Hodgkin lymphoma (HL) — also known as Hodgkin’s disease or Hodgkin’s lymphoma — is a type of blood cancer. It is one of the two main types of lymphoma, a form of cancer that is related to leukemia, myeloma, and myeloproliferative neoplasms (MPNs). About 10 percent of all lymphomas are Hodgkin lymphoma, and the rest are broadly classified as non-Hodgkin lymphoma.
Lymphomas originate in the lymphatic system, which is part of the immune system and the circulatory system. The lymphatic system is made up of multiple organs: the lymph nodes, lymph channels, bone marrow, spleen, thymus, tonsils, and tissue in the digestive tract. The purpose of the lymphatic system is to drain excess fluid from tissue and remove waste and bacteria from the body.
The presence of Reed-Sternberg cells in lymph nodes helps doctors distinguish Hodgkin lymphoma from other lymphomas. Reed-Sternberg cells are a specific type of abnormal lymphocyte (a kind of white blood cell). There are five different types of HL, including four types of classical Hodgkin lymphoma as well as nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). HL usually occurs in adolescents and young adults. It is a very treatable cancer with an excellent survival rate.
What is the difference between signs and symptoms? To put it simply, symptoms are what a person reports about their experience, and signs are what a health care provider observes. In other words, symptoms are subjective descriptions of how a person feels, and signs are objective descriptions of a person’s condition, sometimes using precise, technical words.
For example, you may report symptoms of “dizziness” and “feeling lightheaded,” and your doctor may find that you have low blood pressure — a sign that can be measured. Sometimes, signs and symptoms overlap. A person may complain of itching and a rash — both symptoms — but a rash, or skin lesion, is also a sign that a doctor can see. Sometimes signs exist without any symptoms, too. For example, a doctor may find that you have an enlarged spleen (splenomegaly) during a physical exam, but you may not have noticed any effects — or symptoms — from it.
There is no single sign or symptom that is unique to one type of lymphoma or lymphoma in general. Rather, a combination can help define the disease. The signs and symptoms of Hodgkin lymphoma can be systemic (affecting the whole body) or local (affecting an area of the body due to the location of a tumor). As a general rule, you should seek medical help if you have symptoms that last for more than two weeks or that are severe enough to interfere with daily activities.
Three specific symptoms — unexplained fever, unexplained weight loss, and drenching night sweats — are called “B symptoms.” They are not unique to HL, but the presence and severity of these symptoms are important in establishing a prognosis and staging cases of HL.
B symptoms are believed to be caused by the body’s own immune response to the presence of cancer cells.
Systemic symptoms affect the whole body. In addition to B symptoms, there are several other common systemic signs and symptoms of lymphoma, including enlarged lymph nodes, fatigue, itching, sensitivity to alcohol, and frequent infections.
Painless swollen or enlarged lymph nodes (called lymphadenopathy) are the most common symptom of Hodgkin lymphoma. Lymph nodes exist throughout the body. They are usually found in clusters or chains that run alongside large blood vessels and nerves. Some lymph nodes are deep inside the body, in places such as the back of the abdominal cavity along the spine. Others are more superficial (closer to the skin).
The most common palpable (able to be felt by hand) lymph nodes are found in the underarms (armpits), in the groin, along the sides of the neck, along the top of the clavicle (collarbone), and underneath the jaw. You may have felt some of these lymph nodes, especially in the head and neck, as swollen “glands” that occur with common bacterial and viral infections. Infections can cause painful swelling of lymph nodes, but lymphoma typically causes painless swelling.
It is normal for lymph nodes to occasionally become enlarged, but lymph nodes that are swollen for more than a month or are larger than 1 centimeter wide can be due to lymphoma. NLPHL is known to frequently cause enlarged lymph nodes in the neck, groin, and underarms.
Fatigue describes more than just being tired or exhausted. Fatigue is persistent physical or mental tiredness or exhaustion that does not improve with rest. Many illnesses can cause fatigue, but in the case of lymphoma and associated leukemias, fatigue can be caused by anemia, a lack of red blood cells.
Localized or widespread, unexplained itching of the skin, called pruritus, can occur in people with HL. Itching can be severe and cause a painful burning sensation. It may occur more frequently after drinking alcohol or being exposed to heat.
Signs and symptoms that affect one specific part of the body are described as “localized.” Localized signs and symptoms can be caused by the effects of a tumor in a specific place in the body. Enlarged lymph nodes, other enlarged organs, or tumors can put pressure on nerves, blood vessels, and other organs, causing pain or other symptoms. Localized signs and symptoms of Hodgkin lymphoma are commonly seen in the chest and abdomen.
Lymphoma in the chest can cause a variety of symptoms including pain and pressure in the chest, coughing, shortness of breath, and difficulty breathing. Coughing and difficulty breathing can occur due to swollen lymph nodes irritating or putting pressure on the bronchus (windpipe) in the lungs or neck.
The abdomen, or belly, contains many lymphatic organs. In addition to the many lymph nodes throughout the abdomen, the spleen, liver, and intestines can all be affected by lymphoma. An enlarged spleen or liver can cause a sense of fullness after eating only a small amount of food. Enlarged organs and the accumulation of fluid in the abdomen, called ascites, can cause distention (swelling or bloating), leading to a loss of appetite, nausea, vomiting, and abdominal pain.
All of the signs and symptoms of lymphoma can also have other causes, including other cancers or diseases that are not serious. Regardless of the underlying cause, the presence of any of these symptoms can be a cause for concern. Talk to a health care provider if you have symptoms that don’t go away or that worsen over time.
Signs and symptoms of Hodgkin lymphoma are not enough to make a diagnosis, but they are enough to suspect a serious illness such as cancer. Further tests are needed to discover what is causing these symptoms. A variety of tests are used to diagnose Hodgkin lymphoma and determine the best course of treatment.
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