According to the American Cancer Society, Hodgkin’s lymphoma is a type of cancer that originates in the lymphatic system – a part of the body’s immune system that contains white blood cells called lymphocytes. Hodgkin’s lymphoma starts in a type of white blood cell known as a B lymphocyte. B lymphocytes produce antibodies – proteins that help the body protect itself from bacteria and viruses.
Hodgkin’s lymphoma occurs due to a DNA mutation in the B lymphocytes for unknown reasons. B lymphocytes, along with lymph tissue and lymph vessels, are found in many parts of the body, including the following:
- Digestive tract
- Bone marrow
Given its prevalence throughout the body, Hodgkin’s lymphoma can begin to develop almost anywhere.
Hodgkin’s lymphoma accounts for approximately 0.5 percent of new cancer cases. However, lymphoma is the most common form of cancer found in adolescents between 15 and 19. Of these cases, nearly two-thirds are Hodgkin’s lymphoma, while the rest are non-Hodgkin’s lymphoma. According to the National Cancer Institute, it accounts for approximately 6% of childhood cancer cases. And while it accounts for 0.2 percent of cancer deaths, the survival rate decreases the longer Hodgkin’s lymphoma is untreated.
What Are the Symptoms of Hodgkin’s Lymphoma?
When a person develops Hodgkin’s lymphoma, they will most commonly experience a lump under their arm, neck, or groin. This lump is the result of an enlarged lymph node. It is usually not painful, though it may become so after alcohol is ingested. The lump may swell further, and new lumps may develop over time. Enlarged lymph nodes may be caused by other forms of cancer or some forms of infection as well.
Other symptoms of Hodgkin’s lymphoma include significant weight loss, severe night sweats, and fever without infection. People diagnosed with Hodgkin’s lymphoma have also reported a loss of appetite, fatigue, and itchy skin. And if Hodgkin’s lymphoma has developed in the chest, swollen lymph nodes put pressure on the trachea and result in breathing difficulties and coughing.
If you have a swollen lymph node and experience some or all of these other symptoms, you should have it examined as soon as possible, as it may be a symptom of Hodgkin’s lymphoma or another potentially life-threatening condition.
Diagnosing Hodkin’s Lymphoma: What You Need to Know
Unlike breast cancer, lung cancer, pancreatic cancer, prostate cancer, ovarian cancer, and blood cancer that target specific organs, when a person visits a medical provider, either because they suspect they may have Hodgkin’s lymphoma or simply feel unwell, a doctor will first review their medical record and their family’s health history. What are the Hodgkin’s lymphoma risk factors? Having a sibling with Hodgkin’s lymphoma places a person at higher risk of developing it themselves. But even if a person has no family history of this cancer, there may be other risk factors in their health profile that a doctor will need to know to make an accurate diagnosis.
Next, they will ask about the symptoms and conduct a physical examination, with special emphasis on the lymph nodes. If the doctor believes that Hodgkin’s lymphoma may be a possibility, they will order a biopsy. A biopsy involves the removal of a small piece of a lymph node for further examination in a laboratory. Given that lymph nodes may be swollen for other reasons, this procedure is the only certain way to make a positive Hodgkin’s lymphoma diagnosis.
Excisional or Incisional Biopsies
The most common types of biopsies used to examine an enlarged lymph node are known as excisional biopsies or incisional biopsies. A doctor performs an excisional biopsy when they remove an entire lymph node. An incisional biopsy involves the removal of just a small part of the node.
Biopsies are often fairly simple procedures that can be performed relatively quickly. If the targeted node lies just below the skin, the doctor may provide the patient with local anesthesia before removing it. However, if the node is located deeper inside the body, such as in the abdomen or chest, a patient will receive general anesthesia before a minor surgical procedure is undertaken to remove a lymph node or a part of one.
In some cases, a doctor may opt for a needle biopsy which is less invasive than an excisional or incisional biopsy. Needle biopsies are not commonly used to diagnose Hodkin’s lymphoma because doctors are often unable to extract enough tissue to make a proper diagnosis.
However, needle biopsies can determine whether a swollen lymph node stems from an infection or if an organ-specific cancer has spread to the lymphatic tissue in the affected area. Depending on the needle biopsy results, an excisional biopsy may still be ordered to make a definitive diagnosis of Hodgkin’s lymphoma.
Doctors may order a fine needle aspiration (FNA) biopsy, which involves using a slim and hollow needle to remove small amounts of tissue and fluid. Or, if they need to remove a larger amount, they may order a core needle biopsy, which uses a larger needle for tissue removal.
If the swollen node is just under the skin, the doctor can perform the feature simply by injecting the needle into it. However, in cases where the node is deeper in the body, the doctor will likely perform the procedure using a computed tomography (CT) scan or ultrasound to guide where the needle is introduced.
Related Diagnostic Procedures
When evaluating a patient for Hodgkin’s lymphoma, a doctor must also determine its severity and where it may have spread in the body. After a positive diagnosis, a doctor may order a bone marrow aspiration and/or a bone marrow biopsy – tests that can help determine if the lymphoma resides in the bone marrow.
Bone marrow aspiration involves the extraction of a small amount of bone marrow with a fine needle. A doctor will perform a bone marrow biopsy using a thicker needle if a larger amount is needed. In both instances, anesthesia will be used, although, despite the anesthesia, patients may feel brief pain upon the marrow’s extraction.
