Hodgkin’s lymphoma is a blood cancer. Specifically, it’s a cancer of the lymphatic system, which is part of both your immune system and your circulatory system. It begins in white blood cells called B lymphocytes and grows primarily in the lymph nodes, spleen, and bone marrow. Because it originates in blood cells rather than in an organ like the liver or lungs, it falls squarely in the blood cancer category alongside leukemia and multiple myeloma.
How Hodgkin’s Differs From Other Blood Cancers
Blood cancers are grouped into three main types: leukemia, lymphoma, and multiple myeloma. All three start in blood cells, but they behave differently and show up in different places.
Leukemia involves abnormal white blood cells that multiply rapidly in the bone marrow and spill into the bloodstream. Multiple myeloma targets plasma cells, another type of white blood cell, and causes them to pile up in the bone marrow and produce useless antibodies. Hodgkin’s lymphoma, by contrast, starts in the lymph nodes. The cancer cells tend to stay concentrated in lymph tissue rather than flooding the bloodstream, which is why its symptoms usually begin with swollen, painless lumps in the neck, armpits, or groin.
What makes Hodgkin’s lymphoma distinct from other lymphomas (grouped together as “non-Hodgkin lymphoma”) is the presence of a specific abnormal cell called a Reed-Sternberg cell. These large, distinctive cells are the hallmark of the disease, and spotting them under a microscope is how pathologists confirm the diagnosis.
What Happens Inside Your Lymph Nodes
Hodgkin’s lymphoma begins when the DNA inside a B cell mutates. B cells are white blood cells that normally fight infections by producing antibodies. In Hodgkin’s, the mutations are so extensive that the B cell becomes completely unrecognizable. It transforms into a Reed-Sternberg cell that no longer does anything useful for your immune system.
These cancer cells cause damage in three ways. First, they keep copying themselves instead of dying on schedule the way healthy cells do. Second, they evade the immune cells whose job is to destroy abnormal cells, essentially hiding in plain sight. Third, they release chemical signals that attract large numbers of normal white blood cells to gather around them, creating inflammation and swelling in the lymph nodes. That inflammation is actually what makes up most of the tumor mass. The Reed-Sternberg cells themselves are often only a small fraction of the swollen tissue.
Who Gets Hodgkin’s Lymphoma
Hodgkin’s lymphoma has an unusual age pattern. It peaks twice: first in young adults between ages 15 and 35, and again in people 55 and older. This bimodal distribution sets it apart from most cancers, which become steadily more common with age. The reasons for this two-peak pattern aren’t fully understood, but the subtypes that affect younger and older patients tend to differ.
Recognizing the Symptoms
The most common first sign is a painless, swollen lymph node, typically in the neck, upper chest, or armpit. Many people notice it themselves or have it found during a routine exam. Because swollen lymph nodes are extremely common with ordinary infections, the key difference is that lymphoma-related swelling doesn’t go away after a few weeks.
Doctors also look for a specific set of warning signs called B symptoms: unexplained fever, drenching night sweats (the kind that soak your sheets), and unexplained weight loss of more than 10% of your body weight. Having B symptoms can indicate more advanced disease and influences treatment decisions. Other symptoms can include persistent fatigue, itchy skin, and pain in lymph nodes after drinking alcohol, which is uncommon but fairly specific to Hodgkin’s.
How It’s Diagnosed
A definitive diagnosis requires a biopsy of a suspicious lymph node. The preferred approach is a surgical excision, where the entire lymph node is removed and examined. This method provides a definitive diagnosis about 98% of the time. Needle biopsies, which take a small core of tissue, are less invasive but slightly less reliable, confirming the diagnosis in about 92% of cases. The small difference matters because pathologists need to see the overall structure of the node and identify Reed-Sternberg cells in context to distinguish Hodgkin’s from other conditions.
After the biopsy confirms the diagnosis, imaging scans (typically PET-CT) map out how far the disease has spread. Hodgkin’s is staged from I to IV. Stage I means cancer is in a single group of lymph nodes, stage II involves multiple regions on the same side of the diaphragm, stage III has spread to both sides, and stage IV means it has reached organs outside the lymphatic system.
Types of Hodgkin’s Lymphoma
There are two main categories. Classical Hodgkin lymphoma accounts for about 95% of cases and is further divided into four subtypes: nodular sclerosis (the most common, especially in young adults), mixed cellularity, lymphocyte-rich, and lymphocyte-depleted. These subtypes differ in how the tissue looks under a microscope and can influence prognosis, but all are treated similarly.
The second category, nodular lymphocyte-predominant Hodgkin lymphoma, is rare and behaves differently. It tends to grow more slowly and often requires less aggressive treatment.
Treatment and What to Expect
Hodgkin’s lymphoma is one of the most treatable cancers. The standard first-line treatment for classical Hodgkin lymphoma is combination chemotherapy, most commonly a four-drug regimen known as ABVD. Treatment is given in cycles, each lasting several weeks, with rest periods in between to let your body recover. Early-stage patients typically need fewer cycles, sometimes followed by targeted radiation to the affected area. Advanced-stage disease requires more cycles and sometimes different drug combinations.
For patients whose disease comes back or doesn’t respond to initial treatment, options include more intensive chemotherapy, stem cell transplants, and newer immunotherapy drugs that help the immune system recognize and attack the cancer cells that were previously hiding from it.
Survival Rates by Stage
The five-year relative survival rates for Hodgkin’s lymphoma are high across all stages, based on data from the National Cancer Institute’s SEER program (2016 to 2022):
- Stage I: 92.7%
- Stage II: 95.4%
- Stage III: 87.7%
- Stage IV: 82.8%
Stage II actually has a slightly higher survival rate than stage I, likely because stage I sometimes includes cases with less favorable characteristics that were caught before spreading. Even at stage IV, more than four out of five patients are alive five years later. These numbers reflect all age groups and treatment approaches combined. Younger patients and those without B symptoms generally do better than these averages suggest.
The high cure rates are a relatively recent achievement. Hodgkin’s lymphoma was one of the first cancers where combination chemotherapy proved highly effective, and treatment refinements over the past several decades have pushed survival rates steadily upward while reducing long-term side effects from treatment itself.