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Hodgkin Lymphoma

A cancer of the lymph system that most often starts as a painless swollen lymph node. It is most common in young adults and again in older adults. The National Cancer Institute says Hodgkin lymphoma can usually be cured if found and treated early — and survivors need lifelong follow-up for late effects of treatment.

Getting chemotherapy? Call your oncology team right away — even in the middle of the night — or go to the emergency room for:

  • A fever of 100.4°F (38°C) or higher. During chemotherapy this is a medical emergency: fever may be the only sign of an infection, and infection can be life-threatening (CDC). Chemotherapy lowers the white blood cells that fight infection (neutropenia) (CDC), often most between 7 and 12 days after a treatment (CDC). At the emergency room, say you are a cancer patient getting chemotherapy, so you are seen quickly (CDC).
  • Other signs of infection: chills and sweats, a new or changed cough, shortness of breath, a sore throat or mouth sore, a stiff neck, pain when urinating, redness or swelling anywhere (including around ports), diarrhea, vomiting or new pain (CDC). Ask your doctor before taking anything to lower a fever, because it can hide a serious problem (National Cancer Institute).
  • Trouble breathing, or new swelling of the face, neck, arms or upper chest. Swollen lymph nodes in the chest can press on the windpipe and cause coughing and trouble breathing, especially when lying down (American Cancer Society). A lymphoma in the chest can also press on the large vein that drains the head and arms (superior vena cava, or SVC, syndrome), causing swelling and trouble breathing; ACS says this can be life-threatening and must be treated right away (ACS). NCI lists swelling of the face and neck among its signs (NCI). If you are struggling to breathe, call 911.

Keep your care team’s daytime and after-hours numbers with you (CDC). Never wait for an acupuncture, massage or chiropractic appointment for any of these.

Complementary therapies are used alongside, never instead of, lymphoma treatment. Don’t use unproven products or practices to replace or delay cancer treatment; no complementary approach has been shown to cure cancer (NCCIH, U.S. National Institutes of Health). Tell your oncology team about every supplement, even vitamins (NCI). See also our Cancer guide.

What is Hodgkin lymphoma?

Hodgkin lymphoma (also called Hodgkin disease) is a cancer of the lymph system, the part of the immune system that helps protect the body from infection (MedlinePlus). It affects white blood cells called lymphocytes (NHS). It most often starts in lymph nodes — small, bean-shaped glands — above the diaphragm, often in the area between the lungs (National Cancer Institute).

Most people have classic Hodgkin lymphoma, in which large abnormal cells called Reed-Sternberg cells may be seen. Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is rare, tends to grow more slowly, and is often treated differently (NCI).

Not the same as non-Hodgkin lymphoma. The two main groups of lymphoma start in different types of white blood cells (MedlinePlus). Non-Hodgkin lymphoma is a family of many types (MedlinePlus) whose outlook depends on the specific type (NCI), and it is far more common: about 79,320 new U.S. cases are expected in 2026, compared with 8,920 of Hodgkin lymphoma (NCI SEER Program). Treatments differ, so be sure which one you have.

Who gets it?

Hodgkin lymphoma is rare: about 0.2% of people are diagnosed with it in their lifetime (NCI SEER). NCI says it is most common in early adulthood (ages 20–39) and late adulthood (65 and older), and slightly more common in males (NCI). It is most often diagnosed at ages 20–34 (31.7% of new cases), with a median age at diagnosis of 38 (NCI SEER). It is also the most common cancer in teens aged 15 to 19, and risk rises again after 55 (American Cancer Society). Children are treated differently from adults (NCI).

Risk factors, including Epstein-Barr virus

NCI’s risk factors are age, being male, a family history (a parent, brother or sister with Hodgkin lymphoma) and past Epstein-Barr virus (EBV) infection: having EBV in the teenage years or early childhood increases the risk (NCI). Most people in the U.S. have been infected with EBV, the virus that causes mono; many are infected, but few develop Hodgkin lymphoma. Parts of the virus are found in the cancer cells of about 1 in 4 people with classic Hodgkin lymphoma in the U.S. (American Cancer Society). See our Epstein-Barr Virus guide.

A weakened immune system — from HIV, some autoimmune diseases or anti-rejection medicines after a transplant — also raises risk. Still, many people who get Hodgkin lymphoma have few or no known risk factors, and most cases can’t be prevented at this time (ACS). The NHS adds smoking and being overweight (NHS).

Symptoms

Check with your doctor if any of these don’t go away (NCI):

  • Painless, swollen lymph nodes in the neck, underarm or groin — the most common symptom (ACS). Some people get pain in these glands after drinking alcohol (NHS).
  • Fever for no known reason, drenching night sweats, and weight loss for no known reason in the past 6 months — together called “B symptoms,” which doctors use in staging.
  • Itchy skin, especially after bathing or drinking alcohol, and feeling very tired (NCI).
  • A cough, trouble breathing or pain behind the breastbone, from nodes in the chest (ACS).

Most swollen lymph nodes are caused by infection, not lymphoma, but get one checked, especially without a recent infection (ACS).

Diagnosis and staging

  • A biopsy is the only way to be sure. Doctors may first wait a few weeks or try antibiotics to see whether a node shrinks. If not, removing all or part of the node (excisional or incisional biopsy) is the preferred type; a fine needle aspiration usually doesn’t give enough tissue (American Cancer Society). A pathologist looks for Reed-Sternberg cells and identifies the type (NCI).
  • Blood tests, including a blood count, LDH, sedimentation rate, and tests for hepatitis B and C and HIV that help plan treatment (NCI).
  • PET-CT scan: a small amount of radioactive sugar shows active cells, helping doctors find the lymphoma, stage it, plan treatment and check how treatment is working (NCI). Pregnant women have MRI or ultrasound instead (NCI).

Stages I to IV describe spread: stage I is one group of nodes; stage II, two or more groups on one side of the diaphragm; stage III, nodes above and below it; stage IV, spread into organs such as the liver, bone marrow or lungs. For treatment, doctors group it as early favorable, early unfavorable (stage I or II with risk factors such as a large chest mass or B symptoms) or advanced (stage III or IV) (NCI).

Outlook

In NCI’s words, “Hodgkin lymphoma can usually be cured if found and treated early” (National Cancer Institute). The American Cancer Society says that for many people, treatment cures Hodgkin lymphoma (American Cancer Society).

For people diagnosed in 2016–2022, 5-year relative survival is 89.3% overall: 92.7% for stage I, 95.4% for stage II, 87.7% for stage III and 82.8% for stage IV (NCI SEER Program). These numbers describe large groups and can’t predict one person’s outcome (NCI SEER). Outlook also depends on age, overall health and how the lymphoma responds, and people diagnosed today may do better than these numbers show, because treatment has improved (ACS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Combination chemotherapy (such as ABVD, BV-AVD or BrECADD), often with radiation; brentuximab vedotin and PD-1 inhibitors (nivolumab, pembrolizumab); stem cell transplant if it comes back; clinical trials. Cost estimate being researched. Insurance, Medicare, Medicaid and nonprofit programs can help. The treatment that cures Hodgkin lymphoma: NCI says it can usually be cured if found and treated early. 5-year relative survival is 89.3%. Needs lifelong follow-up for late effects.
Chiropractic No role in treating lymphoma. Possibly gentle care for ordinary back or neck pain — only with your oncologist’s OK. About $55–$100 a self-pay follow-up visit; first visits about $90–$200. No evidence it affects lymphoma. Skip it while platelets are low or if bones are involved; new back pain needs a check by your cancer team first.
Acupuncture Used alongside treatment for chemotherapy nausea and vomiting and for fatigue. About $90–$185 a follow-up visit cash-pay; community clinics about $50–$90. Strongest evidence is for treatment-related nausea; fatigue results are promising but less certain. Needs strict clean-needle technique and your team’s OK when counts are low.
Herbal medicine No herb or supplement treats Hodgkin lymphoma or keeps it from coming back. Cost estimate being researched. Real risks: antioxidant supplements may interfere with chemotherapy or radiation, and St. John’s wort weakens some cancer drugs. Tell your oncology team about everything you take.
Massage therapy Gentle massage for comfort, stress and anxiety during and after treatment, from a therapist experienced with cancer care. One national chain: $125–$160 for 60 minutes (nonmember); prices vary by location. Limited, low-quality evidence for pain and anxiety. No pressure on swollen nodes, ports or lines; check platelets first.
MBHA Wellness Coach Energy and fatigue, eating well and food safety, infection precautions, exercise as able, survivorship care plans, late-effects follow-up and emotional support. Coaching: cost estimate being researched. Many support groups are free. Exercise is safe and helpful for most people and can reduce fatigue. Supports — never replaces — your oncology care.

