How is Hodgkin disease found?
There are no screening tests advised to look for Hodgkin disease in people who have no symptoms. Most people with Hodgkin disease see a doctor because they have felt a lump that hasn’t gone away or they just don’t feel well and go in for a checkup. They may have a swollen lymph node in the neck, arm pit, or groin area. Sometimes it will go away only to come back. Over time, it doesn’t go away, and while it doesn’t hurt, it will get bigger and cause the person to go to the doctor.
Enlarged lymph nodes, especially in children, are more often caused by an infection or other illness – not cancer. Still, if you (or your child) have enlarged lymph nodes and no recent infection, it is best to have them checked by the doctor.
Signs and symptoms of Hodgkin disease
You or your child can have Hodgkin disease and feel perfectly well. But there are some symptoms that this disease may cause.
Lumps under the skin
You may notice a lump in the neck, under the arm, or in the groin. Sometimes it goes away, only to come back. Most often it doesn’t hurt, although it may become painful after you drink alcohol. It may finally not go away and cause you to see a doctor.
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
Itching, tiredness, and poor appetite are other symptoms that may occur. Sometimes the only symptom may be feeling tired all the time. But infections, other types of cancer, or other problems can also cause these symptoms.
Cough, trouble breathing, chest pain
If Hodgkin disease affects lymph nodes inside the chest, the swelling of these nodes may press on the windpipe. This can make you cough or even have trouble breathing, especially when lying down.
If you (or your child) have any of these symptoms, see a doctor right away. 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 things such as an infection. But the sooner the cause is found, the sooner treatment can be started and the better the treatment is likely to work.
Medical history and physical exam
If symptoms suggest that you or your child might have Hodgkin disease, the doctor will ask you questions about your health, including how long you have had the symptoms.
The doctor will do a physical exam. During the exam, the doctor will pay special attention to the lymph nodes. Because it is common for people, especially children, to have swollen lymph nodes, the doctor will look for infection. The doctor also might order blood tests to look for signs of infection or other problems. If the doctor thinks that Hodgkin disease might be causing the symptoms, he or she will want to do a biopsy.
Because swollen lymph nodes are more often caused by infections rather than by Hodgkin disease, doctors often wait a few weeks to see if they stay swollen. Sometimes they give an antibiotic to see if it helps the nodes to shrink. If not, a biopsy will be done.
A biopsy involves removing a lymph node (or a piece of one) and looking at it under a microscope. This is the only way to know for sure if the swelling is caused by cancer. There are many different kinds of biopsies, and the doctor will choose the one best suited for you or your child. The goal is to get enough tissue to be sure of the diagnosis and, if it is Hodgkin disease, to tell what type it is.
Types of biopsies
Excisional or incisional biopsy: This is the most common type of biopsy for a swollen lymph node. An excisional biopsy involves cutting through the skin to take out a whole lymph node. When only a small part of a larger tumor or node is taken out it is called an incisional biopsy.
If the node is near the skin surface, this is fairly simple and can sometimes be done with numbing medicine (local anesthesia). But if the node is inside the chest or belly (abdomen), patients are given medicine to make them relaxed and sleepy, or general anesthesia (where they are in a deep sleep).
Needle biopsies: In another type of biopsy, called a fine needle aspiration (FNA), the doctor uses a very thin, hollow needle to take out a small amount of fluid and tiny bits of tissue from the tumor. For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.
In many cases a needle biopsy cannot get enough of a sample to make a firm diagnosis. Most doctors will use needle biopsies in patients already known to have Hodgkin disease to see whether a swollen lymph node or organ in a different place also contains lymphoma.
Bone marrow aspiration and biopsy: These tests are not used to find Hodgkin disease. But in some cases they may be done after the disease is found to see if it is in the bone marrow. They are described in more detail in the section, “Staging for Hodgkin disease.”
Lab tests of biopsy samples
A doctor (called a pathologist) with special training in blood and lymph tissue disease looks at all biopsy samples under a microscope. The doctor checks how they look, as well as the size and shape of the cells in the sample. The doctor looks for special cells known as Reed-Sternberg cells, which are found in Hodgkin disease.
Looking at the tissue under the microscope can often tell whether you have Hodgkin disease and what type it is, but sometimes special stains and tests are used on the sample to get more information. Sometimes the first biopsy does not give a clear answer and more biopsies are needed.
Last Medical Review: 02/05/2013
Last Revised: 02/07/2014