Biopsy Sample Examination and Testing
Biopsy samples are reviewed by a medical specialist known as a pathologist. Crucial to how Hodgkin’s lymphoma is diagnosed, pathologists are medical doctors specially trained in laboratory techniques that help them investigate diseases. A pathologist may be able to diagnose Hodgkin’s lymphoma simply by observing biopsy tissue samples under a microscope. However, additional tests are often necessary to rule out other possible diseases and assess the cancer’s severity.
One common test is an immunohistochemical (IHC) stain test. This test relies on the fact that antibodies will automatically attach themselves to specific antigens. Antigens are a type of substance found in and around a cell. If the cells in the biopsy sample found in Hodgkin’s lymphoma cancer cells are present, these laboratory-created antibodies will help pathologists detect the cancer by attaching themselves to the unique antigens found in a Hodgkin’s lymphoma-infected cell. IHC tests can also help pathologists distinguish tissues containing an elevated white blood cell count due to infection from those containing cancer cells.
Tests to Determine How Far Hodgkin’s Lymphoma Has Spread
If a doctor suspects an individual may have Hodgkin’s lymphoma or has already diagnosed them with the disease, they may also order certain imaging tests to determine how far the cancer has spread. A routine chest X-ray can help doctors get a better look at swollen lymph nodes inside a patient’s chest. Computed tomography (CT) scans, which produce cross-sectional images of a patient’s body, can be used more broadly and help guide biopsies under the skin.
When a doctor believes cancerous lymph cells may have spread to the spinal cord or brain, they will order a magnetic resonance imaging (MRI) scan. They also may use a positron emission tomography (PET) scan, which involves placing a small amount of marginally radioactive sugar in your bloodstream. This sugar tends to collect in cancer cells. A special camera designed to capture the radioactivity as the sugar clumps together can help a doctor determine whether a lymph node contains Hodgkin’s lymphoma.
A PET scan is also used to determine whether a patient responds to Hodgkin’s lymphoma treatment by seeing whether the sugar no longer gathers in the lymph nodes. While PET scans don’t provide the most detailed look at the body, doctors often use PET scans in conjunction with CT scans to help get a complete picture of where the lymphoma is.
A doctor may also order a bone scan if they believe the cancer may reside in a patient’s bones. Like PET scans, bone scans involve the injection of trace amounts of radioactive material into affected areas of the bone and then photography of those areas using specially designed cameras that capture images of radioactive material.
Medical providers may also order several other types of tests to determine how far the cancer may have spread and which areas of the body it may be affecting. For example, they may order a:
- Complete blood count test, which can identify abnormal blood counts
- Erythrocyte sedimentation rate test, which can assess how much inflammation a patient has
- Chemistry panel that examines the levels of multiple essential chemicals, such as calcium, uric acid, electrolytes, and phosphorus, among others
- Blood test that evaluates liver and kidney function
- Pregnancy, HIV, or hepatitis tests, to rule these conditions out as possible sources of Hodgkin’s lymphoma-like symptoms
- Echocardiogram that produces an ultrasound image of the heart
- Multiple gated acquisition (MUGA) scan is used to determine how well the heart is functioning
- Pulmonary function test(PFT) that evaluates how well the lungs are working
Contact the Immunity Therapy Center If You Believe You May Have Hodgkin’s Lymphoma
If you have Hodgkin’s lymphoma or suspect that your child may, early detection and treatment are crucial to ensuring the best possible health outcome and being aware of the best treatment options available, radiation therapy, or other forms of cancer treatment. And given the complexity of diagnosing it, it’s essential that if you are experiencing swollen lymph nodes and other symptoms, you speak with experienced medical providers well-versed in diagnosing and treating Hodgkin’s lymphoma as soon as possible. We’re here to answer any questions you may have about Hodgkin’s lymphoma, how Hodgkin’s lymphoma is diagnosed, and how it can be treated to ensure the best possible health outcome. As to treating the disease, you should also be mindful of the potential effects, such as developing malignant mesothelioma.
At the Immunity Therapy Center, our clinical staff has substantial experience diagnosing and treating Hodgkin’s lymphoma and other cancer and providing patients with the highest quality of care. We understand how overwhelming a potential diagnosis of Hodgkin’s lymphoma can be, so we’ve structured our practice to make the process as painless for you as possible.
We work hard to provide affordable, compassionate, and effective healthcare service that begins the moment you call us for an appointment. We know that making that call may be difficult, but call us today if you or your child is experiencing the symptoms described above. You can’t afford to wait.
Written By: Dr. David Alvarez
Dr. David Alvarez is a Board Certified Medical Doctor from Universidad Xochicalco and Certified by the American Heart Association (Advanced Cardiovascular Life Support).
Dr. Alvarez has been collaborating with Dr. Bautista as an Assistant Medical Director at the Immunity Therapy Center for over 6 years. He provides daily on site patient care and participates on the medical board on research and development of patient treatment plans and programs. Dr. Alvarez is a knowledgeable and compassionate Doctor committed to helping patients get to where they want to be health wise through a more holistic and comprehensive approach.
At Immunity Therapy Center, our goal is to provide objective, updated, and research-based information on all health-related topics. This article is based on scientific research and/or other scientific articles. All information has been fact-checked and reviewed by Dr. Carlos Bautista, a Board Certified Medical Doctor at Immunity Therapy Center. All information published on the site must undergo an extensive review process to ensure accuracy. This article contains trusted sources with all references hyperlinked for the reader's visibility.