Hodgkin lymphoma

First appointment

Your first appointment at Fred Hutchinson Cancer Center is a time for you and your hematologist-oncologist to meet. You might meet your advanced practice provider, too. You will talk about your diagnosis, subtype, disease stage and likely treatment. This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your care team will decide what needs to happen next.

We encourage you to bring a family member or friend to your first appointment (and any future visits).

Following the merger of long-time partners, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, the organization was renamed to Fred Hutchinson Cancer Center. We are an independent, nonprofit organization that also serves as UW Medicine's cancer program.

Hematologist A physician who specializes in diseases of the blood and blood-forming tissues. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Request an Appointment

“In the first appointment, we focus on the big picture. We communicate what your diagnosis is, what it means and whether any additional information is needed. We discuss next steps, which could include things that need to be done before starting treatment, as well as the logistics of the treatment itself.”

— Ryan C. Lynch, MD, hematologist-oncologist

What to expect

First appointments usually last one to two hours. You will spend about one hour with your physician. The rest of your visit may involve checking in, being escorted to an exam room and getting settled in there, meeting other members of your team and setting up your next appointments. Here is what you can expect to happen.

Confirming your diagnosis

Before coming to Fred Hutch, you likely have already had a biopsy that shows you have Hodgkin lymphoma and know the subtype of your disease. Knowing your subtype is important, because it helps your physician decide which treatments will likely work best for you and when your treatment should start.

Our hematopathologists may run more tests on your tissue sample to confirm your diagnosis or to narrow down your subtype. At your first appointment, your physician will have your results and go over them with you.

Staging your disease

Most newly diagnosed patients have not yet had tests to stage their disease. Staging means finding out how far lymphoma has spread in your lymph system or to other parts of your body. Hodgkin lymphomas range from stage I to stage IV, with I being the least advanced and IV being the most advanced.

If you have had these tests and you already know the stage of your cancer, we will look at the test results before your appointment. If you have not had these tests, we will talk with you about which tests you need, why, how to get them and when you can expect results. The tests usually happen within 10 to 14 days.

Discussing your treatment

The treatment we recommend for you depends on several things, including the subtype and stage of your Hodgkin lymphoma. If you have had a biopsy and we know your subtype, your physician will explain generally which treatments you are likely to need. After we have the results of your staging tests, we will meet with you again to talk about your personalized treatment in more detail.

These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs and preferences. We want to get to know you so we understand the best way to care for you.

Answering your questions

Starting with your first appointment (and after), we are here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch. We invite you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you. We also encourage you to talk with your care team about your hopes and concerns. Knowing more about you helps your team recommend the right treatment for you.

Before you leave, we will make sure you know what is going to happen next and how you can reach us if you have questions later. We will also schedule your next visit.

Staging Hodgkin lymphoma

Staging means finding out how far Hodgkin lymphoma has spread in your lymph system or other parts of your body. This helps your physicians predict which treatments are most likely to control your disease or put it into remission.

Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

Stages of Hodgkin lymphoma

Physicians use Roman numerals I (one), II (two), III (three) and IV (four) to name the stages of Hodgkin lymphoma. Stage I is the least advanced, and stage IV is the most advanced. All stages can be treated, and even advanced Hodgkin lymphoma can often be put into remission.

Stage I: Cancer is only in one group of lymph nodes or is only in one place outside your lymph system.
Stage II: Cancer is in two or more groups of lymph nodes, both above or both below your diaphragm. Cancer can also be in one organ and in lymph nodes in the same area (it can also be in other lymph nodes on the same side of your diaphragm).
Stage III: Cancer is in lymph nodes on both sides of your diaphragm.
Stage IV: Cancer has spread beyond your lymph nodes to other parts of your body, like your bone marrow, lungs or liver.

Physicians may also add a letter after your stage to describe more about your disease.

A (as in “stage IA”) means you do not have symptoms.
B (as in “stage IB”) means you have B symptoms: fever, weight loss or night sweats.
E (as in “stage IIIE”) means your cancer is outside your lymph system (extranodal).
S (as in “stage IIIS”) means the cancer is in your spleen.

To understand your lymphoma and recommend the best treatment for you, your physician will think about many things, such as whether you have:

A tumor in your chest bigger than a certain size
Cancer in an organ other than your lymph nodes
Three or more lymph nodes with cancer
A high sedimentation rate (your red blood cells settle quickly to the bottom of a test tube in a sample of your blood)
Certain levels of blood albumin, hemoglobin, white blood cells and lymphocytes

If your lymphoma comes back after treatment, it is called recurrent or relapsed. Your physician will ask for imaging tests or other tests to restage it. After restaging, your physician will work with you to make a new personalized treatment plan for your situation.

B symptoms In lymphoma, B symptoms include unexplained fever, weight loss or night sweats. Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Diaphragm The thin muscle below the lungs and heart that separates the chest from the abdomen. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Red blood cell A type of blood cell that carries oxygen in the body. Relapse The recurrence (return) of disease after an apparent recovery. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Spleen An organ that is part of the lymphatic system. The spleen makes lymphocytes, filters the blood, stores blood cells and destroys old blood cells. It is on the left side of the abdomen near the stomach. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends. Albumin Albumin is a protein made by the liver. Once it enters your bloodstream, it helps keep fluid from leaking out of the blood vessels and into different parts of the body. In patients with multiple myeloma, albumin levels are used to stage the disease.

Staging tests

To diagnose the stage of your Hodgkin lymphoma, you need imaging and blood tests.

Imaging tests show which lymph nodes are bigger than normal, if other organs are affected and if you have any large tumors.

Blood tests check for lymphoma cells in your blood. They also check for other substances (like proteins) that can tell physicians how serious your disease is, if your organs are working well and how urgently you need treatment.

You will probably also have tests to check if lymphoma is in your bone marrow.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Imaging tests to stage Hodgkin lymphoma

Imaging tests to stage Hodgkin lymphoma may include one or more of the following :

Chest X-ray
CT (computed tomography) scan
PET (positron emission tomography) scan
MRI (magnetic resonance imaging)
Ultrasound

Blood tests to stage Hodgkin lymphoma

Blood tests to stage Hodgkin lymphoma may include:

Complete blood count (CBC)
Comprehensive metabolic panel

Bone marrow aspiration and biopsy

After numbing the area so there is no pain, a physician uses a hollow needle to take a sample of marrow (bone marrow aspiration) and a small piece of bone (bone marrow biopsy). A pathologist checks these samples for signs of cancer.

Other tests you might need

If you have lymphoma, you may need more tests to identify the type. These can include:

An immunohistochemistry study
Immunophenotyping, or flow cytometry
Cytogenetic analysis

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Immunophenotyping A process that uses antibodies to identify cells based on the types of antigens (markers) on the surface of the cells. A process that uses antibodies to identify cells based on the types of antigens (markers) on the surface of the cells. This process is used in basic research and to help diagnose diseases, such as specific types of leukemia and lymphoma. Immunophenotyping may also be used to separate cells into different groups based on the markers they have on the surface. Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Resources for patients and caregivers

Here are tips about how to prepare for your first appointment at Fred Hutch and what to bring.

Preparing for Your First Visit

Resources for New Patients

Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support during a first visit.

Caregiving at the first appointment

As a caregiver, you can give your loved one both emotional and practical support for their first appointment. Ask them if you can help with things like these:

Helping them manage their stress, worry or other feelings.
Planning how to get to and from the appointment, what time to leave home and where to park.
Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care (PDF) has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered.
Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes.

Resources for Caregivers

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.

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