As many as 75 percent of Hodgkin's lymphoma patients are asymptomatic and experience no pain during the early stages of the disease.
Often, the first sign is a painless swelling in the lymph nodes, typically in the neck, underarm, collarbone region or the groin. Because lymph nodes are located throughout the lymphatic system, the cancerous cells found here can spread with relative ease from one lymph node to the next. Sometimes the cancer may spread to organs outside the lymphatic system.
Before Hodgkin's disease is suspected, patients with no apparent lymphoma symptoms commonly seek medical advice about "aches and pains" in the affected area. Sometimes, oddly enough, the complaints follow the consumption of alcohol.
Initial lymphoma symptoms may sometimes be confused with other illnesses and infections such as infectious mononucleosis, influenza, tuberculosis or other forms of lymphoma.
Generalized symptoms such as fever, night sweats and weight loss, sometimes called "B" symptoms, are particularly common in cases where the cancerous cells have spread extensively through the lymphatic system, liver and bone marrow.
As the disease progresses, the body slowly loses its ability to fight infection. The patient may experience an increase in infections due to the malfunctioning of white blood cells and a generally impaired immune system.
The signs and symptoms of HD include:
Instances of swollen lymph nodes, particularly in young children, are usually the result of minor infections such as the common cold or a flu-like virus. However, if the swelling persists longer than usual, further investigation is advisable.
HD is often diagnosed following a chest x-ray or imaging scan carried out for an unrelated health problem.
If Hodgkin's lymphoma is suspected, the oncologist or physician carries out a complete physical examination and obtains a medical history. The doctor asks about classic lymphoma symptoms such as weight loss, fever and night sweats, and looks for swollen lymph nodes, especially in the neck and chest area. The physician examines specific locations along the lymphatic system, looking closely at the size and firmness of any swollen lymph nodes and whether they are tender when palpated. In HD, the lymph nodes are usually firm, but mobile and non-tender.
A chest x-ray is routinely performed to look for enlarged lymph nodes in the mediastinum, the chest cavity between the lungs.
The next step is to perform a biopsy of an enlarged lymph node. This involves removing a small sample of lymphatic tissue for examination under a microscope.
When diagnosing Hodgkin's disease, the pathologist measures the size and shape of the tissue, analyzes its composition and looks for the presence of Reed-Sternberg (RS) cells. Specific cell surface markers on RS cells can be detected by monoclonal antibodies, which are useful tools in the diagnostic procedure.
Fine Needle Aspiration: A fine needle aspiration (FNA) involves inserting a very fine needle attached to a syringe into an enlarged lymph node. This method is best for lymph nodes that are near the surface of the skin. If the enlarged node is located deeper in the body, such as in the abdomen or thymus, the needle is guided by using a computed tomography (CT) scan or ultrasound.
FNA is useful for distinguishing between non-cancerous and malignant tissue and is sometimes used at the first level of diagnosis, or for monitoring recurrence of the disease. The main disadvantage of FNA is the limited size of the sample, and most centers still use a surgical biopsy for definitive diagnosis.
Surgical Biopsy: A surgical biopsy is performed under local or general anesthesia and allows the physician to obtain a larger tissue sample. Whole sections of tissue can be analyzed microscopically in thin sheets rather than in clumps of cells. This method allows the best means of achieving an accurate diagnosis of HD and facilitates typing of the disease.
Once Hodgkin's lymphoma has been diagnosed, the patient may have to undergo additional tests including:
American Cancer Society (updated 2005). What is Hodgkin's disease?
Beers, M. H.,
information on health-related topics, not medical advice, diagnosis or
treatment recommendations. Please consult your physician if you have questions