While Hodgkin lymphoma is a relatively uncommon cancer, affecting an estimated 8,570 people in the US this year, its unique bimodal age pattern means it disproportionately strikes young adults and requires our focused attention.
Key Takeaways
- Estimated 8,570 new cases of Hodgkin lymphoma in the US in 2023
- Age-adjusted incidence rate of 2.8 per 100,000 in the US (2017-2021)
- Lifetime risk of developing Hodgkin lymphoma is 0.21% in the US
- EBV associated in 40-50% of cases overall
- HIV infection increases risk 10-fold
- Family history doubles risk in first-degree relatives
- Painless lymphadenopathy in 70-80% at presentation
- B symptoms (fever, night sweats, weight loss) in 40%
- Cervical/supraclavicular nodes involved in 60-80%
- Reed-Sternberg cells diagnostic in 95% biopsies
- Excisional biopsy preferred over core 90% accuracy
- CD15+, CD30+, CD45- in 85% classical HL
- 5-year overall survival 89.1%
- Stage I/II 5-year OS 92-95%
- Stage III/IV 5-year OS 80-85%
Hodgkin lymphoma is a treatable cancer with high survival rates across most ages.
Diagnosis
- Reed-Sternberg cells diagnostic in 95% biopsies
- Excisional biopsy preferred over core 90% accuracy
- CD15+, CD30+, CD45- in 85% classical HL
- PET/CT for staging sensitivity 90-95%
- Ann Arbor staging used in 100% cases
- Bone marrow biopsy positive in 5-15% stage I/II
- LDH elevated prognostic in 30%
- EBV LMP1 detectable in 40%
- CT chest/abdomen/pelvis standard 95%
- Stage III/IV in 35% at diagnosis
- Nodular sclerosis subtype 70%
- Mixed cellularity 20-25%
- Lymphocyte-rich 5%
- NLPHL subtype 5%, indolent
- IPS score 0-3 low risk 70%
- Gallium scan historical sensitivity 90%
- Flow cytometry not diagnostic <10% utility
- Molecular testing for relapses 20%
- Bulky disease >10cm in 20%
- EBER-ISH positive confirms EBV 40%
Diagnosis Interpretation
The path to a Hodgkin's diagnosis is a well-trodden but precise detective story, where the ghostly Reed-Sternberg cell is caught in 95% of excisional biopsies, confessing its identity with CD30 and CD15 in most cases, while PET/CT scans and Ann Arbor staging map its territory, revealing that while most patients present with early-stage, curable disease, a significant minority arrive with advanced or bulky illness, reminding us this lymphoma, though often conquered, demands serious respect.
Epidemiology
- Estimated 8,570 new cases of Hodgkin lymphoma in the US in 2023
- Age-adjusted incidence rate of 2.8 per 100,000 in the US (2017-2021)
- Lifetime risk of developing Hodgkin lymphoma is 0.21% in the US
- Incidence rate 3.0 per 100,000 for males in the US
- Incidence rate 2.5 per 100,000 for females in the US
- Global incidence of 83,087 new cases in 2020
- Highest incidence in Northern America at 3.4 per 100,000
- Lowest incidence in Eastern Africa at 0.7 per 100,000
- Bimodal age distribution with peaks at 15-34 and over 55 years
- Median age at diagnosis 39 years
- 910 estimated deaths from Hodgkin lymphoma in the US in 2023
- Prevalence of 37.4 per 100,000 in the US (2017-2021)
- Incidence higher in Whites (3.1 per 100k) than Blacks (2.1 per 100k)
- Annual incidence in Europe approximately 3 per 100,000
- Incidence increased 2% per year from 2000-2020 in young adults
- 0.5% of all new cancer cases in the US
- Age-specific incidence peaks at 30-34 years (4.5 per 100k)
- 5-year limited duration prevalence 31,470 cases in US
- Incidence in Australia 3.2 per 100,000
- UK incidence 3.1 per 100,000 (2017-2019)
- Decreasing mortality trend 2.4% per year (2012-2021)
- 82,000 new cases worldwide annually
- Higher incidence in developed countries
- Hispanic incidence 4.0 per 100k highest among races
- Incidence in children under 15: 0.5 per 100k
- 15-19 year olds have highest rate 5.2 per 100k
- Global age-standardized mortality 0.6 per 100,000
- US mortality rate 0.4 per 100,000
- Incidence stable over last decade in US adults
- 1.1% of lymphomas are Hodgkin type
Epidemiology Interpretation
While these numbers paint a statistically modest portrait—a rarer cancer with a persistent if not particularly prominent presence, especially for the young—each new case number is a profound plot twist in a real human story.