Approach 1 of 6

Conventional medicine (AMA)

A medical oncologist oversees treatment, often with a radiation oncologist, hematologist and fertility specialist. The plan depends on the type, stage and treatment group, B symptoms, blood tests, and your age and health (National Cancer Institute). If you may want children someday, raise it before treatment starts — see Protecting fertility.

1. Chemotherapy

Chemotherapy is at least part of the main treatment for most people. Drugs are combined, and the combinations go by abbreviations: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine); AVD, the same without bleomycin, often given with brentuximab vedotin (BV-AVD) or nivolumab; and BrECADD (American Cancer Society). NCI also lists combinations such as BEACOPP and Stanford V (NCI). We don’t list doses or cycles — your oncologist sets them.

Short-term side effects include hair loss, mouth sores, nausea, fatigue, a higher chance of infection and easy bruising or bleeding; they usually go away after treatment (ACS). Anti-nausea medicines work best when started before treatment (NCI).

2. Targeted therapy and immunotherapy

  • Brentuximab vedotin, an antibody that carries a chemotherapy drug to lymphoma cells, is used with combination chemotherapy for early unfavorable and advanced classic Hodgkin lymphoma, and for lymphoma that has come back (NCI). It can cause nerve damage (neuropathy) (ACS).
  • PD-1 inhibitors (nivolumab, pembrolizumab) help immune T cells kill cancer cells. NCI says they are used for Hodgkin lymphoma that has come back, and nivolumab may be added to chemotherapy for advanced disease (NCI). They can cause serious immune reactions in the lungs, intestines, liver, hormone glands or kidneys; report new problems right away (ACS).
  • Rituximab is used for NLPHL (NCI).

3. Radiation therapy

Radiation kills cancer cells in the affected areas (NCI) and may be given after or with chemotherapy (NHS). Proton therapy can spare nearby tissue such as the heart or breast (NCI). Today’s radiation uses lower doses aimed only at affected areas, so late risks are likely lower than in the past (ACS).

4. If it comes back: stem cell transplant

Hodgkin lymphoma can recur. Options then include immunotherapy with or without chemotherapy, which may be followed by a stem cell transplant: high-dose chemotherapy, then the patient’s stored (or a donor’s) stem cells are given back to rebuild the blood (NCI).

5. Special situations and clinical trials

  • NLPHL may be watched closely without treatment at first (NCI).
  • Pregnancy: treatment is chosen to protect the baby; most women diagnosed in the second half of pregnancy can delay treatment until after delivery (NCI).
  • Clinical trials may be the best choice for some patients, and some only take people who haven’t started treatment. NCI’s Cancer Information Service, 1-800-4-CANCER, can help (NCI).

What it costs

Cost estimate being researched. Ask a hospital financial counselor or social worker early; groups such as CancerCare, the HealthWell Foundation and the Leukemia and Lymphoma Society offer financial help (NCI).

How well it works — what to expect

Standard treatment is the path to a cure: NCI says Hodgkin lymphoma can usually be cured if found and treated early (NCI), and 5-year relative survival is 89.3% (NCI SEER). The trade-off is a risk of late effects, so lifelong follow-up by doctors experienced in late effects matters (NCI) — see Late effects and survivorship care.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating Hodgkin lymphoma. No complementary approach has been shown to cure cancer (NCCIH, U.S. National Institutes of Health), and a systematic review of chiropractic care for people with cancer found mostly case reports and commentaries, concluding that the field needs further research (Integrative Cancer Therapies, 2012). We found little research on chiropractic care in people with lymphoma. The chance of a serious side effect from spinal manipulation may be greater in people with underlying health problems (NCCIH).

MBHA caution: get your oncologist’s OK first. No source we found sets rules for chiropractic care in lymphoma, so these are MBHA’s own precautions, based on these facts:

What it costs

A self-pay follow-up visit is about $55–$100, and a first appointment commonly about $90–$200 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is used alongside lymphoma treatment to ease side effects — not to treat the cancer itself (National Cancer Institute).

