Oncology

Hodgkin Lymphoma

Also known as: Hodgkin's Disease

A highly curable lymphatic cancer marked by painless swollen lymph nodes and the presence of unique Reed-Sternberg cells.

Source: NCCN Guidelines - Hodgkin Lymphoma

Updated: Aug 15, 2026

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Red Flag Warning & Emergency Situations

Neutropenic fever requiring immediate IV antibiotics.

Emergency Management: Superior Vena Cava (SVC) Syndrome from large mediastinal mass. Treat with steroids/radiation.

Core Definition:

Hodgkin Lymphoma (HL) is a B-cell malignancy characterized by sparse, multinucleated Reed-Sternberg (RS) cells embedded in a dense background of reactive inflammatory cells.

Detailed Overview

HL classically spreads contiguously through lymph node chains. It has a bimodal age distribution (20-30s and >65). It is highly curable with multi-agent chemotherapy (ABVD) and involved-site radiation, though treatment is associated with significant long-term toxicities like secondary cancers and cardiotoxicity.

Epidemiology & Demographics

Incidence of 2.5 per 100,000. Nodular sclerosis is the most common subtype in young adults.

Etiological Mechanism

EBV infection is implicated in 40-50% of classical HL cases.

Primary Causes

Malignant transformation of germinal center B-cells

EBV Infection: Prior infectious mononucleosis.
Immunosuppression: HIV infection greatly increases risk.

Malignant RS cells secrete cytokines (IL-5, TARC) recruiting benign lymphocytes and eosinophils, which make up 98% of the tumor. RS cells express PD-L1, exhausting host T-cells and enabling immune evasion.

Characteristic Clinical Presentation

Painless lymphadenopathy: Enlarged cervical or supraclavicular nodes.
B Symptoms: Fever, drenching night sweats, weight loss >10% over 6 months.
Alcohol-induced nodal pain: Pain in affected nodes immediately after drinking alcohol.

Physical Examination Signs

Firm, rubbery, non-tender lymph nodes.
Splenomegaly.

Clinical Risk: Uncontrolled or untreated conditions may progress to the following complications:

Bleomycin pulmonary toxicity: Pulmonary fibrosis from chemotherapy.
Secondary malignancies: Breast or lung cancer from radiation/chemo.

Diagnostic Criteria & Guidelines

Excisional lymph node biopsy showing Reed-Sternberg cells with appropriate IHC.

Differential Diagnosis

Non-Hodgkin Lymphoma
Infectious Mononucleosis
Tuberculosis

Laboratory Tests & Biomarkers

IHC Staining: CD15+, CD30+, CD20-, CD45-.
ESR: Elevated (>50 mm/h is a poor prognostic factor).

Imaging Modalities & Findings

PET/CT:

Stage I
Single lymph node region.
Stage II
≥2 node regions on the same side of the diaphragm.
Stage III
Node regions on both sides of diaphragm.
Stage IV
Diffuse extralymphatic involvement (e.g., liver, bone marrow).

First-Line Treatment:

Advanced stage: ABVD (Doxorubicin 25 mg/m2, Bleomycin 10 U/m2, Vinblastine 6 mg/m2, Dacarbazine 375 mg/m2) for 6 cycles. Often adapted based on interim PET/CT (dropping Bleomycin).

Second-Line & Adjunctive Therapy

Salvage chemotherapy (ICE) followed by Autologous Stem Cell Transplant.

Surgical & Procedural Management

Excisional biopsy for diagnosis. No therapeutic surgery.

Recommended Lifestyle Changes

Strict smoking cessation to reduce secondary lung cancer risk.
Sperm banking/oocyte cryopreservation before chemo.

Patient Counseling & Advice

Discuss high cure rates. Instruct to report fever >38.3°C immediately due to neutropenia. Warn of temporary hair loss.

Follow-Up & Monitoring Schedule

H&P every 3-6 months. Annual TSH if neck radiated. Mammogram/MRI at age 40 or 8 years post-chest radiation.

Preventive Strategies

No primary prevention.

Excellent. 5-year survival is ~89%.

Frequently Asked Questions

Yes, ABVD usually causes temporary hair loss.

Authoritative Sources & Evidence References

NCCN Guidelines - Hodgkin Lymphoma:
View Official Guideline

Key Literature & References:

Evidence Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma