What is Hodgkin lymphoma (Hodgkin disease)?

Hodgkin lymphoma in New Zealand

Hodgkin lymphoma (Hodgkin disease) usually begins when white blood cells called B lymphocytes develop in your lymph nodes and spread to other parts of the body.

While Hodgkin lymphoma is considered a rare cancer, around 120 people in New Zealand are diagnosed with it each year.

It’s one of the most treatable forms of cancer, and survival rates are high. With modern therapies, many people are cured and go on to live full, healthy lives.

Insurance can make a huge difference when facing a serious diagnosis. If you want peace of mind while you focus on your health and recovery, talk to Policywise today. Our team is ready to help you understand your options and find a plan that fits.

Hodgkin lymphoma vs non-Hodgkin lymphoma

The defining feature of Hodgkin lymphoma is the presence of cancer cells called Reed-Sternberg cells, which are absent in non-Hodgkin lymphoma.

Non-Hodgkin lymphoma is more common and includes a wider range of subtypes, from a broad and diverse group, arising from either B cells or T cells. Hodgkin lymphoma is comparatively rare and more uniform in its behaviour.

Types of Hodgkin lymphoma

Hodgkin lymphoma is divided into two main groups: classical Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant B-cell lymphoma (NLPBL).

The most common type of classical Hodgkin lymphoma is nodular sclerosis, which mainly impacts young adults. Other types include mixed cellularity, lymphocyte-rich, and lymphocyte-depleted. Each has its own pattern and may affect different age groups.

1. Classical Hodgkin lymphoma (CHL): For this type, the lymph nodes contain large cancerous cells called Reed-Sternberg cells.

CHL is further divided into four main subtypes:

• Nodular sclerosis classical Hodgkin lymphoma: Most common, often found in young adults (especially women). Usually affects the neck or chest lymph nodes, which may have scar-like tissue.

• Mixed cellularity classical Hodgkin lymphoma: More common in people over 60, often involves several lymph node groups, and sometimes appears in the abdomen.
• Lymphocyte-rich classical Hodgkin lymphoma: Rare, and more frequent in men. Contains many healthy lymphocytes and few Reed-Sternberg cells, making it harder to diagnose but often has a good outlook.
• Lymphocyte-depleted classical Hodgkin lymphoma: Lymphocyte-depleted CHL—the rarest type, usually in older adults or those with HIV/AIDS, with dense tissue and fewer healthy lymphocytes.

2. Nodular lymphocyte-predominant B-cell lymphoma (NLPBL): This is a rare form that tends to grow more slowly than classical Hodgkin lymphoma. It often appears as painless, swollen lymph nodes. Under the microscope, the cancer cells look different from those in classical Hodgkin lymphoma and are sometimes called “popcorn cells” because of their shape.

It is usually found at an early stage and may be treated successfully, sometimes with less intensive treatment than the classical type.

Causes of Hodgkin lymphoma

There is no clear reason why some people develop Hodgkin lymphoma.

The disease starts with changes to your immune cells. These cells help fight infections, but when they change (mutate), they grow quickly and don’t die as they should. This leads to a build-up of abnormal cells (Reed-Sternberg cells) in the lymph nodes, attracting healthy immune cells that actually help the cancer grow and spread.

Some factors may slightly increase your risk of developing Hodgkin lymphoma. These include having a weakened immune system, previous infections, like Epstein-Barr virus (EBV), or exposure to high levels of radiation or certain chemicals.

Hodgkin lymphoma symptoms

The most common symptom of Hodgkin lymphoma is a swelling in your neck, armpit, or groin. This is caused by a build-up of abnormal white blood cells in your lymph nodes. These lumps often feel firm but don’t usually hurt.

It's worth remembering that a swollen lymph node is much more likely to be caused by an infection than by cancer. Get it checked if it doesn’t go away.

Many people with Hodgkin lymphoma experience what are known as B symptoms. These include:

• Unexplained weight loss
• Drenching night sweats
• Fever that comes and goes.

You may also notice:

• Ongoing tiredness or extreme fatigue
• Itchy skin, sometimes with a rash
• Loss of appetite
• A persistent cough or breathlessness
• Chest pain or discomfort
• Abdominal pain or a feeling of fullness.

