and breast cancer in women. These long-term problems were partly the result of the types of chemotherapy used at that time and partly the result of extensive radiation therapy.

To avoid or reduce the risk of these problems, modern treatment of Hodgkin lymphoma involves newer chemotherapy treatments and the use of much smaller fields of radiation therapy. Most patients with Hodgkin lymphoma, even stage I or stage II, will now be recommended to receive some chemotherapy, followed by radiation therapy to the affected lymph node areas. (For some patients with early stage disease, it may be possible to have treatment with a relatively short course of chemotherapy only, without the need for radiation therapy. This applies to a few, carefully chosen patients and should be discussed with their doctor.) For stage III or stage IV disease, chemotherapy is still the primary treatment although additional radiation therapy may be recommended, especially to areas of large lymph nodes.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. Radiation therapy for Hodgkin lymphoma is always external-beam radiation therapy, which is radiation given from a machine outside the body. Whenever possible, radiation therapy is now typically targeted to the affected lymph node areas to reduce the risk of side effects.

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 received 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 damage gets lower as treatments improve, radiation therapy may still sometimes cause long-term side effects, also called late effects. To minimize the risk of long-term side effects, clinical trials are being done to determine the best doses and smallest possible field for radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Many different types of chemotherapy may be used for Hodgkin lymphoma. The most commonly used combinations of drugs in the United States are called "ABVD" and "Stanford V." Another combination of drugs known as “BEACOPP” is now widely used in Europe and is being used more commonly in the United States.

ABVD: doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban), and dacarbazine (DTIC). ABVD chemotherapy is usually given every two weeks for four to eight months.

Stanford V: mechlorethamine (Mustargen, Nitrogen Mustard), doxorubicin, vinblastine, vincristine (Oncovin), bleomycin, etoposide (VePesid, Etopophos, Lastet), prednisone, and G-CSF (granulocyte colony stimulating factor). Chemotherapy is given weekly for two to three months, and usually two to three of these drugs are given each week.

BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide (Cytoxan, Neosar), vincristine, procarbazine (Matulane), and prednisone. The treatment schedule and number of cycles varies according to each patient’s needs.

At the moment, it is unclear which of these chemotherapy treatments is best for patients with Hodgkin lymphoma, and the best treatment may differ according to the type and stage of the disease. For this reason, many clinical trials are underway comparing these different chemotherapy treatments. These clinical trials are designed to determine which combination is the most effective for the treatment of Hodgkin lymphoma and which has the fewest short-term and late side effects.

At various times during the course of chemotherapy, it is usual to have some of the original tests, especially CT scans and PET scans, repeated. These tests are used as a way to monitor the disease and to see how well it is responding to treatment.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Although the risk of long-term side effects decreases as treatments improve, chemotherapy sometimes causes late and permanent side effects.

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 through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.

Stem cell transplantation/bone marrow transplantation

A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are 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 blood stem cells are typically what is being transplanted (injected into a vein), not the actual bone marrow tissue.

There are two types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO transplantation may be recommended for patients who have lymphoma remaining in the bone marrow after treatment.

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 or sister serves as the donor, although unrelated donors can serve as the donor too. Millions of people worldwide have volunteered to donate stem cells for patients who do not have matched family members; matches can be made by searching a computer registry. In addition, a donation of stem cells derived from umbilical cord blood is sometimes considered if family donors are not available.

In an AUTO transplant, the patient’s own stem cells are used. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are then frozen until they are needed, usually after the high-dose treatment (explained below) is completed.

In both types, the goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and have replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system so that, in an ALLO transplant, the donor cells are not rejected by the body. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts from donor cells. Sometimes, ALLO transplants can also be performed after giving lower doses of chemotherapy and/or radiation therapy that are still sufficient to suppress the immune system and allow growth of the donor cells. (These transplants, sometimes termed “mini-transplants” or “reduced intensity transplants” have less immediate side effects, allowing the procedure to be used for older patients.)

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health.

For both ALLO and AUTO transplant types, the replacement cells engraft (begin to make new blood cells) and turn into healthy, blood-producing tissue in two to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune system is back to normal, patients may need antibiotics and blood transfusions.

