Signs and Symptoms of Hodgkin Disease

You or your child can have Hodgkin disease and feel perfectly well. However, there are some symptoms that this disease may cause.

Lump(s) Under the Skin

You may notice a lump in the neck, under the arm, or in the groin, which is an enlarged lymph node. Sometimes this may go away, only to come back. Eventually, it may not go away, and although it doesn't hurt, it may become more noticeable and lead you to go to the doctor. There may even be several areas of enlarged lymph nodes.

But Hodgkin disease is not the most common cause of lymph node swelling. Most lymph node enlargement, especially in children, is caused by an infection. The node should return to its normal size within a couple of weeks or months after the infection goes away.

Other cancers can also cause lymph node swelling. If your lymph nodes have enlarged to more than an inch, especially if you haven't had a recent infection, it is best to have your doctor examine the lymph nodes so that any disease found can be treated without delay.

Generalized (non-specific) Symptoms

Some patients with Hodgkin disease have fever, drenching night sweats, or weight loss. The fever can come and go over several days or weeks. Itching, tiredness, and decreased appetite are other symptoms that may occur. Sometimes the only symptom may be being tired all the time. However, infections, other types of cancer, or other conditions can also produce these symptoms.

Cough or Trouble Breathing

When Hodgkin disease affects lymph nodes inside the chest, the swelling of these nodes may compress the windpipe (trachea) and make you cough or even have trouble breathing, especially when lying down.

If you or your child has any of these symptoms, discuss them with your doctor without delay. The sooner a correct diagnosis is made, the sooner treatment can be started and the more effective the treatment will be.

Medical History and Physical Exam

If symptoms suggest the possibility of Hodgkin disease, the doctor will want to get a thorough medical history, including how long the symptoms have been present.

Next, the doctor will perform a complete physical exam. This provides information about whether there are any enlarged lymph nodes and whether there is any sign of an infection that might be causing the symptoms. The doctor will pay special attention to the lymph nodes and will inspect other areas of the body that may be involved. Because infections are the most common cause of enlarged lymph nodes, especially in children, the doctor will look for an infection in the part of the body near the swollen lymph nodes. If the doctor suspects that Hodgkin disease may be causing the symptoms, he or she will recommend a biopsy of the area.

Biopsy Procedures to Diagnose Hodgkin Disease

The only way to know for sure whether Hodgkin disease is present is by removing a sample of the lymph node and looking at it under the microscope. This procedure is called a biopsy. The goal of a biopsy is to get enough of a sample to be sure of the diagnosis, as well as to identify the type of Hodgkin disease if it's present. There are different types of biopsy methods, and doctors choose one based on the unique aspects of your situation.

Excisional or Incisional Biopsy

This is the preferred and most commonly used procedure. After giving anesthesia, the doctor cuts through the skin to remove the entire lymph node (excisional biopsy) or a small part of a larger tumor or node (incisional biopsy). If the node is near the skin surface, this is a fairly simple operation that can sometimes be done with numbing medicine (local anesthesia). But if the node is inside the chest or abdomen, the patient is given general anesthesia (where he or she is in a deep sleep). This type of biopsy almost always provides enough of a tissue sample to make a diagnosis of the exact type of Hodgkin disease.

Fine Needle Aspiration (FNA) Biopsy

FNA involves using a thin needle attached to a syringe to withdraw (aspirate) a small amount of fluid and tiny bits of tissue from a lymph node or organ in the body. This procedure avoids the need for minor surgery. It is useful for some cancers, but the FNA often does not remove enough tissue for a reliable diagnosis of Hodgkin disease (or to determine the type of HD). If the doctor suspects that your lymph node swelling is caused by an infection or by the spread of cancer from another organ (such as the breast, lungs, or thyroid), FNA may be the first type of biopsy done. But an excisional biopsy may still be needed to diagnose Hodgkin disease properly, even after an FNA has been done.

Once Hodgkin disease has been diagnosed and treated, the FNA is sometimes used to check areas in other parts of the body that might represent Hodgkin disease spreading or coming back.

Lab Tests Used to Diagnose and Classify Hodgkin Disease

All biopsy specimens are looked at under a microscope by a doctor called a pathologist, who is specially trained to recognize changes in cells and tissues caused by cancer and other diseases. The doctor looks at the appearance, as well as the size and shape of the cells and determines whether any of them are Reed-Sternberg cells. Sometimes the first biopsy does not provide a definite answer and more biopsies are needed.

Looking at the tissue under the microscope can often reveal whether Hodgkin disease is the diagnosis (and what type it is), but sometimes testing called immunohistochemistry is needed. This consists of special stains of the specimen to look for the presence of certain proteins on the surface of the Reed-Sternberg cells, such as CD15 and CD30. These are typically found in the classical type of Hodgkin disease. Tests for other proteins may point to non-Hodgkin lymphoma rather than Hodgkin disease or to other diseases entirely.