Prognosis
- 5-year overall survival 89.1%
- Stage I/II 5-year OS 92-95%
- Stage III/IV 5-year OS 80-85%
- ABVD chemo cure rate early stage 90%
- Relapse rate 10-15% after first remission
- IPS high risk >3 poor PFS 60% at 5y
- Age >45 years HR 2.5 for mortality
- 10-year OS 84%
- NLPHL 10-year OS 95%
- Advanced HL with B symptoms OS 75%
- Stem cell transplant cure salvage 50%
- Bulky disease impacts PFS 70% vs 85%
- EBV+ HL worse OS HR 1.4
- Pediatric HL 5y OS 98%
- Elderly >60 5y OS 60-70%
- HIV-HL 5y OS 70% with ART
- Complete response rate ABVD 80%
- Long-term survivors CV risk increased 2-7 fold
- Secondary cancers 15-20% at 20y
- Brentuximab vedotin PFS 75% relapsed
Prognosis Interpretation
Hodgkin Lymphoma is a remarkably curable disease for most, but these encouraging survival statistics serve as a stark reminder that the real battle often shifts from the clinic to the heart, with a lifelong elevated risk of cardiovascular disease and secondary cancers for long-term survivors.
Risk Factors
- EBV associated in 40-50% of cases overall
- HIV infection increases risk 10-fold
- Family history doubles risk in first-degree relatives
- EBV infection risk RR 4.1 in developing countries
- Mononucleosis history increases risk 3-4 times
- Smoking associated with 1.5-fold increased risk
- Autoimmune diseases like RA increase risk 2.4-fold
- Immunosuppression post-transplant RR 6.3
- Male gender RR 1.2
- Age 15-40 years higher relative risk
- HLA genotype A1-B8-DR3 associated with risk
- Obesity BMI>30 OR 1.5
- Alcohol consumption protective OR 0.7
- Socioeconomic status inverse association in young adults
- HIV prevalence in HL patients up to 10% in some regions
- Genetic syndromes like Klinefelter 3-5x risk
- Celiac disease OR 6.9
- Sjögren syndrome RR 5.8
- EBV latency type II in 40% nodular sclerosis subtype
- Twin studies show 80% heritability in monozygotic
- Physical activity protective OR 0.8 per hour/week
- Early menopause protective OR 0.6
- Breastfeeding history OR 0.7
- Asbestos exposure weak association OR 1.3
Risk Factors Interpretation
While a perfect storm of viral ghosts, family ties, weakened immunity, and lifestyle factors conspire to raise the risk of Hodgkin Lymphoma, the body's own history—like past pregnancies or a regular drink—can sometimes offer a surprising shield.
Symptoms
- Painless lymphadenopathy in 70-80% at presentation
- B symptoms (fever, night sweats, weight loss) in 40%
- Cervical/supraclavicular nodes involved in 60-80%
- Mediastinal mass in 50-60% of cases
- Pruritus in 10-30%
- Fatigue reported in 30%
- Cough/dyspnea from mediastinal involvement 25%
- Pel-Ebstein fever cyclical in 20-30%
- Splenomegaly in 20-30%
- Alcohol-induced pain in nodes 5-10%
- Anemia in 30% at diagnosis
- Elevated ESR (>50 mm/h) in 40%
- Back pain from retroperitoneal disease 10%
- Facial edema superior vena cava syndrome 5%
- Generalized weakness 25%
- Night sweats drenching in 20%
- Unintentional weight loss >10% in 30%
- Axillary nodes 20-30%
- Inguinal nodes less common 5-10%
- Paraneoplastic syndromes rare <5%
Symptoms Interpretation
Hodgkin's Lymphoma is a master of disguise, most often introducing itself as a suspicious but painless lump in the neck, yet it keeps a whole menu of systemic annoyances—from drenching night sweats to puzzling alcohol-induced pain—in its back pocket to complicate the plot.
Sources & References
- Reference 1CANCERcancer.orgVisit source
- Reference 2SEERseer.cancer.govVisit source
- Reference 3GCOgco.iarc.who.intVisit source
- Reference 4CANCERcancer.govVisit source
- Reference 5NCBIncbi.nlm.nih.govVisit source
- Reference 6PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 7AIHWaihw.gov.auVisit source
- Reference 8CANCERRESEARCHUKcancerresearchuk.orgVisit source