Your lymphatic system includes your bone marrow, spleen, thymus and lymph glands (nodes). Your lymph glands make and store white blood cells called lymphocytes, ready to fight any infections you might get. Your lymphatic system also includes lymph vessels, which carry and recycle fluid (known as lymph fluid) in your body.
The image below shows where the main glands, organs and vessels of your lymphatic system are. There are groups of lymph glands in your neck, armpit and groin. You may be able to feel some of them under your skin. There are deeper lymph glands in other areas of your body, such as in your abdomen (tummy), pelvis and chest, though you can’t feel these.
There are many different types of cancer that can develop in the lymphatic system. These are called lymphomas. Hodgkin lymphoma is just one type of these cancers, and you get it in a group of lymph glands in one area of your body.
Sometimes, the cancer cells can spread through your lymph vessels to lymph glands in other parts of your body. The cancer cells may also spread further in your body to your spleen, liver, lungs or bone marrow.
Doctors separate Hodgkin lymphomas into two main groups according to how the cells look under a microscope.
- Classical type. Most people with Hodgkin lymphoma have this one.
- Nodular lymphocyte predominant Hodgkin lymphoma. This is rare and affects young adults more than older people.
Often, the first symptom of Hodgkin lymphoma that you’ll notice is a swelling in your neck, chest, armpit or groin. This is a swollen lymph gland, which doesn’t usually hurt. It will feel firm (like rubber) rather than hard, and these lumps can appear slowly over time. Other symptoms can include:
- sweating at night
- a fever
- unexplained weight loss
- an itchy feeling all over your body
- feeling tired
- pain in your lymph glands after you drink alcohol
- a cough
- shortness of breath
- pain in your chest or tummy
These symptoms aren't always caused by Hodgkin lymphoma, but if you have them, contact your GP.
To diagnose Hodgkin lymphoma, your GP will ask about your symptoms and examine you. They’ll also ask you questions about your medical history. Some of the symptoms of Hodgkin lymphoma are non-specific, which means they could be caused by something else. Depending on your symptoms, your GP may organise some initial tests such as blood tests and a chest X-ray to check for other possible causes. If your GP then suspects you could have Hodgkin lymphoma, they’ll refer you to a hospital specialist for further tests.
If you have swollen glands and your GP suspects it could be Hodgkin lymphoma, it’s likely that they’ll refer you to a specialist at hospital for further tests straightaway. You’ll usually get an appointment within two weeks (or two days for children).
Further tests may include having scans (such as a CT scan or positron emission tomography (PET) that look at the inside of your body). You may have a biopsy, where a sample of skin tissue, lymph gland or bone marrow is taken to look at under a microscope. If you have a biopsy taken, this may be done under local or general anaesthesia.
If you’re diagnosed with Hodgkin lymphoma, tests will look at whether or not the cancer has spread and how big it is. This is described by the ‘stage’ of the disease; from stage 1(the cancer has stayed within the organ it started in) to stage 4 (the cancer has spread from where it started to another part of the body). See Related information for explanations of the terminology used in cancer.
Your treatment will depend on the type of Hodgkin lymphoma you have, whether or not it has spread, and your general health. Most people have chemotherapy, and some may have radiotherapy too.
Your healthcare team
A team of professionals, called a multidisciplinary team (MDT), will guide you through your treatment. This team may include:
- a haematologist (a doctor who specialises in treating conditions that affect the blood)
- an oncologist (a doctor who specialises in cancer care)
- a radiologist (a doctor who specialises in using imaging to diagnose conditions)
- a radiation oncologist (or clinical oncologist) who uses radiation to treat conditions
- a specialist nurse
- a counsellor
They’ll explain your treatment options and help you decide that treatment is best for you.
After treatment, your team will assess whether or not there are any remaining signs of cancer. If there are, you’ll need more treatment. You’ll have regular check-ups with your doctor to check for any signs of the cancer returning. You’ll have check-ups every three months for the first couple of years, and gradually, you’ll go less often.
About eight or nine out of every 10 people with Hodgkin lymphoma go into remission after their treatment and it goes away for good. Remission means the signs and symptoms of cancer have decreased or disappeared. Your cancer can be in complete or partial remission. Complete remission means there are no signs of your cancer. Partial remission means some but not all signs have disappeared.
