Hodgkin Lymphoma Symptoms
Hodgkin lymphoma often develops in people between the ages of 16 and 34, but it can also develop in people older than 60. Younger patients are usually otherwise healthy, which can allow the disease to progress for some time without noticeable symptoms. Although certain symptoms are commonly associated with Hodgkin lymphoma, it’s important to understand that most people who experience these symptoms do not have the disease. Many of these signs can be caused by more common, less serious conditions.
Early signs and symptoms of Hodgkin lymphoma
In its early stages, Hodgkin lymphoma may cause only subtle or nonspecific symptoms, or no symptoms at all. Some people discover they have the disease during tests for unrelated health issues. Common early signs include:
- Painless swelling of lymph nodes (especially in the neck, underarms, or groin)
- Fatigue
- Mild fever
- Night sweats
- Unexplained weight loss
- Itchy skin
- Loss of appetite
Late signs and symptoms of Hodgkin lymphoma
As the disease progresses, symptoms may become more pronounced and widespread. These include:
- Persistent fatigue or weakness
- Significant weight loss (more than 10% of body weight over 6 months)
- Frequent or drenching night sweats
- Recurring fever without an obvious cause
- Cough, shortness of breath, or chest discomfort, especially if lymph nodes in the chest become enlarged
- Abdominal swelling or discomfort due to enlarged lymph nodes, liver, or spleen
- Pain in lymph nodes after drinking alcohol
- Widespread rash or red patches on the skin
- Severe itching (pruritus)
What does Hodgkin lymphoma feel like?
Many people with Hodgkin lymphoma feel generally unwell or notice a persistent sense of fatigue that doesn’t improve with rest. One of the typical features is painless swelling in lymph nodes, which may feel firm and rubbery to the touch. Some people describe deep aches or pressure in the chest or abdomen due to enlarged lymph nodes or organs.
A unique symptom seen in some patients is pain in affected lymph nodes after consuming alcohol—this is rare but very specific to Hodgkin lymphoma. Other symptoms may include unexplained fevers, drenching night sweats, and a persistent feeling of being run-down that can’t be explained by other causes.
Other conditions with symptoms similar to Hodgkin lymphoma
Several other medical conditions can mimic the signs of Hodgkin lymphoma, including:
- Non-Hodgkin lymphoma
- Infectious mononucleosis (mono) from Epstein-Barr virus (EBV)
- HIV/AIDS
- Tuberculosis
- Other infections (e.g., cytomegalovirus, toxoplasmosis)
- Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
- Other cancers, such as leukemia
- Thyroid disorders
- Skin conditions or allergic reactions (especially those causing itching or rashes)
This overlap is why diagnostic tests such as blood work, imaging, and biopsies are essential for an accurate diagnosis.
Risk factors for Hodgkin lymphoma
While the exact cause of Hodgkin lymphoma is not known, several factors can increase the risk of developing the disease:
- Sex: Slightly more common in males than females
- Family history: A sibling with Hodgkin lymphoma increases risk
- Weakened immune system: From HIV infection, organ transplantation, or autoimmune diseases
- Previous EBV infection
When to see a doctor
You should see a health care provider if you experience any of the following:
- Persistent swelling of lymph nodes that does not go away in a few weeks
- Unexplained fever, night sweats, or weight loss
- Fatigue that interferes with daily life
- Shortness of breath or persistent cough
- Severe itching without a clear cause
- Unusual pain in lymph nodes after alcohol consumption
While these symptoms do not confirm Hodgkin lymphoma, early evaluation is important. Many other conditions can cause similar symptoms, and early diagnosis (whatever the cause) can improve outcomes.
Swollen lymph nodes and other symptoms of lymphoma
Almost everyone will experience a swollen lymph node at some point. That’s because these structures are designed to filter germs and other impurities from the body.
Lymph nodes become swollen as they trap viruses, harmful bacteria and damaged cells, then attempt to destroy them with lymphocytes, the white blood cells that fight off infection.
But swollen lymph nodes can also be a sign of cancer, including a type of blood cancer called lymphoma. So, when are swollen lymph nodes just a sign of infection, as opposed to a symptom of lymphoma? We checked in with lymphoma and myeloma specialist Felipe Samaniego, M.D.
How often do swollen lymph nodes appear as the first sign of lymphoma in undiagnosed patients?
That’s kind of hard to say. By the time we see most patients here at MD Anderson, they’ve already been diagnosed elsewhere or been told there’s a strong possibility that whatever it is that they have is cancer.
That being said, in the greater community, swollen lymph nodes among undiagnosed patients tend to fall into one of two categories:
- Lymph nodes that patients notice or that a doctor sees or feels during a physical exam, like swollen lymph nodes in neck, armpit or groin areas.
- Lymph nodes that are found during an MRI or a CT scan because the patient is complaining of something else, such as chest pain or a lump in their breast
What are the most common places in the body where swollen lymph nodes occur as a sign of lymphoma?
Most will be in the neck, because the mouth and throat — or oropharyngeal tract — are the main gateway for things to get inside our bodies. So, we need to have a good defense system there.
But patients can find swollen lymph nodes in other places, too — especially where they lie close to the skin’s surface, like the groin area (where the leg meets the trunk) and the axilla, or armpit.
Lymphoma is actually detected pretty frequently during mammograms, because the field of view also covers the armpit, so it reveals swollen lymph nodes in that area.
Occasionally, patients may develop swollen lymph nodes all over their bodies, but this is relatively rare.
Is there a way to tell the difference between cancerous swollen lymph nodes and non-cancerous ones?
Anyone who’s really concerned about a swollen lymph node should go see their doctor. But here are some general guidelines:
- Size: Lymph nodes are made to change in size because they’re doing a job. They grow larger as the number of cells caught inside of them increases and shrink back down to normal as that number drops. But the normal size of an average lymph node is under 1.5 centimeters, or about ¾ of an inch or smaller. So, if something is larger than that or growing continuously, it needs to be checked out.
- Age: Infections are a frequent cause of swollen lymph nodes among young people. So, if you’re a teen or a college student, my first thought would be something like strep throat or mononucleosis. Cancer is more likely in older people, though I’d still want to rule out an infection first. Even among older groups, probably less than half the people who have swollen lymph nodes will have them because of cancer.
- Consistency: Press the tip of your nose with your finger and you’ll have a pretty good idea of what a typical lymph node should feel like. Tumors tend to be harder and more solid, like what you’ll feel if you push on your chin with your finger.
- Sensitivity: Some people think cancer always hurts, but that’s not true. Tenderness tends to be a sign of an infectious process, because the immune system has been challenged. But lymph nodes that are swollen due to lymphoma are usually not painful.
What are other common symptoms of lymphoma?
In lymphoma’s earliest stages, patients often report itchy, inflamed skin or unexplained rashes. In more advanced cases, where patients have large tumors, we start seeing weight loss, fevers, night sweats, and fatigue. Some experience painful muscle aches after drinking alcohol, too, though that is fairly unusual.
When should someone see their doctor about a swollen lymph node?
Swollen lymph nodes usually just mean your body is working the way it’s supposed to. But if a swollen lymph node keeps getting bigger or doesn’t resolve on its own within two weeks, get it checked out.
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