In an ALLO transplant, another major risk is that the donor’s cells will recognize the patient’s body as foreign, causing graft-versus-host disease (GVHD). GVHD may be a serious complication of allogeneic transplants and can be fatal. Other side effects may include liver problems, diarrhea, infections, and rashes. However, GVHD can also be a benefit, in that the donor cells can recognize the cancer cells as foreign and destroy these cells, a mechanism that is one of the major reasons why ALLO transplantation generally works so well over the long term. The risk of GVHD can be reduced with exact HLA-type matching and the use of preventative drugs.

In an AUTO transplant, there is little risk of GVHD because the replacement stem cells are the patient’s own cells. However, there is a risk in an autologous transplant that some of the cells that are put back into the patient could still be cancerous.

Learn more by reading the Cancer.Net Feature series, Understanding Bone Marrow and Stem Cell Transplantation.

Progressive and recurrent Hodgkin lymphoma

Progressive disease is present if the cancer becomes larger or spreads while the patient is being treated for the original lymphoma. Progressive disease and recurrence are uncommon in Hodgkin lymphoma. If either occurs, most patients will be advised to receive high-dose therapy with a stem cell transplantation (see above), which appears to be more effective in treating progressive or recurrent Hodgkin lymphoma than another standard chemotherapy treatment.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.

For More Information

The National Comprehensive Cancer Network (NCCN) has a series of treatment guidelines that have been translated into patient-friendly language. In accordance with Cancer.Net’s Linking Policy, please note that this link does not imply ASCO’s endorsement of the content, but rather it is an effort to provide additional information that may be helpful to people living with cancer and their families. The NCCN treatment guide for Hodgkin lymphoma can be found at www.nccn.org.

Doctors and scientists are always looking for better ways to treat patients with Hodgkin lymphoma. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

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 finding new drugs and other therapies is 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.

To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so 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 than 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.

Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.

Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health.

Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.net’s section on Managing Side Effects, based on ASCO’s curriculum.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient.

For more information on late effects or long-term side effects, please read the Late Effects and After Treatment sections or talk with your doctor.

Patients treated for Hodgkin lymphoma have an increased risk of developing other diseases or conditions later in life 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, but there is still some risk. Therefore, it is important that patients stay current with their follow-up care to monitor any developments.

• Some survivors of Hodgkin lymphoma have a higher risk of developing a secondary cancer, especially acute myelomonocytic leukemia (following certain types of chemotherapy), non-Hodgkin lymphoma, lung cancer, or breast cancer. The risk of a secondary cancer is likely to be lower in the future because the types of therapy now used have fewer risks. Patients can lower their risk of secondary cancers by eliminating other risk factors, such as smoking.
  
  
• Radiation therapy to the chest area can cause lung damage, increase the risk of heart disease, and increase the risk of lung and breast cancer. It is important that men and women who received radiation to the chest limit other risk factors that may lead to heart damage, such as smoking, obesity, and high cholesterol. It is important that women who received radiation therapy to the chest begin regular breast cancer screening at an early age.
  
  
• Patients who received anthracyclines (doxorubicin) or bleomycin during chemotherapy have a higher risk of heart damage and lung damage, respectively.
  
  
• Radiation therapy to the neck or chest area (specifically, or as part of total body irradiation [TBI] during a stem cell transplantation) can cause thyroid dysfunction, including hypothyroidism. Hypothyroidism is when a body produces too little thyroid hormone, which regulates metabolism.
  
  
• Radiation therapy to the pelvic area can lead to infertility (inability to bear children) in men or women. 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). Men who received combination chemotherapy may be at risk for sterility after treatment. The risk appears to be associated with drugs known as alkylating agents, which are used much less in current chemotherapy for Hodgkin lymphoma. Although the risk of infertility for men is low after chemotherapy for Hodgkin lymphoma, it is still possible, and men who are considering having a family should consider sperm storage prior to starting chemotherapy. Men who undergo stem cell transplantation are almost always sterile after this treatment. Women who received chemotherapy for Hodgkin lymphoma have an increased risk of infertility or early menopause. Again, this is mostly related to alkylating agents and is less common with modern chemotherapy treatments. It is unusual, but not impossible, for women to become pregnant after stem cell transplantation.
  
