hematology and oncology
Hodgkin Lymphoma
Symptoms and Signs of Hodgkin Lymphoma
Most patients with Hodgkin lymphoma present with painless cervical adenopathy. Although the mechanism is unclear, pain rarely may occur in diseased areas immediately after drinking alcoholic beverages, sometimes providing an early indication of the diagnosis. Other manifestations develop as the disease spreads through the reticuloendothelial system, generally to contiguous sites. Intense pruritus refractory to usual therapies may occur early. Systemic symptoms include fever, night sweats, and loss of appetite resulting in unintentional weight loss (>10% of body weight in previous 6 months), which are referred to as "B symptoms." B symptoms are significant to prognosis and staging because they may signify involvement of internal lymph nodes (mediastinal or retroperitoneal), viscera (liver), or bone marrow. Splenomegaly is often present; hepatomegaly is unusual. Pel-Ebstein fever (a few days of high fever regularly alternating with a few days to several weeks of normal or below-normal temperature) occasionally occurs. Cachexia is common as disease advances. Bone involvement is often asymptomatic but may cause vertebral osteoblastic lesions (ivory vertebrae) and, rarely, pain with osteolytic lesions and compression fractures. Intracranial, gastric, and cutaneous lesions are rare and when present can suggest uncontrolled HIV-associated Hodgkin lymphoma. Local compression by tumor masses often causes symptoms and signs, including Jaundice secondary to intrahepatic or extrahepatic bile duct obstruction Localized edema ( Lymphedema ) secondary to lymphatic obstruction by the tumor Severe dyspnea and wheezing secondary to tracheobronchial compression due to mediastinal disease Dyspnea, cough, and/or chest discomfort due to infiltration of lung parenchyma, which may simulate lobar consolidation or bronchopneumonia Epidural invasion that compresses the spinal cord may result in paraplegia. Horner syndrome and laryngeal paralysis may result when enlarged lymph nodes compress the cervical sympathetic and recurrent laryngeal nerves. Neuralgic pain follows nerve root compression. 