There are no tests to find Hodgkin disease early, and some people with the disease have no symptoms at all. 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 check-up. 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 though it doesn't hurt, it will get bigger and cause the person to go to the doctor.

But in most people, especially children, enlarged lymph nodes are caused by an infection or other illness -- not cancer. Still, if you (or your child) have lymph nodes over an inch in size 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 lead you to see a doctor.

General 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
• weight loss, when you were not trying to lose weight

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 or trouble breathing: When 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 has any of these symptoms, see a doctor right away. The sooner a correct diagnosis is made, the sooner treatment can be started and the better the treatment will work.

Medical history and physical exam

If symptoms suggest that you might have Hodgkin disease, the doctor will ask you questions about your health, including how long you have had the symptoms, and to do a physical exam to see whether there is an infection. 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 first. If the doctor thinks that Hodgkin disease might be causing the symptoms, he or she will want to do a biopsy.

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 causes the nodes to shrink. If not, a biopsy will be done.

A biopsy involves removing a piece (sample) of the lymph node 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.

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 an entire lymph node. When only a small part of a large tumor or node is taken out 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 belly (abdomen), the patient is given general anesthesia (where he or she is put into a deep sleep).

Needle biopsy: In another type of biopsy, called a fine needle aspiration (FNA), the doctor uses a very thin 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 definite diagnosis. Most doctors will use needle biopsies in patients already known to have Hodgkin disease to see if a swollen lymph node or organ in a different place also contains lymphoma.

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 to see if the Hodgkin disease is in the bone marrow. They are described in more detail in the section, "After the tests: Staging."

Lab tests

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 to find out whether any of them are Reed-Sternberg cells. Sometimes the first biopsy does not give a clear answer and more biopsies are needed.

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. Your doctor may talk about these tests using names like flow cytometry, FISH, or PCR.

Last Medical Review: 08/06/2009
Last Revised: 08/06/2009