  
• Survivors of Hodgkin lymphoma may also have a higher risk of depression or other psychologic problems. Learn more about the importance of follow-up care in the After Treatment section.

The risks of secondary cancers are likely to be lower in the future because the types of therapy now used carry fewer risks.

After treatment for Hodgkin lymphoma ends, talk with your doctor about developing a follow-up care plan. This plan may include doctor visits and medical tests to monitor your recovery for the coming months and years. Follow-up care after treatment for Hodgkin lymphoma is important to monitor for possible recurrence of the lymphoma and late effects of treatment.

The frequency of follow-up care and the tests performed depends on several factors, including the original extent of the Hodgkin lymphoma and type of treatment. Typically, all of the tests, including CT scans, PET scans, and bone marrow biopsies, are repeated after treatment ends to ensure that there has been a complete disappearance of the disease. Then, the frequency of additional screening depends on the results of the initial set of tests performed after treatment.

In general, each follow-up visit includes a discussion with the doctor, physical examination, and blood tests. At some visits, scans are done. At most cancer centers, follow-up visits are initially scheduled every two to three months during the time period with the greatest risk of recurrence, and the interval between visits increases over time. Later visits may only be two to three times per year until five years has passed; then, annual visits should be continued with an oncologist. Special attention needs to be paid to cancer screening and detection, as well as to cardiac (heart) risk factors, for the person’s lifetime. For patients who received radiation therapy to the neck or chest, monitoring thyroid 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 symptoms of depression and promptly report them to their doctor.

Patients treated for Hodgkin lymphoma should get an annual flu shot. It may be recommended that some patients get an immunization against pneumonia, which may be repeated every five to seven years.

People recovering from Hodgkin lymphoma are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: After Treatment.

Research for Hodgkin lymphoma is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.

New scanning techniques. Newer scanning techniques, such as PET scanning, are being tested for initial staging of the disease, to help determine the disease’s response to treatment, and detect recurrence. Although many centers now use PET scans routinely in Hodgkin's disease, its exact role is still being defined. Clinical trials are in progress or are being designed to understand how to use PET scanning to get reliable information that can help with decisions about treatment.

New chemotherapy. New chemotherapy, combinations of chemotherapy, lower doses, and shorter schedules are being investigated in clinical trials to reduce short-term side effects and long-term health risks to patients receiving chemotherapy.

Immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. Some treatments involve antibodies that attach to proteins on the surface of cancer cells. Some antibodies have radioactive substances attached that will direct radiation therapy to the lymphoma (called radioimmunotherapy), and other antibodies direct drugs to the cancer cells.

Gene profiling. Some investigators 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 and new targets for chemotherapy or immunotherapy.

Other advances. Vaccine therapy is being studied to see if it helps the body’s immune system kill cancer cells. Stem cell transplantation is being studied in combination with various chemotherapy/immunotherapy regimens for new or recurrent Hodgkin lymphoma. Mini-allogeneic or allogeneic transplantation is being tested in combination with chemotherapy/immunotherapy for new or recurrent Hodgkin lymphoma. Several new types of drugs which work in a different way than chemotherapy are also being studied. Many of these are given in tablet (pill) form.

Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:

• What type of Hodgkin lymphoma do I have?
  
  
• How many patients do you see with Hodgkin lymphoma every year?
  
  
• 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 good and poor prognostic factors do I have?
  
  
• What treatment options do I have?
  
  
• What clinical trials are open to me?
  
  
• What treatment plan do you recommend? Why?
  
  
• What chemotherapy treatment do you recommend, how many treatments, and why?
  
  
• What are the advantages and disadvantages of chemotherapy alone versus chemotherapy plus radiation treatment?
  
  
• What, if any, radiation treatment do you recommend, and why?
  
  
• What are the possible side effects of treatment, both in the short term and the long term?
  
  
• Should I get a second opinion?
  
  
• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  
  
• How can I stay as healthy as possible during treatment?
  
  
• How will treatment affect my ability to have children in the future? Should I bank sperm (males) or take birth control pills (females)?
  
  
• What follow-up tests will I need, and how often will I need them?
  
  
• What support services are available to me? To my family?