Hodgkin lymphoma: symptoms, diagnosis and treatment

Cancer Research UK explains that Hodgkin lymphoma starts in white blood cells called lymphocytes, part of the lymphatic system, a network of thin vessels and bean-shaped lymph nodes that helps fight infection. Under the microscope, Hodgkin lymphoma contains abnormal cells called Reed-Sternberg cells, which non-Hodgkin lymphomas do not. Doctors need to tell them apart because they are different diseases with different treatment.

Because the lymphatic system runs throughout the body, Hodgkin lymphoma can start anywhere. The most common place to notice it is the neck, but it can begin in the centre of the chest, armpit, tummy or groin, and may occasionally involve organs such as the lungs, bones, liver or spleen. Cancer Research UK also points out that cancers spreading to lymph nodes from elsewhere, such as breast cancer, are not lymphoma.

The NHS lists the following symptoms of Hodgkin lymphoma. It stresses that many are common and caused by other conditions, but that finding Hodgkin lymphoma early means treatment is more likely to be successful.

• A painless lump or swelling, usually in the neck, armpit or groin, which is the most common symptom.

• Pain in the glands in the neck, armpit or groin when you drink alcohol.

• A high temperature.

• Night sweats.

• Shortness of breath.

• Itchy skin.

• Sudden, unexplained weight loss.

Lymphoma Action says the most common sign of lymphoma is a lump or lumps, usually in the neck, armpit or groin, which are swollen lymph nodes (often called glands). They are usually painless, although rapidly growing nodes can be sore. Swollen nodes caused by lymphoma are usually smooth and round, usually move out of the way when you press on them (they are mobile) and usually have a rubbery texture. They can become very large.

Lymphoma Action adds that rarely, swollen lymph nodes can become painful soon after drinking alcohol, which affects up to 5 in 100 people with Hodgkin lymphoma. It says swollen nodes in the chest or tummy may only be found on a scan because they cannot be felt from the outside.

Other symptoms can affect the whole body (systemic symptoms): fatigue (exhaustion that is different from normal tiredness), unexplained weight loss, fevers above 38 degrees C, drenching night sweats, itching without a rash and getting infections more easily. Lymphoma Action says unexplained weight loss, night sweats and fever are called B symptoms, and that they are more common in Hodgkin lymphoma and high-grade non-Hodgkin lymphoma. Local symptoms depend on where the nodes are: for example a cough, breathlessness or a feeling of pressure in the chest, or loss of appetite and feeling full or bloated.

Lymph nodes often swell when you have an infection such as a cold. Lymphoma Action says that if you notice a lump that does not go away within 2 to 3 weeks, or a lump that is getting bigger, you should see your GP. It also says it is not possible to tell whether someone has lymphoma just by feeling a lymph node, so tests are needed.

The NHS says the GP will ask about symptoms and may feel for lumps in the neck, armpit and groin, and you may have a blood test. If they think a condition needs investigation they may refer you to a hospital specialist; an urgent referral may be made if symptoms could be cancer, which the NHS notes does not definitely mean you have cancer. Cancer Research UK advises talking to your GP about swollen lymph nodes that keep getting bigger or do not go down, since lymph nodes commonly swell with infections such as colds and then settle.

The main test is a lymph node biopsy, in which cells are taken from a gland using a thin needle and checked for cancer. The NHS says you will usually have a local or general anaesthetic, and should get results within 2 weeks. If Hodgkin lymphoma is confirmed, further tests to see how far it has spread, called staging, can include a CT scan, a PET scan, blood tests and a bone marrow biopsy. Staging helps the team decide on treatment. You will usually have a clinical nurse specialist as your main contact.

The NHS says treatment depends on the type, where the lymphoma is, whether it has spread, your symptoms and general health. It names two types: classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). Lymphoma Action says all four subtypes of classical Hodgkin lymphoma are treated in the same way.

You may be offered a combination of radiotherapy, chemotherapy and other medicines that target cancer cells. Chemotherapy, sometimes with steroid medicine, may be the first treatment with or without radiotherapy, and a different chemotherapy may be used if the first does not work. Radiotherapy may follow or accompany chemotherapy if there are large areas of lymphoma. Targeted medicines and immunotherapy may be used if the cancer comes back or treatment does not work, or for NLPHL. A stem cell transplant may be considered if the cancer returns after treatment.

If you have NLPHL and it is slow growing, the NHS says you can sometimes delay treatment and have regular tests instead, known as watch and wait.

The NHS says some treatment can affect fertility, so speak to the specialist team before treatment if you want children in future. For most people treatment will clear the lymphoma, and if it does return, treatment may still be able to get rid of it. If advanced disease cannot be cured, the aim becomes slowing growth, controlling symptoms and helping you live longer, with a palliative care team. Macmillan Cancer Support, Cancer Research UK and Lymphoma Action are charities named by the NHS and these sources for information and support.

If you develop a high fever during chemotherapy, breathlessness or sudden severe symptoms, call the number your cancer team gave you, NHS 111 or 999.

The cause is not known. The NHS lists factors that may raise the chance: being in your early 20s or late 70s, being a man, having had Epstein-Barr virus (glandular fever), a weakened immune system from a condition such as HIV or from treatment, a close relative with Hodgkin lymphoma, smoking and being overweight. Anyone can get it.