Symptoms, Diagnosis & Risk Factors

Symptoms

The symptoms of Hodgkin’s lymphoma can be caused by other non-cancer conditions. So it’s important to see a doctor if you have symptoms that concern you, such as:

• Painless swollen lymph nodes in the neck, underarm, groin, chest or abdomen
• Unexplained fever, weight loss or night sweats—sometimes called “B symptoms”
• Ongoing fatigue
• Itchy skin
• Swelling in the face, neck or upper chest, caused by lymphoma pressing on the major vein that drains blood from these areas
• Feeling of fullness in the abdomen from an enlarged liver, spleen or lymph nodes
• Abdominal problems, such as nausea, vomiting and indigestion
• Sensitivity to alcohol or pain in the lymph nodes after having alcohol
• Coughing, trouble breathing or chest pain

For Hodgkin’s lymphoma, there is usually a longer, slower onset of lymph-node symptoms, compared to non-Hodgkin’s lymphoma. For instance, a person may have some swelling for as long as a year before diagnosis.

Diagnosis 

Your doctor will do a physical exam first to look for signs of lymphoma. The doctor will also ask about your health history.

If the doctor thinks that you may have lymphoma, the doctor will probably perform a biopsy next to confirm the diagnosis. To perform a biopsy, a doctor removes a small sample of tissue to examine under a microscope. This may mean removing part or all of a lymph node or some tissue by surgery.

Another method is to take a sample of fluid or tissue using a needle, called needle biopsy or fine-needle aspiration. This type of biopsy may be done to check the bone marrow or the fluid around the lungs (pleural fluid) or in the membrane around the abdominal organs (peritoneal fluid).

Your doctor may also want you to have imaging studies, such as a chest X-ray, magnetic resonance imaging (MRI), computed tomography (CT) scan or positron emission tomography (PET) scan, to see pictures of the inside of your body. This allows the doctor to look for enlarged lymph nodes, tumors or areas of cancer activity.

Doctors may do further tests to detect whether the cancer has spread around the lymph system or to other areas. This helps your doctor determine the stage of your cancer, which will be important when it’s time to make decisions about your treatment. You may need these or other tests:

• Complete blood count, or CBC: to determine how many cells of each type are circulating in the blood stream
• Blood chemistry analysis: to look for chemicals in the blood that indicate disease in certain organs or tissues
• Bone-marrow test: to see if the lymphoma has spread to the bone marrow

Staging

Staging refers to the way doctors classify lymphoma based on where it is in the body. People who have lymphoma are considered to be at one of these stages:

• Stage I: This stage applies to those who have lymphoma in only one lymph-node area or one organ.
• Stage II: This stage applies to those who have lymphoma in two or three lymph-node areas near each other, such as all in the neck and chest.
• Stage III: This stage applies to those who have lymphoma in several lymph-node areas in the neck, chest and abdomen.
• Stage IV: This stage applies to those who have widespread lymphoma in their lymph nodes and other organs, such as the bone marrow, lungs or liver.

Doctors may add a letter after your stage to describe more about your disease. In Hodgkin’s lymphoma, doctors use the letters A and B to describe whether you have symptoms:

• A (such as “stage IA”) means you do not have symptoms.
• B (such as “stage IB”) means you have the B symptoms: fever, weight loss or night sweats.

Risk Factors

Doctors do no know what causes Hodgkin’s lymphoma. However, doctors and researchers have found some risk factors that are associated with Hodgkin’s disease.

Keep in mind that most people who get the disease have none of the risk factors. And most people with the risk factors do not develop the disease.

Sex and age are two of the risk factors. The disease is more common in men than in women, and more common in people ages 15 to 35 and over the age of 50.

Also, you may be at higher risk for Hodgkin’s lymphoma if any of these is true:

• Your immune system is weakened by an inherited disease, autoimmune disease, human immunodeficiency virus (HIV) or drugs given because you had an organ transplant.
• You have been infected with Epstein-Barr virus (which causes mononucleosis). 
• You have a brother or sister who has had Hodgkin’s disease.