Shouldn’t “cured” mean you’ll stay healthy? Although Hodgkin lymphoma (formerly called Hodgkin’s disease) has a favorable prognosis and is considered one of the most curable types of cancer, people with the condition sometimes develop complications — new medical problems related to the disease.

Complications can significantly affect a person’s quality of life or overall health status — and they can even be life-threatening. In this article, we’ll discuss seven major medical complications related to Hodgkin lymphoma or lymphoma treatment. Getting monitored regularly and recognizing symptoms may help you get treatment early.

What Is a Complication?

Complications of Hodgkin lymphoma can be caused by the disease itself or by the therapies used to treat it, such as high-dose chemotherapy, radiation, or bone marrow transplant.

Complications can develop during treatment — or they can arise many years after a person has been diagnosed and treated, when they’re known as late effects. They can be long term, lasting for many years or even a person’s entire life. They may need their own specific treatment.

Complications of Hodgkin Lymphoma

Following are seven potential complications of Hodgkin lymphoma.

1. Second Cancers

Survivors of Hodgkin lymphoma are at an increased risk of developing new cancers later on in life. These are called “second cancers.” According to the American Cancer Society, second cancers associated with Hodgkin lymphoma include:

• Other blood cancers such as leukemia, myelodysplastic syndrome, or non-Hodgkin lymphoma
• Lung cancer
• Head and neck cancers, such as those of the lip, tongue, thyroid, or salivary glands
• Cancers of the gastrointestinal system, such as stomach, colon, liver, pancreas, or anal cancers
• Skin cancers such as melanoma or Kaposi’s sarcoma
• Bone cancer
• Soft tissue cancer
• Uterine cancer

2. Breast Cancer

Breast cancer is one of the second cancers that occur in Hodgkin lymphoma survivors. It tends to develop 10 to 15 years after treatment. Research has found that the incidence of breast cancer in female survivors of Hodgkin lymphoma aged 20 to 45 is 24 times greater than those who haven’t been treated for Hodgkin lymphoma.

Risk factors for secondary breast cancer include radiation therapy in the chest area and age at the time of radiotherapy. Women diagnosed with Hodgkin lymphoma prior to age 30 and treated with chest radiation therapy have the greatest risk, according to a study in Blood.

New lumps in the breast tissue and enlarged lymph nodes near the armpit are two potential symptoms of breast cancer. Be sure to schedule regular checks and mammograms as directed to help catch breast cancer early.

3. Thyroid Problems

People with Hodgkin lymphoma who’ve received radiation therapy in their neck or upper chest have a higher chance of developing thyroid problems. This includes hypothyroidism, or underactive thyroid. Symptoms of hypothyroidism include weight gain, hair loss, and dry skin.

If you ever received radiation treatment in your neck or upper chest, you should have your thyroid function checked at least once per year through blood tests, according to the American Cancer Society.

4. Infertility

Infertility (inability to conceive) is a known complication that affects more than 50 percent of people with Hodgkin lymphomas. Infertility may affect both sexes.

Research has shown that men diagnosed with Hodgkin lymphoma have impaired sperm at the time of diagnosis, according to research in Haematologica. This indicates that Hodgkin lymphoma itself likely affects fertility.

Treatments for Hodgkin lymphoma that can affect a person’s ability to have children include:

• Chemotherapy with medications known as alkylating agents
• Radiation therapy in the pelvic region
• Bone marrow transplants

Alkylating drugs work by damaging the DNA of cancer cells. However, they can also damage normal cells. Damage to sperm cells in males and egg cells in females can lead to infertility. People on treatment regimens that include the alkylating drug cyclophosphamide (Cytoxan) are at a further increased risk of infertility. This drug can lead to infertility in 90 percent to 100 percent of men and 5 percent to 25 percent of women, according to the Haematologica study.

Most people who undergo bone marrow transplants lose the ability to have children. This is due to the high-dose chemotherapy and radiation conditioning treatments that are done before the transplant. Being unable to become pregnant or to impregnate one’s partner after one year of trying is the primary symptom of infertility. Additionally, not getting one’s menstrual period may also be a symptom.

Young adults and parents of children and teens living Hodgkin lymphoma may be especially concerned about treatment-induced infertility. If you’re concerned, talk to your oncology health care team before initiating treatment. You can discuss cancer treatment options and ways to preserve fertility.

5. Cardiovascular Disease

Cardiovascular (heart) disease is a late-term complication of treatment for Hodgkin lymphoma. It may appear 10 or more years after treatment.

Heart disease is specifically linked to radiation therapy in the chest or neck and to chemotherapy drugs in the anthracycline class. Doxorubicin (Adriamycin) is an anthracycline drug that can cause heart problems. According to research in American Family Physician, your risk of heart disease due to doxorubicin is greater if you:

• Receive high-dose chemotherapy with this medicine
• Are female
• Take this medicine at a younger age

A 2021 research study published in the Journal of the National Cancer Institute found that 18 percent of Hodgkin lymphoma survivors died of heart disease. Heart failure, heart attack, and stroke are examples of heart diseases. This was a large-scale and long-term study of the cause of death in Hodgkin lymphoma. The study included over 4,000 people and followed them over long periods of time.

Be sure to alert your health care provider to any potential signs of heart problems, which can include:

• Angina (chest pain)
• Pressure, heaviness, or discomfort in your chest
• Dyspnea (shortness of breath)
• Extreme fatigue
• Dizziness
• Signs of blockages in your blood vessels, such as pain, sores, or swelling in your legs

6. Severe Infection

The Journal of the National Cancer Institute study found that infection was the cause of death in 3.2 percent of people with Hodgkin lymphoma.

Immune system problems are a key feature of Hodgkin lymphoma. In Hodgkin lymphoma, B cells of the immune system become dysfunctional and lose their ability to defend the body from infections. Herpes zoster (shingles), tuberculosis, and certain fungal infections are common complications of Hodgkin lymphoma. Moreover, Hodgkin lymphoma treatments such as radiotherapy and chemotherapy can further weaken the immune system. This adds to infection risk.

People whose treatment included radiation to the spleen or splenectomy (removal of the spleen) are also at increased risk for certain infections. The spleen is an organ located on the left side of the abdomen. It works as a part of the body’s immune system. Its jobs include fighting blood infections and controlling the amount of white blood cells and red blood cells in the body.

Spleen removal surgery used to be a common treatment for Hodgkin lymphoma, but it’s less common now. Hodgkin lymphoma survivors who underwent spleen removal are at increased risk for certain infections. In cases in which a splenectomy is absolutely necessary, your doctor will advise taking certain low-dose antibiotics to prevent you from catching an infection. These antibiotics are prescribed for a minimum of two years and may even be continued lifelong.

Fever and shortness of breath are two symptoms of infection.

Given the increased risk of severe infection, it’s important for people living with Hodgkin lymphoma to stay up to date on their vaccinations.

7. Transformation to a High-Grade Lymphoma

Hodgkin lymphoma generally has a good outcome, with a cure rate between 80 percent and 90 percent. However, a rare complication is possible in which Hodgkin lymphoma transforms to a high-grade non-Hodgkin lymphoma — most commonly diffuse large B-cell lymphoma. If this happens, the blood cancer becomes aggressive and difficult to treat. This transformation is seen more commonly in people whose Hodgkin lymphoma has affected their spleen.

Talk With Others Who Understand

On MyLymphomaTeam — the social network for people with lymphoma and their loved ones — more than 15,000 members come together to ask questions, give advice, and share their stories with others who understand life with lymphoma.

Have you experienced Hodgkin lymphoma complications? Share your experience, or post a comment on your Activities page to start a conversation.