Some people have Hodgkin lymphoma in their bone marrow. This can lead to:

• Anaemia (feeling tired or dizzy)
• Frequent infections
• Easy bruising or bleeding, like nosebleeds or bleeding gums
• Pinpoint spots of blood under your skin.

These signs can be quite general and might be attributed to more common conditions.

But if you notice any combination, see your GP. The sooner Hodgkin lymphoma is diagnosed, the easier it is to treat.

How is it diagnosed?

The first step is a visit to your GP. They’ll ask questions about your overall health, symptoms, and risk factors.

They will also check for swollen lymph nodes, particularly in your neck, armpits, or groin. Your doctor might order blood tests to rule out infection or other conditions.

If your symptoms continue, you’ll likely be referred to a hospital for more tests.

The most important test is a biopsy. This means removing part or all of a swollen lymph node, which is then examined under a microscope to look for cancerous cells. Most commonly, an excisional biopsy is performed, where a whole lymph node is removed. Sometimes, a needle biopsy is used, but it may not give enough information on its own.

You might also have:

• A CT scan or MRI to take detailed pictures inside your body
• A PET scan to see how active the cancer is
• Some people may also need a chest X-ray or a lumbar puncture to check the brain or spine.

Staging and classification

After you've been diagnosed with Hodgkin lymphoma, your doctor will carry out tests to find out how far the cancer has spread. This process is called staging.

Knowing the stage helps your medical team decide on the best treatment and gives an idea of how the cancer might behave. The most common staging system is the Lugano classification. It puts Hodgkin lymphoma into four stages:

• Stage I – The cancer is in one group of lymph nodes or in a single area of one organ.
• Stage II – Two or more lymph node groups are affected, but only on one side of your diaphragm (the muscle between your chest and tummy).
• Stage III – Lymph nodes on both sides of the diaphragm are involved. It may also affect your spleen.
• Stage IV – The cancer has spread beyond the lymph nodes to other organs like the liver, lungs, or bone marrow.

Each stage may also be labelled A or B:

• A means you don’t have additional symptoms.
• B means you have symptoms like fever, night sweats, or weight loss. These often mean the cancer is more active.

Another term you might hear is “bulky disease.” This refers to large tumours, especially in the chest. It can affect the type of treatment you need.

Your staging results are based on scans, biopsies, and blood tests, and your doctor will walk you through what they mean for your care.

Hodgkin lymphoma treatment options

Your treatment plan will depend on the stage of the cancer, your overall health, and whether your lymphoma is recurrent. Here are the main options:

Chemotherapy

Generally, the first line of treatment. Anti-cancer drugs are used to kill lymphoma cells or stop them from dividing. Most people receive chemotherapy intravenously (IV). Sometimes, tablets are also used.

Chemotherapy is often given in cycles over several months. You’ll usually go to a hospital or clinic for your treatment, but you can go home the same day. If side effects become severe, a hospital stay might be needed.

Side effects can include tiredness, nausea, hair loss, infections, and a drop in blood cells, which can cause bruising or breathlessness. Most side effects improve after treatment ends.

If chemotherapy is not effective or the cancer returns, a stronger round of chemotherapy may be offered, followed by a stem cell transplant to rebuild your bone marrow.

Radiotherapy

Radiotherapy uses targeted beams of energy to kill cancer cells. It’s often used alongside chemotherapy for early-stage Hodgkin lymphoma.

It's painless but can cause fatigue, sore skin, or nausea, depending on the treatment area. Long-term side effects, like infertility, are also possible, so always ask your doctor what to expect.

Steroids

Steroid medicines are sometimes used with chemotherapy to make the treatment more intensive. They’re given through a drip and can cause side effects like weight gain, indigestion, or sleep problems. These usually go away once treatment ends.

Targeted therapy and immunotherapy

If standard treatments don’t work, newer options like biological therapies may help. These medicines target cancer cells or boost your immune system to fight the lymphoma. They’re usually given as an infusion.

While treatment focuses on getting you well, it can also bring unexpected financial pressures, from time off work, specialist visits, and extra scans to advanced therapies not always covered publicly. Having the right insurance can make a real difference.

