Hodgkin's lymphoma is a cancer of white blood cells called lymphocytes, marked by the presence of a specific abnormal cell that doctors can identify under a microscope

Hodgkin's lymphoma develops when lymphocytes—a type of white blood cell that normally helps fight infection—become cancerous and multiply uncontrollably. The disease gets its name from Thomas Hodgkin, who first described it in 1832. What makes Hodgkin's lymphoma distinct from other lymphomas is the presence of Reed-Sternberg cells, large abnormal cells that pathologists can see when they examine a tissue sample under a microscope. These cells are the hallmark of the disease and are what doctors look for to confirm a diagnosis.

The cancer typically starts in lymph nodes—small bean-shaped structures scattered throughout the body that are part of the immune system. From there, it can spread to other lymph nodes or to organs like the spleen, liver, or lungs. Hodgkin's lymphoma accounts for roughly 10 percent of all lymphomas diagnosed in the United States, making it less common than non-Hodgkin's lymphomas but still a significant disease that affects thousands of people each year.

Key Takeaways

  • Hodgkin's lymphoma is identified by the presence of Reed-Sternberg cells, which are abnormal lymphocytes visible under a microscope during a biopsy.
  • The disease usually begins in lymph nodes in the chest, neck, or armpits and can spread to other parts of the body if left untreated.
  • Hodgkin's lymphoma occurs in two main forms: classical Hodgkin's lymphoma and nodular lymphocyte-predominant Hodgkin's lymphoma, which behave differently and are treated differently.
  • Symptoms often include swollen lymph nodes, fever, night sweats, and fatigue, though some people have no symptoms and discover the disease during imaging for another reason.
  • Certain risk factors—including age, Epstein-Barr virus infection, and a weakened immune system—increase the likelihood of developing the disease.

How Hodgkin's lymphoma differs from non-Hodgkin's lymphoma

The main difference between Hodgkin's and non-Hodgkin's lymphoma is the type of abnormal cell present and how the cancer spreads. Hodgkin's lymphoma contains Reed-Sternberg cells and tends to spread in an orderly way from one lymph node group to adjacent groups. Non-Hodgkin's lymphomas are a diverse group of cancers that lack Reed-Sternberg cells and often spread randomly throughout the body, skipping lymph node regions.

Hodgkin's lymphoma also tends to affect younger people (typically in the 20s and 30s) and older people (typically in the 55 and older range), whereas non-Hodgkin's lymphomas are more common in older adults overall. The two diseases also respond differently to treatment, and doctors use different staging systems to assess how far each has progressed. Because of these differences, diagnosis requires a biopsy—a tissue sample examined by a pathologist—to determine which type of lymphoma is present.

The two main types of Hodgkin's lymphoma

Classical Hodgkin's lymphoma accounts for about 95 percent of all Hodgkin's cases. It is subdivided into four subtypes based on the appearance of the cancer cells and the composition of surrounding immune cells: nodular sclerosis, lymphocyte-rich, mixed cellularity, and lymphocyte-depleted. Nodular sclerosis is the most common subtype, making up roughly 60 to 70 percent of classical cases.

Nodular lymphocyte-predominant Hodgkin's lymphoma makes up the remaining 5 percent of cases. It contains different abnormal cells (called LP cells rather than Reed-Sternberg cells) and generally grows more slowly than classical Hodgkin's. People with this type often have a better long-term outlook, though treatment approaches differ from classical cases.

The distinction between these types matters because they can behave differently, spread at different rates, and respond to different treatment strategies. A pathologist's detailed examination of the biopsy sample determines which type is present, and this information guides treatment decisions.

Common symptoms and how they develop

Many people with Hodgkin's lymphoma first notice swollen lymph nodes in the neck, chest, or armpits. These nodes may be painless or tender, and they often persist for weeks. Some people experience what are called B symptoms: fever (often in the late afternoon), drenching night sweats that soak through clothing, and unexplained weight loss. Fatigue and loss of appetite are also common.

Other symptoms depend on where the cancer has spread. If it involves the chest, a person may have a cough or chest pain. If it affects the abdomen, there may be abdominal swelling or pain. Some people have no symptoms at all and discover the disease when imaging done for another reason reveals enlarged lymph nodes.