What the research shows

  • Nausea and vomiting: the strongest evidence for acupuncture in cancer care comes from trials for nausea and vomiting; a 2013 review of 41 trials found it helped chemotherapy-related nausea and vomiting (NCI). Most of this research came before current anti-nausea guidelines, so it’s uncertain how much acupuncture adds to today’s medicines (NCCIH). Keep taking the anti-nausea medicines your team prescribes.
  • Fatigue: several trials found acupuncture improved cancer-related fatigue compared with standard care alone, but it isn’t clear that real acupuncture works better than sham (NCI). A 2018 review of 10 studies suggested acupuncture may be more helpful than sham acupuncture or usual care (NCCIH).
  • We found little research on acupuncture specifically in people with Hodgkin lymphoma.

Staying safe

  • Complications are few when sterile needles are used. Because chemotherapy and radiation weaken the immune system, a strict clean-needle method is a must for people with cancer (NCI, NCCIH).
  • If your blood counts are low, ask your oncology team first: low white cells raise infection risk and low platelets make bleeding easier (NCI, NCI).
  • Check any herbs an acupuncturist suggests with your oncology team — see the herbal section.

What it costs

Cash-pay follow-up visits run about $90–$185, first visits up to about $125–$230, and community acupuncture about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement treats Hodgkin lymphoma. There are no studies proving that any special diet, food, vitamin, mineral, dietary supplement or herb can slow cancer, cure it or keep it from coming back — and some can change how cancer treatment works (National Cancer Institute). No dietary supplement has been shown to clearly lower the risk of Hodgkin lymphoma progressing or coming back (American Cancer Society).

Why supplements are a concern during treatment

  • Antioxidant supplements (such as vitamins C and E): some trials found that people who took them during cancer therapy had worse outcomes, especially smokers, and NCI advises caution until more is known (NCI). Because these supplements might interfere with chemotherapy or other cancer therapies, discuss them with your providers (NCCIH). Vitamin C supplements may interact with chemotherapy and radiation therapy (NCCIH).
  • St. John’s wort can interact in dangerous ways with many medicines and can weaken some cancer drugs (NCCIH); NCI warns it may make certain cancer drugs not work as well as they should (NCI).
  • Other interactions: some supplements interfere with how the body breaks down chemotherapy, making it less effective or increasing side effects, and some cause severe skin reactions during radiation. Many cancer experts advise avoiding supplements during treatment (ACS).

Tell your oncology team about everything

Tell your doctor about every dietary supplement, even vitamins, no matter how safe you think they are, and bring a list of everything you take (NCI). After treatment, keep telling your doctors about any new vitamins, herbs or supplements (NCI). We don’t list doses here.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage can help some people feel calmer and more comfortable during cancer care, but it does not treat lymphoma. With appropriate precautions, massage can be part of supportive care for people with cancer who want to try it, though the evidence that it relieves pain and anxiety is not strong (NCCIH).

What the research shows

  • A 2016 review of 19 studies found some evidence that massage might help with pain and anxiety in people with cancer, but the evidence was very low quality and inconsistent (NCCIH).
  • Guidelines for breast cancer care include massage among approaches that may help with stress, anxiety, depression, fatigue and quality of life (NCCIH).
  • We found little research on massage specifically for people with Hodgkin lymphoma.

Staying safe

  • Gentle, not deep. Therapists may need to use less pressure in areas made sensitive by cancer or its treatment (NCCIH). Serious side effects such as a blood clot or broken bone are rare; some reported cases involved vigorous massage or people at higher risk of injury (NCCIH).
  • MBHA caution — no pressure on swollen lymph nodes, ports or central lines. We found no source that sets this rule, so it is our own precaution. Redness, soreness or swelling around a port is a sign of infection to report to your team right away (CDC).
  • Low platelets: chemotherapy can make you bruise or bleed easily (NCI) — check your counts with your care team before any massage.
  • Low white cells: stay away from people who are sick (NCI) — reschedule if your therapist has a cold. Tell your oncology team you are getting massage (NCI).

What it costs

As one example from a national chain, three locations list a 60-minute massage at $125–$160 for nonmembers, and memberships run about $70–$90 a month; prices vary by location (The Pricer). Massage from a therapist trained in cancer care may cost differently.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach works alongside your oncology team on everyday habits during and after treatment — never as a substitute for medical care.

