Most people with Hodgkin disease see their doctor because they have felt a lump that hasn't gone away, they develop some of the other symptoms listed below, or they just don't feel well and go in for a checkup.

If signs or symptoms suggest that a patient may have Hodgkin disease, exams and tests are done to find out for certain if this disease is present 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 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 enlarged lymph nodes, especially in children, are 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 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 any disease found can be treated without delay.

Generalized (non-specific) symptoms

Some patients with Hodgkin disease have what are known as B symptoms:

• fever (which may come and go over several days or weeks)
• drenching night sweats
• unintentional weight loss (at least 10% of body weight over 6 months)

Itching skin, tiredness, and decreased appetite are other possible symptoms. Sometimes the only symptom may be being tired all the time. However, infections, other types of cancer, or other conditions can also cause these symptoms.

Cough, trouble breathing, chest pain

When 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.

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

Next, the doctor will do a complete 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 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 used to diagnose Hodgkin disease

Many of the symptoms of Hodgkin disease are not specific enough to say for certain if the disease is present. They can also be caused by non-cancerous problems or by other kinds of cancers.

As we stated before, 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 remain large. Sometimes they prescribe antibiotics to see if they cause the nodes to shrink.

If the nodes continue to grow or stay the same size, 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 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.

Types of biopsies

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 common type of biopsy for an enlarged lymph node. In this procedure, 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) or core needle biopsy: In an FNA biopsy, the doctor uses a very 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. For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.

For an enlarged node 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 later in this section).

A needle biopsy does not require surgery, but in many cases it may not remove enough of a sample to diagnose Hodgkin disease (or to determine the type of HD). Most doctors do not use needle biopsies (especially FNA biopsies) to make an initial diagnosis of HD. 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 may be the first type of biopsy done. Even then, an excisional biopsy may still be needed to diagnose Hodgkin disease properly, even after a needle biopsy has been done.

Once Hodgkin disease has been diagnosed, needle biopsies are sometimes used to check areas in other parts of the body that might represent Hodgkin disease spreading or coming back after treatment.

Bone marrow aspiration and biopsy: These tests are not used to diagnose Hodgkin disease, but in some cases they may be done after the diagnosis is made to see if the Hodgkin disease is in the bone marrow. They are described in more detail in the section, "How is Hodgkin disease staged?"

Lab tests used to diagnose and classify Hodgkin disease

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 may point to the type of Hodgkin disease. Because the diagnosis of Hodgkin disease can be tricky, it helps if the pathologist specializes in diseases of the blood. Sometimes the first biopsy does not provide a definite answer and more biopsies are needed.

Immunohistochemistry: Looking at the samples under the microscope can often reveal if the diagnosis is Hodgkin disease (and what type it is), but sometimes further testing is 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 the classic type of Hodgkin disease. Tests for other proteins may point to non-Hodgkin lymphoma rather than Hodgkin disease or to other diseases entirely.

Last Medical Review: 07/21/2009
Last Revised: 07/21/2009