What are the symptoms of Hodgkin lymphoma? How is it diagnosed?

Author: Zhu Jun, Chief Physician, Peking University Cancer Hospital

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Hodgkin is the name of a British pathologist. More than a hundred years ago, he found that several patients had similar pathologies and summarized a disease. Later, people confirmed the existence of this disease, and in order to commemorate him, the disease was named Hodgkin lymphoma.

Hodgkin's lymphoma is more common in young people and can even be seen in children and adolescents.

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In foreign countries, the age of onset of Hodgkin's lymphoma shows a bimodal phenomenon, with a peak in adolescence and another peak in the middle-aged and elderly people after the age of 50 or 60. However, in my country, this bimodal phenomenon is not particularly obvious. In general, the age of onset of Hodgkin's lymphoma is younger than that of non-Hodgkin's lymphoma. It is more likely to occur in children, adolescents, and young people, while the number of middle-aged and elderly people suffering from Hodgkin's lymphoma is relatively small.

Generally speaking, the occurrence of Hodgkin's lymphoma is related to viral infection, such as Epstein-Barr virus, referred to as EBV, which has a certain relationship with the increase in the incidence of Hodgkin's lymphoma. In addition, Hodgkin's lymphoma is related to some autoimmune diseases, chemical drugs, physical radioactive factors, etc. However, we cannot know exactly which factor caused the patient's disease.

In fact, we know that it is difficult to say which factor determines any disease, especially tumor diseases. It is often a combination of factors, both internal and external.

Internal factors may be gene mutations or defects; external factors may be infections, physical factors, environment, diet and other external factors; and the living environment, life rhythm, living habits, etc. during the development of the human body itself are comprehensive and complex factors. Our overall hope is to work towards a better attitude and living habits, and avoid some infectious factors, such as Epstein-Barr virus infection, hepatitis virus infection, etc.

The process of Hodgkin's lymphoma developing in the body, gradually progressing, sending out signals, and finally being diagnosed through specialist examinations in hospitals varies in length. But generally speaking, patients who come to see a doctor often have some symptoms, either suddenly or gradually discovering a lump in a certain part of the body, or swollen lymph nodes, which we call painless, progressive lymph node enlargement.

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What does it mean? It is not like an inflammatory reaction, such as toothache or tonsillitis, which may cause an inflammatory reaction and swelling of a lymph node in a nearby part. This is because the lymph node inflammation is caused by infection. Generally, this lymph node will feel a little painful to the touch.

Lymph node tumors are generally painless and grow gradually and progressively, so we call it continuous progressive growth. The growth rate varies from tumor to tumor and from person to person. Sometimes it may grow significantly in a week or a month, and sometimes it may grow in a day or two. However, the basic tendency is that it grows larger and larger without obvious pain.

About 40% of patients will have some symptoms, such as unexplained fever, and if the body temperature is measured, it will be above 38.5℃.

For example, patients may lose weight for unknown reasons. In other words, they are not deliberately not eating, exercising, or losing weight. There is no clear reason, but they are getting thinner and thinner, their diet is not good, and they feel weak.

Another symptom is excessive sweating. This kind of excessive sweating is not caused by the hot weather without air conditioning or after activities, but sweating in a resting state, which we call spontaneous sweating. There is also night sweating, which is waking up in the middle of the night sweating all over, and this kind of sweating is not just a little damp, but the kind of sweating that makes your clothes, even the sheets and quilts, soaked.

Of course, some patients will experience severe skin itching. Some patients will experience severe skin itching immediately after drinking alcohol. This is a special manifestation.

For patients, if relevant abnormal symptoms occur, what they need to do is to seek medical attention in time, conduct relevant examinations under the guidance of a doctor, and make a clear diagnosis as soon as possible.

For example, we first need to check the enlargement of lymph nodes. Lymph nodes include superficial lymph nodes and deep lymph nodes. Superficial lymph nodes can be determined by physical examination by a doctor, that is, touching the superficial lymph nodes, including the lymph nodes in the neck, armpits, and groin. Of course, deep lymph nodes may require the help of some examination methods, such as B-ultrasound, CT or PET/CT examination. Based on these examinations, we can highly determine whether there are abnormally swollen lymph nodes and preliminarily determine whether they are tumorous.

After determining the location of the enlarged lymph nodes, we can select a lymph node in a certain location and take a pathological biopsy to confirm the diagnosis. To confirm lymphoma, a biopsy must be taken for pathological examination. It is a principle that lymphoma cannot be diagnosed without a biopsy.

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In addition, blood tests are also very important. For example, when some lymphomas occur, blood routine tests may be abnormal, including increased white blood cells, changes in the absolute number and proportion of lymphocytes, anemia, increased or decreased platelets, abnormal biochemical enzyme spectrum, increased erythrocyte sedimentation rate, etc. These blood tests can also provide some evidence. But in the final analysis, the gold standard for diagnosing lymphoma is pathological biopsy.