Chemotherapy uses medicines to destroy cancer cells. You’ll usually have these medicines through a drip into a vein in your arm. Your team may give you a few different medicines over a few months. You won’t have the medicines everyday – you’ll have breaks to allow your body to recover from the side-effects of the medicines. See our information on chemotherapy to learn about the side-effects of the treatment.
Your doctor may give you steroid medicines (e.g. prednisolone) alongside your chemotherapy. These medicines help the chemotherapy to work and you usually take them as tablets.
Radiotherapy uses X-rays to destroy cancer cells. A radiotherapy treatment takes less than 10 minutes. Your radiologist will target a beam of radiation to the cancer to shrink it. Depending on the type of Hodgkin lymphoma you have and its stage, you might have radiotherapy after chemotherapy.
You’ll need to go to the hospital for radiotherapy treatment, usually from Monday to Friday, and then have a rest over the weekend. How long your course of treatment lasts will depend on the area you’re having it on. Your doctor will let you know how long they expect you’ll need treatment for.
Monoclonal antibodies are medicines that can recognise and target cancer cells. They aren’t used very often for people with Hodgkin lymphoma. But you may be given a monoclonal antibody medicine called rituximab if you have the nodular lymphocyte predominant type.
If you’ve already had treatment for Hodgkin lymphoma but it comes back, your doctor may give you an antibody treatment called brentuximab.
Stem cell transplant
If you’ve had chemotherapy to treat Hodgkin lymphoma and it hasn’t worked, or the cancer comes back, you might need a higher dose of chemotherapy. This will kill off your stem cells, which your body needs to make new blood cells.
To stop you becoming unwell, you’ll be offered a stem cell transplant. This is an injection of stem cells into your body to replace the ones you lost. Your body will use the stem cells to make new blood cells to replace the ones the high-dose chemotherapy destroys. For more information about this treatment option, see our FAQ Stem cell transplant.
Doctors don’t know exactly why people develop Hodgkin lymphoma yet, but there are some things that increase your chance of getting it. These include if you:
- have a weakened immune system (for example, if you have HIV/AIDS, or you’re taking medicines that suppress your immune system)
- have the Epstein–Barr virus (which causes glandular fever)
- have previously had non-Hodgkin lymphoma
- are a man, as it’s slightly more common in men than women
- are around 25, or 50 to 60, as it’s more common in these age groups (although it can affect people of all ages)
- are a smoker
Your doctor will usually take the stem cells from your own blood before you begin high-dose chemotherapy or, much less frequently, from your bone marrow. If for some reason this isn’t possible, the stem cells will need to come from another person. This will usually be from a close family member, such as your brother or sister, because their cells are most likely to match your own. If you don’t have any siblings, or they aren’t a good match, you might have stem cells from a donor who’s unrelated to you. For information about what happens, see Bone marrow (stem cell) transplant.
This treatment affects everyone differently and the length of time it takes to recover varies. But the side-effects usually come from the high-dose chemotherapy you have before the transplant, not the transplant itself.
After having a stem cell transplant, you’ll be in hospital for around three weeks. At first, you’ll probably have a sore mouth, feel sick and have diarrhoea. You’ll have fewer white blood cells in your body after your stem cell transplant so will be more at risk of getting infections. You’ll need to take antibiotics to prevent these. And your red blood cell count will be down too, which might make you feel tired and breathless. You’ll need to have blood transfusions to top up your red blood cells.
Once you leave hospital and go home, you’ll continue to make a steady recovery but might still feel tired and weak. It can take about three to six months to recover fully and go back to work.
You’ll need to have new vaccinations against diseases, because you will have lost any immunity you previously had. You’ll also be offered the annual flu vaccine.
Both chemotherapy and radiotherapy can reduce your chances of having children or cause infertility.
Some chemotherapy medicines can cause infertility, particularly if you have very high doses. Radiotherapy may also affect your fertility if you have it in your pelvic or abdominal area (tummy).
You might be able to freeze your eggs or sperm before you start treatment. But remember it’s not always possible to do this before you start treatment, and infertility treatments don’t always work. Ask your doctor about your treatment and what your options are.
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2017
Expert reviewer, Dr Prem Mahendra, Consultant Haematologist
Next review due May 2020
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