NSHL is the most common type of Hodgkin’s lymphoma and mostly affects children and young adults. It’s highly curable with prompt treatment, so recognizing the symptoms can be important.

Hodgkin’s lymphoma (HL) is a cancer of the white blood cells that begins in your lymph nodes. There are two main forms of this cancer: classical and nodular lymphocyte-predominant. Classical HL is far more common and is further divided into multiple subtypes.

About 70% of people with HL have a classical subtype called nodular sclerosis Hodgkin’s lymphoma (NSHL). NSHL is the most common form of HL.

NSHL tends to affect teens and young adults. Most people with NSHL receive a diagnosis between the ages of 15 and 34 years.

A lymphoma diagnosis is serious and requires urgent treatment. But NSHL is highly curable and tends to have a more favorable outlook and better survival rates than other forms of HL.

The most common symptom of NSHL is painless swelling of your lymph nodes, often in your neck, chest, and underarms. A mediastinal lymphoid mass is present in 80% of people with NSHL.

About 40% of people with NSHL also experience B symptoms, such as:

  • unexplained fevers
  • drenching night sweats
  • unintended weight loss of more than 10% of your body weight

Other possible symptoms include:

  • fatigue
  • chronic itching
  • persistent cough or shortness of breath
  • decreased appetite
  • abdominal pain, swelling, or fullness
  • pain in your lymph nodes after drinking alcohol

A doctor will begin by talking with you and examining you. If they suspect lymphoma, the doctor might order:

If you’ve received an NSHL diagnosis, hematologists and oncologists (experts in blood disorders and cancer) will direct your staging and treatment.

Staging HL helps doctors determine your best initial treatment.

  • Stage 1 disease is found in only one lymph node area or lymphoid organ, such as your thymus.
  • Stage 2 disease is present in two or more lymph node areas on the same side of your diaphragm (above or below) or extends locally from a single affected lymph node area into a nearby organ.
  • Stage 3 disease is found in lymph node areas both above and below your diaphragm.
  • Stage 4 disease is widespread and involves one or more organs outside your lymphatic system, such as your liver and lungs.

Doctors add letters to the stage to provide additional context:

  • A” or “B” indicates the absence or presence of B symptoms (fever, night sweats, weight loss).
  • “X” indicates a larger, bulky tumor.
  • “E” indicates early stage, otherwise limited disease that affects an organ outside your lymphatic system.

Is nodular sclerosis Hodgkin’s lymphoma curable?

With standard treatment, up to 90% of cases of newly diagnosed early stage Hodgkin’s lymphoma (HL) can be cured. NSHL tends to have a better outlook than other types of classical HL.

According to the National Cancer Institute, 5-year relative survival rates for those with distant spread of HL are also quite good, averaging more than 80%.

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Recommended treatment for HL depends on the specific features of your disease.

Initial treatment often involves chemotherapy and radiation therapy.

Your doctor might also recommend options such as targeted immunotherapy drugs. In some cases, they may offer autologous stem cell transplantation.

Effective treatments are available for all stages of NSHL, including for relapses of the disease.

Clinical trials are ongoing.

Survival rates in NSHL are generally quite high. Most people respond well to initial treatment, though side effects can be challenging. You’ll need plenty of support during chemotherapy and radiation.

Overall, 10–30% of people with HL will experience a relapse. Most of these relapses happen within the first 5 years after diagnosis, but relapse is possible as much as 20 years after treatment. High dose chemotherapy followed by stem cell transplant can still be curative in many relapsed cases.

Because NSHL diagnoses frequently occur in young people, long-term monitoring for both disease recurrence and treatment-related negative effects is necessary.

Long-term complications of chemotherapy and radiation can include:

Resources for support

Receiving a cancer diagnosis can feel scary, overwhelming, and isolating.

If you or your child has received a Hodgkin’s lymphoma diagnosis, know that you’re not alone! Many resources are available to support you and your family during this challenging time.

Check in with your cancer treatment team about local support groups. Ask about multidisciplinary resources that are available within your treatment program, such as child life specialists, social workers, mentors, psychologists, or counselors.

Additional resources include:

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NSHL begins when the DNA in one of your lymphocyte white blood cells mutates, causing it to become a cancerous lymphoma cell.

The cancerous cell reproduces uncontrollably, causing inflammation and crowding out healthy white blood cells in your lymph nodes or other lymphoid tissues.

In classical HL, the cancerous cells seen under the microscope are called Reed-Sternberg cells. In NSHL, they appear in a partially nodular growth pattern with fibrous sclerotic (thickened) bands, giving the disease its name.

The exact cause of a lymphocyte’s transformation to an HL cell is unknown. But doctors have identified several genetic and environmental risk factors that can increase your likelihood of developing HL.

Factors that can increase your risk of developing NSHL include:

  • Epstein-Barr virus (EBV) infection: EBV is quite common and causes mononucleosis. EBV may increase your risk of HL, but the risk is still very low — about 1 in 1,000.
  • Younger age: HL peaks in adolescence and early adulthood. It’s the most common cancer in teens 15–19 years old. There is a second incidence peak after 55 years of age.
  • Family history: Having a parent or sibling with HL increases your risk of developing it.
  • A weakened immune system: Immunosuppressant medications and infections such as HIV can increase your risk.

While HL is generally more common in males, sex does not seem to play a role in NSHL risk.

NSHL is the most common subtype of Hodgkin’s lymphoma, representing about two-thirds of all diagnoses. NSHL tends to have a favorable outlook and a good response to treatment.

Treatment for newly diagnosed NSHL usually involves chemotherapy and radiation. NSHL is highly curable, with 5-year survival rates of up to 90% or even higher. Effective treatments are also available for widespread or recurrent NSHL.

Because NSHL often affects young people, long-term monitoring for disease recurrences and treatment-related negative effects is especially crucial. Your expert oncology team can help develop the best treatment and monitoring plan to maximize a healthy future.