Hodgkin lymphoma: symptoms, causes, tests, treatment and survival

The NHS says symptoms include a painless lump or swelling, usually in the neck, armpit or groin, which is the most common symptom. Cancer Research UK says lymph nodes commonly swell with infections such as a cold but usually go back to normal after a short time, so talk to your GP if you have swollen lymph nodes that keep getting bigger or do not go down.

The NHS stresses that some of these symptoms are common and can be caused by many different conditions. Having them does not definitely mean you have Hodgkin lymphoma, but it is important to get them checked by a GP, because finding it early makes treatment more likely to be successful.

• A painless lump or swelling in the neck, armpit or groin.

• 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 weight loss.

The NHS says to see a GP if you have any symptoms of Hodgkin lymphoma. The GP will ask about symptoms and may feel for lumps in your neck, armpit and groin, and may ask for a blood test. If the GP thinks your symptoms could be cancer, you may get an urgent referral for more tests or to see a specialist in hospital, which does not definitely mean you have cancer.

Lymphoma Action advises contacting your GP if you are worried that you might have lymphoma or have any concerns about your health. Lymphoma in the chest can compress the airway, causing shortness of breath, coughing and discomfort.

Cancer Research UK explains that Hodgkin lymphoma starts in white blood cells called lymphocytes. The lymphatic system is a network of thin tubes and lymph nodes running throughout the body, which includes the bone marrow, spleen and thymus and plays a role in fighting infections. Because it runs through the whole body, Hodgkin lymphoma can start anywhere, though it is most commonly noticed in the lymph nodes of the neck.

Hodgkin lymphoma contains abnormal cells called Reed-Sternberg cells, which non-Hodgkin lymphoma does not. Cancer Research UK says most lymphomas are non-Hodgkin lymphoma, and that the two are different diseases with different treatment. Hodgkin lymphoma was named after the doctor who first recognised it and used to be called Hodgkin's disease.

The NHS and Lymphoma Action describe two types. Classical Hodgkin lymphoma contains Reed-Sternberg cells, and Lymphoma Action says there are four subtypes, all treated in the same way. Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) contains a variant called lymphocyte-predominant cells, sometimes called popcorn cells. Lymphoma Action says NLPHL is now classified by the International Consensus Classification as a low-grade B-cell lymphoma rather than a Hodgkin lymphoma.

The NHS says it is not known what causes Hodgkin lymphoma, but some things may increase your chance. Anyone can get it, but you may be at higher risk if you are in your early 20s or late 70s, are a man, have had the Epstein-Barr virus that causes glandular fever, have a weakened immune system (from a health condition such as HIV or from treatment), have a close relative who has had Hodgkin lymphoma, smoke or are overweight.

Lymphoma Action says it is rare, develops in people of any ethnic background and slightly more often in males than females. Cancer Research UK says that in the UK it is more common between ages 20 to 24 and 80 to 84.

The NHS says the main test is a biopsy, where a sample of cells is taken from the lymph nodes using a thin needle, usually with a local or general anaesthetic so you do not feel pain. You should get the results within 2 weeks and can call the hospital or GP if you are worried.

If the biopsy shows Hodgkin lymphoma, you may need more tests such as a CT scan, a PET scan, blood tests and a bone marrow biopsy. Results show how far the cancer has spread (staging), which helps the specialist team decide on treatment. You will be looked after by a team of specialists including a clinical nurse specialist as your main contact.

The NHS says treatment depends on the type, where it is in the body, whether it has spread, your symptoms and your general health. You may be offered a combination of radiotherapy, chemotherapy and medicines that target cancer cells. For most people, treatment will get rid of the lymphoma completely, but there is a risk it might come back and need more treatment, which may still be able to get rid of it.

Some treatment can affect fertility, so speak to your specialist team before treatment if you want children in the future. If advanced Hodgkin lymphoma cannot be cured, treatment aims to slow its growth and spread, help with symptoms and help you live longer, with support from a palliative care team.

Cancer Research UK says the outlook for Hodgkin lymphoma is generally good, particularly if diagnosed early. For adults in the UK, almost 95 out of 100 survive their cancer for 1 year or more, almost 90 out of 100 for 5 years or more, and more than 80 out of 100 for 10 years or more. For people diagnosed in England between 2016 and 2020, five-year survival was around 95% at stage 1, 90% at stage 2, more than 85% at stage 3 and almost 85% at stage 4.

These are general statistics based on large groups and cannot tell you what will happen in your individual case. Your doctor can give you more information about your outlook.

On the NHS, a GP refers you urgently for tests if cancer is suspected, and a haematology team plans and delivers treatment, with a clinical nurse specialist as your main contact. Macmillan Cancer Support runs a free helpline, and Cancer Research UK has an information nurse line.

Private haematology consultations can speed up the first appointment, biopsy or scans, but treatment decisions should be shared with the NHS multidisciplinary team. Ask for all results to be sent to your GP.