How is Hodgkin disease diagnosed?
Most people with Hodgkin disease see their doctor because they have felt a lump that hasn’t gone away, they have some of the other symptoms listed below, or they just don’t feel well and go in for a checkup.
If a person has signs or symptoms that suggest Hodgkin disease, exams and tests are done to find out for sure and, if so, to determine the exact type.
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. Although it doesn’t usually hurt, the area may become painful after you drink alcohol. The lump may become more noticeable over time. There may even be several areas of enlarged lymph nodes.
But Hodgkin disease is not the most common cause of lymph node swelling. Most enlarged lymph nodes, especially in children, are caused by an infection. If this is the case, the node should return to its normal size a couple of weeks or months after the infection goes away.
Other cancers can also cause swollen lymph nodes. If you have an enlarged lymph node, especially if you haven’t had a recent infection, it is best to see your doctor so that the cause can be found and treated without delay, if needed.
General (non-specific) symptoms
Some people with Hodgkin disease have what are known as B symptoms:
- Fever (which can come and go over several days or weeks)
- Drenching night sweats
- Weight loss without trying (at least 10% of body weight over 6 months)
These symptoms can help find Hodgkin disease, but they are also important in determining the stage and prognosis (outlook) if Hodgkin disease is found (see “How is Hodgkin disease staged?”).
Other possible symptoms of Hodgkin disease include:
- Itching skin
- Loss of appetite
Sometimes the only symptom may be being tired all the time.
Cough, trouble breathing, chest pain
If Hodgkin disease affects lymph nodes inside the chest, the swelling of these nodes may press on the windpipe (trachea) and make you cough or even have trouble breathing, especially when lying down. Some people may have pain behind the breast bone.
Having one or more of the symptoms above does not mean you have Hodgkin disease. In fact, many of these symptoms are more likely to be caused by other conditions, such as an infection. Still, if you or your child has any of these symptoms, it is very important to have them checked by a doctor so that the cause can be found and treated, if needed.
Medical history and physical exam
If the symptoms suggest you or your child might have Hodgkin disease, your doctor will want to get a thorough medical history, including information about symptoms, possible risk factors, family history, and other medical conditions.
Next, the doctor will do a physical exam, paying special attention to the lymph nodes and other areas of the body that may be involved, including the spleen and liver. 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 any swollen lymph nodes.
The doctor also might order blood tests to look for signs of infection or other problems. If the doctor suspects that Hodgkin disease may be causing the symptoms, he or she will recommend a biopsy of the area.
Many of the symptoms of Hodgkin disease are actually more likely to be caused by non-cancerous problems or by other kinds of cancers. For example, enlarged lymph nodes are more often caused by infections than by Hodgkin disease. Because of this, doctors often wait a few weeks to see if they shrink on their own as the infection goes away. Antibiotics may also be prescribed to see if they cause the nodes to shrink.
If the nodes don’t shrink or continue to grow, either a small piece of a node or, more commonly, the entire node is removed to be looked at under the microscope and for other lab tests. This procedure, called a biopsy, is needed to be sure of the diagnosis. If it is Hodgkin disease, the biopsy can also tell what type it is.
Types of biopsies
There are different types of biopsy methods, and doctors choose one based on your situation.
Excisional or incisional biopsy: This is the preferred and most common type of biopsy for an enlarged lymph node. The doctor uses surgical tools to cut through the skin and remove the tumor or lymph node. If the doctor removes the entire lymph node, it is called an excisional biopsy. If a small part of a larger tumor or node is removed, it is called an 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 sedated or 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) or core needle biopsy: In an FNA biopsy, the doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of fluid and tiny bits of tissue from a lymph node or an organ in the body. For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.
If the enlarged node is near the surface of the body, the doctor can aim the needle while feeling the node. If a tumor is deep inside the body, the doctor can guide the needle using a computed tomography (CT) scan or ultrasound (see discussion of imaging tests in “How is Hodgkin disease staged?”).
A needle biopsy does not require an incision, but in many cases it might not remove enough of a sample to diagnose Hodgkin disease (or to determine which type it is). Most doctors do not use needle biopsies (especially FNA biopsies) to diagnose Hodgkin disease. But 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), a needle biopsy might be the first type of biopsy done. An excisional biopsy may still be needed to diagnose Hodgkin disease, even after a needle biopsy has been done.
After Hodgkin disease has been diagnosed, needle biopsies are sometimes used to check areas in other parts of the body that might be Hodgkin disease spreading or coming back after treatment.
Bone marrow aspiration and biopsy: These tests are not used to diagnose Hodgkin disease, but they may be done after the diagnosis is made to see if Hodgkin disease is in the bone marrow. They are described in more detail in the section, “How is Hodgkin disease staged?”
Lab tests of biopsy samples
All biopsy samples are looked at under a microscope by a pathologist (a doctor specially trained to recognize cancer cells), who looks at the size and shape of the cells and determines if any of them are Reed-Sternberg cells. The pathologist also looks at how the cells are arranged, which could point to the type of Hodgkin disease.
Because diagnosing Hodgkin disease can be tricky, it helps if the pathologist specializes in diseases of the blood. Sometimes the first biopsy does not give a definite answer and more biopsies are needed.
Immunohistochemistry: Looking at the samples under the microscope is often enough to diagnose Hodgkin disease (and what type it is), but sometimes further tests are needed. Special stains of the specimen can spot certain proteins, such as CD15 and CD30, on the surface of the Reed-Sternberg cells. These are typically found in classic Hodgkin disease. Tests for other proteins may point to nodular lymphocyte predominant Hodgkin disease, to non-Hodgkin lymphoma rather than Hodgkin disease, or to other diseases entirely.
Last Medical Review: 12/10/2012
Last Revised: 02/07/2014