Hodgkin Lymphoma: Frequently Asked Questions

What is lymphoma?

Lymphoma is a kind of cancer that starts in your lymphatic system. There are 2 main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. In both types, cells in the lymphatic system grow out of control. Normally, the body makes new cells only when they are needed. But sometimes the body starts making cells when they are not needed. When this happens cancer cells grow as a tumor. Hodgkin lymphoma also is known as Hodgkin disease.

What is the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

The cells of Hodgkin lymphoma look different from other lymphomas when checked under a microscope. Also, each disease spreads in a different pattern. Hodgkin lymphoma spreads in a more predictable way. The 2 types of lymphoma are also treated differently.

What is the lymphatic system?

The lymphatic system is part of the immune system. The immune system helps your body fight infections.

The lymphatic system also helps keep the fluid balance in different parts of your body. It brings extra fluid back into your bloodstream. The main parts of the lymphatic system are:

• Lymphatic vessels. These are thin tubes that go all over your body, much like blood vessels.

• Lymph. This is the fluid inside the lymphatic vessels. This clear or white, watery fluid is rich in white blood cells, mainly lymphocytes. These cells help your body fight infection.

• Lymph nodes. These are pea- to bean-sized groups of cells, mainly lymphocytes. They are found throughout your body. They are connected by lymph vessels. Lymph runs through the vessels and passes through the lymph nodes toward the heart.

• Some organs. These include the bone marrow, spleen, thymus, and tonsils. Other organs, such as the digestive tract, also have lymphatic tissue.

What causes Hodgkin lymphoma?

Experts don’t know what causes this disease. Many possible causes have been studied. These include viruses and the environment. The Epstein-Barr virus and the HIV virus both seem to be involved in causing some cases of Hodgkin lymphoma. But it is not clear how. Hodgkin lymphoma is also more common in males, in people of certain ages, and in people with a family history of the disease. But it's not clear how these factors might affect risk.

What are the symptoms of Hodgkin lymphoma?

Some of the most common symptoms of Hodgkin lymphoma include:

• Swollen lymph nodes, which may look like lumps under the skin in your neck, groin, or underarms

• Fever

• Fatigue

• Itchy skin

• Night sweats

• Unexplained weight loss

People may have only some of these symptoms. All of these symptoms can be caused by other health problems. If you have any of these symptoms, see your healthcare provider.

What is the difference between an excisional and incisional biopsy?

An excisional biopsy is when a surgeon takes out a whole lymph node to be checked for cancer. An incisional biopsy is when the surgeon takes out only part of the lymph node. These are the most common biopsies for Hodgkin lymphoma.

What is a needle biopsy?

Needle biopsies are less invasive than excisional or incisional biopsies. There are two main types of needle biopsies: a fine needle aspiration and a core needle biopsy. With a fine needle aspiration (FNA), the healthcare provider uses a very thin, hollow needle to take a small sample of tissue from the tumor. A core needle biopsy uses a larger needle to take slightly more tissue. FNA and core needle biopsy are often not the best way to get cells to check for Hodgkin lymphoma. Sometimes they can’t take enough tissue for the provider to see cancerous cells. Then the doctor may need to use an incisional or excisional biopsy.

How is Hodgkin disease treated?

The treatment for Hodgkin disease depends on the type and stage of the disease, among other factors. The main treatment for Hodgkin disease is chemotherapy. Sometimes, both radiation and chemotherapy are used. Stem cell transplantation or monoclonal antibodies may be used if these treatments don't work. 

Should everyone get a second opinion for Hodgkin lymphoma?

Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. They include:

• You are not comfortable with the treatment decision.

• Your type of cancer is rare.

• There are different ways to treat the cancer.

• You are not able to see a cancer expert.

Many people have a hard time deciding which treatment to have. It may help to have a second doctor review your diagnosis and treatment options before starting treatment. In most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many other companies will pay for a second opinion if asked.

How can I get a second opinion for Hodgkin lymphoma?

These are some of the ways to get a second opinion:

• Ask a primary care doctor. Your doctor may be able to suggest a specialist. This may be a hematologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs. Never be afraid to ask for a second opinion.

• Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Seek other options. Check with a local medical society, hospital, medical school, or cancer advocacy group. They can provide names of doctors who can give you a second opinion. Or ask other people who have had Hodgkin lymphoma to refer you to someone.

Can Hodgkin disease be cured?

Many people with Hodgkin lymphoma can be cured. If the disease is found in the early stages, it can almost always be cured. In later stages, most cases of Hodgkin lymphoma can still be cured.