Fatigue and exercise

  • More than 80% of people getting chemotherapy or radiation have fatigue, and rest doesn’t fully relieve it. A fatigue diary helps your team look for causes such as anemia; exercise, eating well and planned rest can help (National Cancer Institute).
  • For most people, exercise is safe and helpful during and after treatment and can reduce fatigue. Start slowly — if very tired, try 10 minutes of light activity a day. Check with your team first, especially with severe fatigue or weak bones, and avoid public gyms and crowds while your infection risk is high (American Cancer Society).
  • Chronic fatigue can be a late effect of treatment (NCI); see our Chronic Fatigue guide and tell your doctor.

Infection precautions and eating well

Survivorship plan and late-effects follow-up

A coach can help you keep your treatment summary and survivorship care plan together and track follow-up visits (NCI), including heart, thyroid and cancer-screening checks. ACS lists avoiding tobacco, a healthy weight, staying active, eating well and avoiding or limiting alcohol as steps that can help lower the risk of a second cancer — and may also lower the risk of heart disease (ACS).

Emotional support

Some depression, anxiety and worry about the lymphoma coming back are normal, and everyone can benefit from support (ACS). Ask your hospital social worker or nurse about resources (NCI); support groups, in person or online, can help you feel less alone (NCI). See our Depression and Anxiety guides. In a crisis, call or text 988 (988 Suicide & Crisis Lifeline).

What it costs

Wellness coaching: MBHA cost estimate being researched. Many support groups are free, though some charge a small fee (NCI).

Another approach

Late effects and survivorship care

Many people with Hodgkin lymphoma are cured, but treatment can cause health problems later (American Cancer Society). These late effects depend on the treatment and your age when treated (National Cancer Institute):

  • Second cancers, such as breast, lung and thyroid cancer and acute myelogenous leukemia (NCI), usually more than 10 years after treatment and linked mainly to radiation and some chemotherapy drugs (ACS). MBHA’s Leukemia guide is coming soon.
  • Heart disease from chest radiation or doxorubicin, sometimes more than 10 years later; neck radiation raises stroke risk. Lung damage from bleomycin or chest radiation (ACS).
  • Low thyroid after neck or chest radiation — ACS advises a thyroid blood test at least yearly for anyone who had radiation to the neck or upper chest (ACS).
  • Infertility, severe infection, avascular necrosis of bone, chronic fatigue and thinking problems (NCI).

Your survivorship care plan

Ask for a plan that sets out your follow-up schedule, screening and late-effects checks, what to watch for, and diet and activity advice (ACS), plus a written treatment summary to share with every doctor you see (NCI).

  • Follow-up is usually every 3 to 6 months for the first several years, and often yearly even after 5 years, because Hodgkin lymphoma can sometimes come back many years later (ACS).
  • Breast screening: for women who had chest radiation before age 30, ACS recommends a yearly breast MRI with a mammogram starting at 30 (ACS).
  • Survivorship clinics: many NCI-designated cancer centers offer follow-up programs for adult survivors (NCI). Those treated young can use the Children’s Oncology Group survivorship guidelines with their doctors (ACS).

Another approach

Protecting fertility before treatment

Hodgkin lymphoma often strikes people in their 20s and 30s, so fertility matters. Chemotherapy and radiation, especially in younger people, can reduce or end fertility (American Cancer Society). Some chemotherapy drugs, such as alkylating agents, carry a high risk (National Cancer Institute), and men with Hodgkin lymphoma may already have a low sperm count at diagnosis (NCI).

Talk about it before treatment starts. Ask how your treatment could affect fertility and for a referral to a fertility specialist. Survivors who met with a fertility specialist had less regret, whether or not they chose to preserve fertility (NCI).

  • For men: sperm banking is the most common option after puberty; other options include testicular shielding during radiation and sperm or tissue retrieval (NCI).
  • For women: options include egg or embryo freezing, ovarian tissue freezing (for girls before puberty or women who can’t delay treatment), shielding, and moving the ovaries out of the radiation field (ovarian transposition) (NCI). Moving the ovaries does not affect cure rates, because Hodgkin lymphoma almost never spreads there (ACS).
  • Cost: success rates, costs and availability vary, and some states require insurers to cover fertility preservation; ask for a social worker who can help with insurance questions (NCI).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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