Hodgkin's Disease

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Signs and Symptoms

The most common sign of both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) is a painless swelling in one or more of the lymph nodes of the neck, collarbone region, armpits, or groin. But it is important to remember that most lymph node swelling—especially in children—is caused by an infection, not by lymphoma. Affected lymph nodes usually return to normal size within a few weeks or months after an infection has cleared. Physicians often observe swollen lymph nodes during this time to see if they change in size following antibiotic treatment. However, if a lymph node(s) is larger than one inch in size (> 1 in), and if there are other suspicious symptoms, the physician may choose to perform an immediate biopsy to rule out or confirm a diagnosis of cancer.

Hodgkin's disease has a characteristic pattern of lymphatic spread that may aid in diagnosis. The disease typically invades the lymph nodes of the neck, collarbone, armpits, and/or chest above the diaphragm (large abdominal muscle that controls breathing) without "skipping" a nodal group.

If HD or NHL involves lymphatic tissue within the abdomen the belly may become swollen, and even resemble pregnancy in some female patients. Fluid may build up within the abdominal cavity, and swelling near the intestines may block the normal passage of feces. Such blockage may cause sensations of abdominal pressure or pain.

Chest Pain
If lymphoma involves the lymphatic tissue of the thymus, the gland located in front of the heart, it may cause chest pain. In addition, an enlarged thymus may press on nearby structures such as the trachea (windpipe) or superior vena cava (SVC), the large vein that carries blood from the head and arms back to the heart.

Trachea
Pressure on the trachea can lead to coughing, fatigue, shortness of breath, and other respiratory difficulties. Pressure on the superior vena cava may produce SVC syndrome, a swelling of the head and arms. SVC syndrome involving the brain can be fatal and must be treated immediately. But enlarged lymphatic tissue in the chest cavity generally tends to displace—rather than press upon or encase—adjacent structures. Therefore, compromised breathing and SVC syndrome are relatively uncommon signs of lymphoma.

General Symptoms
As lymphomas progress and cancerous lymphocytes spread beyond the lymphatic system, the body loses its ability to fight infections. The generalized symptoms that develop may be confused with influenza, other infections, such as infectious mononucleosis ("mono"), tuberculosis (TB), or other cancers. In particular, people with HD or NHL may experience:

• Appetite loss
• Drenching night sweats
• Fatigue
• Fever
• Red patches on the skin
• Severely itchy skin, often affecting the legs/feet
• Weight loss

The itching associated with Hodgkin's disease is much more severe than that caused by dry skin. In some cases, patients may actually scratch through the skin with their fingernails in attempts to get some relief. The night sweats caused by HD or NHL may be so extreme that they completely soak the individual's sheets and blankets.

Some oncologists refer to these generalized symptoms as B symptoms. Unfortunately, B symptoms are related to an increased cancer "burden"—more cancerous tissue—in many patients and, therefore, indicate a worse prognosis, or outcome.

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