How insurance can help

While New Zealand’s public health system offers free or lower-cost care, wait times can be long, and some advanced treatments or non-Pharmac-funded drugs may only be available privately. Health insurance can help you access timely care and broaden your treatment options.

Health insurance

• Covers private hospital treatments, specialist consultations, diagnostic scans, cover for cancer, and non-Pharmac-funded drugs
• Offers faster access to diagnostic tests and treatment, avoiding delays in the public system.

Trauma (critical illness) insurance

• Pays a lump sum upon diagnosis of a serious illness, including other types of cancers
• Funds can be used for private healthcare, household expenses, or replacing lost income if you or a caregiver must take time off work.

Trusted insurance brokers, like Policywise, compare providers and find cover that fits your budget so you can focus on your recovery, not the bills. You can talk to one of our advisers as early as today.

Risk factors for Hodgkin lymphoma

Hodgkin lymphoma can affect anyone, but some people may be more at risk than others.

Age is one of the biggest risk factors. Hodgkin lymphoma is most often diagnosed in people in their 20s and 30s, and again in those over 65.

Sex also plays a role. Men are slightly more likely to get Hodgkin lymphoma, except for the nodular sclerosis classical Hodgkin lymphoma type, which is more common in women.

Here’s the incidence rate for Hodgkin lymphoma by gender:

Source: Figure NZ

A family history of Hodgkin lymphoma can potentially raise your risk, especially if you have a sibling or parent with the condition.

Certain viral infections, like Epstein-Barr virus (which causes glandular fever) or HIV, can increase your risk.

People with weakened immune systems, such as those taking anti-rejection medication after an organ transplant, may also be more likely to develop Hodgkin lymphoma.

Having one or more of these factors doesn’t mean you’ll get cancer, and many people who do have no clear risk factors at all.

Hodgkin lymphoma survival rates

With early diagnosis and the right care, Hodgkin lymphoma can be treated successfully and is one of the most curable forms of blood cancer. In New Zealand, survival outcomes are encouraging, with the Cancer Control Agency’s February 2025 study highlighting a general 80% five-year survival rate. Globally, the five‑year relative survival rate is around 89%.

Your outlook will depend on things like your age, the stage of your cancer, your general health, and how well your body responds to treatment.

Hodgkin lymphoma and pregnancy

While rare, Hodgkin lymphoma can occur during pregnancy and needs careful planning to protect both mother and baby.

Treatment decisions depend on the stage of the cancer, symptoms, and how far along the pregnancy is. If possible, treatment is delayed until after the first trimester to reduce risks to the baby. Some women with early-stage, slow-growing disease can wait until after delivery to start treatment.

When treatment is needed during pregnancy, chemotherapy—often the ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) combination—can be given safely in the second and third trimesters. Radiation is generally avoided, but if deemed necessary, is delayed until later in pregnancy and carefully shielded.

Care is managed by a multidisciplinary team, and most women go on to deliver healthy babies while receiving effective treatment for Hodgkin lymphoma.

Living with Hodgkin lymphoma

A diagnosis of Hodgkin lymphoma can change many aspects of your life. Treatment often works well, but the journey can still feel challenging—physically, mentally, and emotionally.

Look after your body

Both Hodgkin lymphoma and its treatments can cause fatigue. Rest when you need to, and don’t feel guilty about it. Eating balanced meals can help keep your strength up and support your immune system. Gentle exercise, like walking or stretching, can lift your mood and reduce stress.

Take care of your mind

It’s normal to feel worried about the treatment outcome or the cancer returning. Talk to your medical team if anxiety is affecting you. They can give you honest, personalised information. You may also find support groups or counselling helpful.

Manage day-to-day life

You might need to adjust your work, study, or social commitments during treatment and recovery. Keep a calendar for appointments, and plan enjoyable activities on your good days. Accept offers of help from friends and family.

Stay connected

Talking openly with loved ones can strengthen relationships and help you feel supported. If friends or family don’t know how to respond, let them know what you need: whether that’s practical help, a listening ear, or space.

Follow-up care

After treatment, you’ll have regular check-ups to monitor your health. These visits are important for catching any changes early. Over time, you’ll find a routine that works for you.

The key is to be patient with yourself. Recovery is all about your body, finding your new normal and regaining confidence in everyday life.

How Policywise can support you through Hodgkin lymphoma

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