|
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
|