Delta Goodrem, Hodgkin Lymphoma, and a Diagnosis at 18

In her own words

Delta Goodrem has described the diagnosis herself on the website of the foundation she started. "At 18, my life changed forever when I was diagnosed with Hodgkin's Lymphoma and underwent treatment at St Vincent's Hospital in Sydney," she writes. She credits the doctors and nurses who cared for her, along with her family and community. That care, she writes, shaped a lasting commitment to giving back.

She established the Delta Goodrem Foundation in 2020. She has served as Patron of the Kinghorn Cancer Centre, and says that together with supporters she has helped raise more than 120 million dollars for St Vincent's programs since her diagnosis.

That is her account, and this article adds nothing to it. What follows is the medicine behind the diagnosis she received.

A cancer that peaks in young adults

Hodgkin lymphoma starts in the lymphatic system, the network of vessels and nodes that carries immune cells around the body. For 2026 the American Cancer Society projects 8,920 new cases and 1,100 deaths in the United States, the figures SEER carries on its stat page. NCI's PDQ summary still prints the 2025 projection of 8,720 and 1,150.

Its age pattern is unusual. Most cancers become steadily more common with age. Hodgkin lymphoma has two peaks, one in early adulthood between roughly 20 and 39, and a second after 65. Men are affected somewhat more often than women.

Under the microscope, classical Hodgkin lymphoma is defined by a distinctive giant cell called the Reed-Sternberg cell. Finding it is what separates this disease from the many other lymphomas. Classical disease has four patterns, named nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted.

A separate form is called nodular lymphocyte-predominant Hodgkin lymphoma. It arises from B cells and carries different surface markers. It behaves differently enough that NCI lists watchful waiting among its treatment options.

The lump that does not hurt

The usual first sign is a swollen lymph node that causes no pain, most often in the neck, the armpit, or the groin. Because it does not hurt, it is easy to dismiss.

Alongside it sits a specific trio that doctors call B symptoms, and NCI defines each precisely:

• Fever of 38 degrees Celsius, or 100.4 Fahrenheit, or higher, with no infection to explain it.
• Drenching night sweats, meaning sweats that soak nightclothes or bedding.
• Unexplained weight loss of more than 10 percent of body weight over six months.

Two other complaints are common. Itchy skin without a rash can precede the diagnosis. So can fatigue far out of proportion to activity.

When to get checked

Ask for an appointment if:

• A swollen node in the neck, armpit, or groin has been there for more than three or four weeks and is not shrinking, particularly if it is painless and firm.
• You have run a fever of 38 degrees Celsius or higher with no infection anyone can find.
• Night sweats have been soaking your bedclothes.
• You have lost more than a tenth of your body weight in six months without trying.
• Your skin itches persistently and there is no rash.
• Fatigue has been building for weeks and rest does not fix it.

There is no screening test for lymphoma, and NCI has no evidence-based screening or prevention summary for it. Symptoms are the whole route in. The reassuring counterweight is that swollen nodes are usually caused by infection, and the tests that settle the question are straightforward.

Making the diagnosis

Blood tests come first, including a complete blood count, blood chemistry, LDH, and an erythrocyte sedimentation rate. NCI also lists testing for hepatitis B, hepatitis C, and HIV, because those affect treatment planning.

Imaging is usually a PET-CT scan, which combines a metabolic scan with a CT scan to show where active disease sits. During pregnancy, MRI and ultrasound are used instead, to protect the fetus.

The diagnosis itself requires a lymph node biopsy. A pathologist looks for Reed-Sternberg cells and runs surface marker tests, since classical disease and the nodular lymphocyte-predominant form carry opposite marker patterns.

Staging and treatment

Staging follows the Lugano classification, which replaced the older Ann Arbor system. Stage I is one node group. Stage II is two or more groups on the same side of the diaphragm. Stage III involves nodes on both sides. Stage IV means disease has moved into organs outside the lymph system, such as liver, bone marrow, or lung.

Doctors then compress this into two groups. Limited stage means I and II. Advanced stage means III and IV. Limited disease is sorted further into early favorable and early unfavorable. A bulky mass in the chest counts as massive mediastinal disease when it measures 10 cm or more, or takes up at least a third of the chest width.

The backbone of treatment is combination chemotherapy. The usual regimen is ABVD, four drugs given together: doxorubicin, bleomycin, vinblastine, and dacarbazine. Radiation is sometimes added. A PET-CT scan after the first two cycles shows how well the disease is responding, and the plan is adjusted from there.

Newer options have widened the field. Brentuximab vedotin is a targeted antibody drug. Pembrolizumab and nivolumab are immune checkpoint inhibitors. Both are used in disease that returns, sometimes ahead of a stem cell transplant.

NCI states that up to 90 percent of all newly diagnosed patients can be cured with combination chemotherapy, radiation therapy, or both.

Why follow-up lasts for decades

High cure rates create a second problem, and NCI is candid about it. Treatment that works can cause harm many years later.

The figures are specific. The cumulative incidence of a second cancer reaches 13 percent at 15 years after treatment, 17 percent at 20 years, 22 percent at 25 years, and 48 percent at 40 years. Lung and breast cancers are the most common solid tumors. Heart disease risk from chest radiation and anthracycline chemotherapy persists for 30 years or more. Neck radiation can cause an underactive thyroid. About 20 percent of survivors report severe fatigue five years after therapy.

NCI puts the consequence plainly. By 15 to 20 years after treatment, deaths from second cancers, cardiovascular disease, or lung scarring exceed deaths from the lymphoma coming back.

That is why survivorship care here is lifelong. It is also why fertility is discussed before treatment starts rather than after. None of these percentages describes an individual. They describe groups treated with the regimens of past decades. Treatment has been deliberately scaled back over time to reduce exactly these harms.

Sources

• https://www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq
• https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq
• https://deltagoodremfoundation.org/about/
• https://www.cancer.org/research/cancer-facts-statistics.html
• https://seer.cancer.gov/statfacts/html/hodg.html