Hodgkin’s disease, now commonly called Hodgkin lymphoma, is a type of cancer that develops in the lymphatic system, a vital part of the body’s immune defense network. This rare but highly treatable cancer typically begins in specific white blood cells and often first appears as painless swelling in the lymph nodes of the neck, chest, or other areas.

Understanding Hodgkin’s Disease

Hodgkin’s disease affects the lymphatic system, which includes organs, glands, and small bean-shaped structures called lymph nodes scattered throughout the body. This system is essential for protecting against infection and disease. The cancer starts in special white blood cells known as B lymphocytes, or B cells, which normally help fight off infections. When these cells undergo genetic changes at some point in life, they can begin to multiply uncontrollably, leading to Hodgkin lymphoma.

This condition is distinguished from other lymphomas by the presence of unusual cells called Reed-Sternberg cells, large abnormal cells that doctors look for when examining tissue samples under a microscope. These distinctive cells are surrounded by a mixture of non-cancerous inflammatory cells, creating a characteristic pattern that helps doctors make a diagnosis. The disease most commonly begins in lymph nodes located in the neck or the central chest area, though it can also develop in lymph nodes under the arms, in the groin, abdomen, or pelvis.

There are two main categories of this disease: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Classic Hodgkin lymphoma accounts for approximately 95 percent of all cases and is further divided into four subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted. Each subtype has slightly different characteristics, though all are treated as highly curable forms of cancer.

How Common Is Hodgkin’s Disease?

Hodgkin lymphoma is considered a rare form of cancer. It affects roughly 3 in every 100,000 people each year globally. In the United States, between 8,500 and 9,000 new cases are diagnosed annually. Despite its rarity in the general population, Hodgkin lymphoma holds a particular distinction: it is one of the most common cancers affecting teenagers between the ages of 15 and 19, as well as young adults. This pattern of occurrence in younger people sets it apart from many other cancers that typically affect older populations.

The disease shows some interesting patterns across different groups. It is slightly more common in males than in females, though one subtype, nodular sclerosis Hodgkin lymphoma, affects young adult women more frequently. The condition can occur at any age, but it has two peak periods of diagnosis: the first is in early adulthood, typically between ages 20 and 39, and the second occurs later in life, in people aged 65 and older. Children can develop Hodgkin lymphoma, though this is less common, and when they do, they often have excellent treatment outcomes.

Compared to non-Hodgkin lymphoma, which is its counterpart in the lymphoma family, Hodgkin lymphoma is much less common. However, its relative rarity does not diminish its significance, especially given how successfully it can be treated when detected early. In 2015, approximately 574,000 people worldwide were living with Hodgkin lymphoma, showing that many individuals survive well beyond their initial diagnosis.

What Causes Hodgkin’s Disease?

The exact cause of Hodgkin lymphoma remains unknown to medical researchers. What is clear is that the disease develops when genes inside B lymphocytes undergo mutations or changes. These genetic alterations cause the cells to grow and multiply abnormally, eventually forming cancerous masses in lymph nodes and potentially spreading to other parts of the lymphatic system. However, scientists have not identified a single definitive trigger for these genetic changes.

There is strong evidence linking Hodgkin lymphoma to infection with the Epstein-Barr virus, often abbreviated as EBV. This virus, which belongs to the herpes family, is extremely common and causes infectious mononucleosis, commonly known as “mono.” Most people are exposed to EBV during childhood, often without developing any noticeable symptoms. However, when infection occurs during the teenage years, it can cause mono. Research has demonstrated that people who had mono as teenagers are approximately three times more likely to develop Hodgkin lymphoma later in life. About half of all Hodgkin lymphoma cases show evidence of EBV presence in the cancer cells, particularly in the mixed cellularity and lymphocyte-depleted subtypes.

Beyond viral connections, researchers have noted that Hodgkin lymphoma sometimes appears to run in families, suggesting a possible genetic predisposition. Having a parent or sibling with Hodgkin lymphoma increases a person’s risk of developing the disease. Additionally, people with compromised immune systems, whether from HIV/AIDS or from medications that suppress immunity, face a higher risk. Despite these associations, it’s important to understand that the exact mechanism by which these factors contribute to disease development is still being studied. Most people with these risk factors will never develop Hodgkin lymphoma, and many people who are diagnosed have no identifiable risk factors at all.

Risk Factors for Developing the Disease

Several factors have been identified that increase the likelihood of developing Hodgkin lymphoma, though having one or more risk factors does not guarantee that a person will develop the disease. Age is one significant factor. The condition most commonly affects people in two distinct age groups: young adults in their twenties and thirties, and older adults over 60 or 65. Being in these age ranges increases risk compared to other life stages.

Gender plays a modest role, with males having a slightly higher overall risk than females. However, this varies by subtype, as some forms of the disease show different patterns. Past infection with the Epstein-Barr virus, especially if it caused mononucleosis during adolescence, is another recognized risk factor. A family history of Hodgkin lymphoma also increases risk, with siblings and children of affected individuals facing higher chances of developing the condition.

People with weakened immune systems are more vulnerable to Hodgkin lymphoma. This includes individuals with HIV/AIDS, many of whom have been exposed to EBV. It also includes people taking immunosuppressive medications following organ transplants or for autoimmune diseases. Autoimmune conditions themselves, such as rheumatoid arthritis, lupus, Sjögren syndrome, or celiac disease, have been associated with increased risk. However, it’s crucial to remember that the vast majority of people with these conditions will never develop Hodgkin lymphoma.