These symptoms can result from many conditions other than Hodgkin's lymphoma—infections, other cancers, and autoimmune diseases can all cause swollen nodes and fever. A doctor who suspects lymphoma will order imaging and a biopsy to confirm the diagnosis rather than relying on symptoms alone.

Risk factors that increase the chance of developing Hodgkin's lymphoma

Age is a significant risk factor. Hodgkin's lymphoma shows a bimodal age distribution, meaning it occurs more often in two age groups: people in their 20s and early 30s, and people aged 55 and older. The reasons for this pattern are not fully understood.

Infection with Epstein-Barr virus (EBV)—the virus that causes mononucleosis—is associated with an increased risk, particularly in people who had severe or prolonged EBV infection. People with weakened immune systems, whether from HIV infection, organ transplant, or immunosuppressive medications, have a higher risk of developing Hodgkin's lymphoma. A family history of lymphoma also raises risk, though most people with Hodgkin's lymphoma have no family history of the disease.

Having one or more risk factors does not mean a person will develop Hodgkin's lymphoma. Many people with these risk factors never develop the disease, and many people without known risk factors do develop it. Risk factors help doctors and researchers understand patterns in the disease but do not determine individual outcomes.

How doctors diagnose Hodgkin's lymphoma

Diagnosis begins with a physical exam and imaging. A doctor will feel for swollen lymph nodes and may order a chest X-ray or CT scan to look for enlarged nodes in the chest or abdomen. If imaging suggests lymphoma, the next step is a biopsy—removal of a small piece of tissue from a swollen lymph node or affected organ.

A pathologist examines the tissue under a microscope, looking specifically for Reed-Sternberg cells or LP cells. The pathologist also notes the subtype, the number of abnormal cells, and the composition of surrounding immune cells. This microscopic examination is the only way to confirm Hodgkin's lymphoma and determine which type is present.

Once Hodgkin's lymphoma is confirmed, doctors perform additional tests to determine the stage—how far the cancer has spread. This may include PET scans, bone marrow biopsies, or blood tests. Staging helps doctors predict how the disease will behave and guides treatment decisions.

Survival rates and what they mean

Hodgkin's lymphoma has one of the highest survival rates among cancers. The five-year survival rate—the percentage of people alive five years after diagnosis—is approximately 90 percent overall in the United States. Survival rates vary by stage at diagnosis, age, and other factors. People diagnosed at an earlier stage generally have better outcomes than those diagnosed at a later stage.

Survival rates describe what happened to groups of people in the past and cannot predict what will happen to any individual. A person's actual outcome depends on many factors, including the specific subtype of Hodgkin's lymphoma, how well the cancer responds to treatment, and overall health. Doctors can discuss individual prognosis based on specific circumstances, but this conversation is separate from population-level statistics.

Frequently Asked Questions

Is Hodgkin's lymphoma hereditary?

Hodgkin's lymphoma is not directly inherited, but having a family member with the disease does increase risk slightly. Most people with Hodgkin's lymphoma have no family history of it. Genetic factors may influence immune system function in ways that affect risk, but the disease itself is not passed down like a genetic mutation.

Can Hodgkin's lymphoma turn into non-Hodgkin's lymphoma?

No. These are distinct diseases with different cell types and behaviors. A person diagnosed with Hodgkin's lymphoma will not develop non-Hodgkin's lymphoma as a result. However, some people who have been treated for Hodgkin's lymphoma may later develop a different cancer, including non-Hodgkin's lymphoma, as a side effect of treatment—though this is uncommon.

What does it mean if Reed-Sternberg cells are found?

Finding Reed-Sternberg cells in a biopsy confirms the diagnosis of classical Hodgkin's lymphoma. These cells are the defining feature of the disease. Their presence tells doctors which type of lymphoma is present and helps guide treatment decisions. The number and appearance of these cells also provide information about how the disease may behave.

Can young children get Hodgkin's lymphoma?

Hodgkin's lymphoma is rare in children under age 5 but does occur in older children and teenagers. The disease shows different age patterns than many other cancers, with peaks in the 20s and again after age 55. Children and teenagers with Hodgkin's lymphoma are typically treated at specialized pediatric cancer centers.