Most Hodgkin’s lymphoma patients (as many as 75 percent) are asymptomatic and experience no pain during the early stages of the disease.Early Lymphoma Symptoms
Often, the first sign is a painless swelling in the lymph nodes, typically in the neck, underarms, collarbone region, or the groin. Because lymph nodes are located throughout the lymphatic system, the cancerous cells found here are able to spread with relative ease from one lymph node to the next. Sometimes the cancer may spread to organs outside the lymphatic system.
Before Hodgkin’s disease is suspected, it is not uncommon for patients with no apparent lymphoma symptoms to seek medical advice about “aches and pains” in the affected area, sometimes, oddly enough, following the consumption of alcohol.
Generalized Hodgkin’s Lymphoma Symptoms
Initial lymphoma symptoms may sometimes be confused with other illnesses and infections such as glandular fever (infectious mononucleosis), influenza, tuberculosis or other forms of lymphoma.
The onset of Hodgkin’s lymphoma symptoms and their intensity generally depends on the specific type of Hodgkin’s disease affecting the patient.
Generalized symptoms such as fever, night sweats, and weight loss, sometimes referred to as “B” symptoms, are particularly common in cases where the cancerous cells have spread extensively through the lymphatic system, liver and bone marrow. As the disease progresses, the body slowly loses its ability to fight infection. The patient may experience an increase in infections, due to the malfunctioning of white blood cells and a generally impaired immune system.
Common Symptoms. The signs and symptoms of HD include:
painless, swollen lymph nodes in the neck, chest, armpit, groin, ankle or spleen
pain in the lymph nodes after drinking alcohol
night sweats so severe that they may soak the patient’s bedding
unexplained night fevers, with temperatures above 38° C (100° F)
unexplained weight loss of more than ten percent of body weight in the six months prior to diagnosis
anemia (low hemoglobin value)
patches of red skin
loss of appetite
itching (especially of legs or feet) so severe that patients may scratch their skin raw
persistent breathlessness, especially if the clavicle or chest region isaffected.
Diagnosis of Hodgkin’s Lymphoma. Instances of swollen lymph nodes, particularly in young children, are usually the result of minor infections such as the common cold or a flu-like virus. However, if the swelling persists longer than usual, further investigation is advisable.
HD is often diagnosed following a chest x-ray or imaging scan carried out for an unrelated health problem.
The First Step. If Hodgkin’s lymphoma is suspected, the oncologist or physician carries out a complete physical examination and obtains a medical history. The doctor asks about classic lymphoma symptoms such as weight loss, fever and night sweats, and looks for signs such as swollen lymph nodes, especially in the neck and chest area. The physician examines specific locations along the lymphatic system, looking closely at the size and firmness of any swollen lymph nodes and whether they are tender when palpated (touched). In HD, the lymph nodes are usually firm, but mobile, and non-tender.
A chest x-ray is also routinely performed to look for enlarged lymph nodes in the mediastinum, the chest cavity located between the lungs.
The Next Step
The next step is to perform a biopsy of an enlarged lymph node. This involves removing a small sample of lymphatic tissue for examination under a microscope.
In making a diagnosis of Hodgkin’s disease, the pathologist measures the size and shape of the tissue, analyzes its composition and looks for the presence of Reed-Sternberg (RS) cells. Specific cell surface markers on RS cells can be detected by monoclonal antibodies, which are useful “tools” in the diagnostic procedure.
Types Of Biopsy
Fine Needle Aspiration
A fine needle aspiration (FNA) involves inserting a very fine needle attached to a syringe into an enlarged lymph node. This method is best for lymph nodes that are near the surface of the skin. If the enlarged node is located deeper in the body, such as in the abdomen or thymus, the needle is guided by using computed tomography (CT) scan or ultrasound.
FNA is useful for distinguishing between non-cancerous and malignant tissue and is sometimes used as a first level of diagnosis, or for monitoring recurrence of the disease. The main disadvantage of FNA is the limited size of the sample, and most centers still use a surgical biopsy for definitive diagnosis.
Surgical biopsy is performed under local or general anesthesia and allows larger tissue samples to be obtained. Whole sections of tissue can be analyzed microscopically in thin sheets rather than in clumps of cells. This method allows the best means of achieving an accurate diagnosis of HD and facilitates typing of the disease.
Once Hodgkin’s lymphoma has been diagnosed, the patient may be required to undergo additional tests including:
CT scan: an imaging device that produces cross-sectional images of the body
MRI scan: uses magnetic resonance imaging to detect enlarged lymph nodes or abnormalities of the spleen and other organs
lymphangiogram: a type of x-ray that highlights the lymph nodes and vessels using a special dye injected into the lymphatic system
bone marrow aspiration: sampling of bone marrow cells by needle asipration to help determine the extent of the cancer
lumbar puncture: a “spinal tap” procedure used to determine whether the disease has spread to the central nervous system or not.