Recognizing the Symptoms

The most common first sign of Hodgkin lymphoma is painless swelling of one or more lymph nodes. These swollen nodes most frequently appear in the neck, but can also be noticed in the underarm area, groin, or above the collarbone. The affected lymph nodes typically feel rubbery and enlarged when touched, yet they cause no pain, which distinguishes them from lymph nodes swollen due to common infections. These lumps do not arise from any injury and do not disappear as quickly as swelling from minor infections would.

Beyond visible or palpable lumps, Hodgkin lymphoma can cause a constellation of symptoms that affect the whole body. Medical professionals call three specific symptoms “B symptoms” when they occur together: fever that cannot be explained by other causes, drenching night sweats that are so intense they soak through bedclothes and sheets, and unintentional weight loss. For weight loss to be considered significant, it typically means losing 10 percent or more of total body weight over six months without trying to lose weight through diet or exercise changes.

Many people with Hodgkin lymphoma experience persistent, overwhelming fatigue that goes beyond normal tiredness. This exhaustion doesn’t improve with rest and can last for many days or weeks. Some people develop very itchy skin, a condition called pruritus, which may become more intense after drinking alcohol or taking a bath. This itching can be severe enough to significantly impact quality of life and sleep.

Depending on where the lymphoma develops, other symptoms may arise. If cancer cells are present in the chest, people may experience chest pain, persistent coughing, or difficulty breathing, especially when lying down. This occurs because enlarged lymph nodes or tumors in the chest can press against the lungs or airways. When Hodgkin lymphoma affects the abdomen, it can cause abdominal pain, swelling, or a feeling of fullness. If it develops in bone, it may cause bone pain. Some people report that previously painless swollen lymph nodes become painful after consuming alcoholic beverages, though this is a less common symptom.

Prevention Strategies

Because the exact causes of Hodgkin lymphoma are not fully understood, there are no guaranteed methods to prevent the disease. Unlike some cancers that have clear preventable risk factors such as smoking or excessive sun exposure, Hodgkin lymphoma does not have similarly well-defined behavioral causes that can be avoided. However, understanding what is known about risk factors can help people make informed decisions about their health.

Since infection with the Epstein-Barr virus is associated with increased risk, avoiding EBV exposure could theoretically reduce risk. However, this is impractical in reality because EBV is extremely common worldwide, with most people becoming infected at some point during childhood or adolescence, often without knowing it. The virus spreads through saliva, which is why infectious mononucleosis is sometimes called “the kissing disease,” but it can also spread through coughing, sneezing, or sharing drinks and utensils. Complete avoidance of EBV exposure is nearly impossible in normal social life.

Maintaining a healthy immune system through general good health practices may offer some indirect benefit. This includes eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins; getting regular physical activity; maintaining a healthy weight; getting adequate sleep; managing stress; and avoiding smoking and excessive alcohol consumption. For people with HIV, taking antiretroviral medications as prescribed to keep the virus under control and maintain immune function is important, as it may reduce cancer risk along with many other health benefits.

There are no screening tests recommended for Hodgkin lymphoma in people without symptoms, unlike some other cancers such as breast, colorectal, or cervical cancer. This is because the disease is relatively rare, and screening large numbers of healthy people would not be practical or beneficial. Instead, early detection relies on people being aware of potential symptoms and seeking medical attention if they notice persistent, unexplained lymph node swelling or other concerning signs.

How the Disease Changes Body Function

Understanding what happens inside the body during Hodgkin lymphoma helps explain why symptoms occur and why treatment is necessary. In a healthy lymphatic system, lymphocytes circulate through lymph nodes and other lymphoid tissues, constantly surveying for foreign invaders like bacteria, viruses, and other threats. When they encounter something dangerous, they multiply rapidly to mount an immune response. Once the threat is eliminated, these cells normally stop multiplying and many die off in a controlled process.

In Hodgkin lymphoma, genetic mutations disrupt this normal control mechanism. B lymphocytes begin to multiply excessively without stopping, and they fail to die when they should. As these abnormal cells accumulate, they transform into the distinctive Reed-Sternberg cells and fill up lymph nodes, causing them to swell. The characteristic appearance under a microscope shows these large, abnormal cells scattered among a background of various inflammatory cells that the body has recruited in response to the malignancy.

As lymph nodes become packed with cancer cells, they enlarge but typically don’t hurt because the expansion happens gradually and doesn’t involve the acute inflammation that causes pain in infected lymph nodes. However, the mechanical pressure from very large nodes can cause discomfort or interfere with nearby structures. For example, enlarged lymph nodes in the chest can press against airways or blood vessels, causing breathing difficulties or swelling in the arms or face. Nodes in the abdomen can press on the stomach or intestines, causing feelings of fullness or digestive discomfort.

The disease affects more than just lymph nodes. As abnormal lymphocytes circulate through the bloodstream and lymphatic vessels, they can settle in other organs, including the spleen, liver, bone marrow, lungs, or bones. When cancer cells invade the bone marrow, they can interfere with the production of normal blood cells. This may lead to anemia, a condition where there aren’t enough red blood cells to carry oxygen efficiently, causing fatigue and weakness. Low white blood cell counts can increase infection risk, while low platelet counts can affect blood clotting.

The systemic symptoms of Hodgkin lymphoma—fever, night sweats, and weight loss—result from the body’s complex immune response to the cancer. Cancer cells and the immune cells surrounding them release various chemical messengers called cytokines. These substances can reset the body’s temperature regulation, leading to fevers and sweats. They can also affect metabolism and appetite, contributing to weight loss. The persistent fatigue experienced by many patients results from multiple factors: the cancer itself, anemia, the body’s ongoing immune response, poor sleep due to night sweats, and the psychological stress of dealing with a serious illness.