or “glands,” that swell when the lymphocytes respond to an infection or because of an increased number of abnormal lymphocytes “B symptoms,” including fevers for no known reason, unexplained weight loss, and drenching night sweats that soak clothing and sheets Increased levels of inflammatory chemicals in the blood that are released by lymphoma cells or by the immune system reacting to the lymphoma cells Unexplained itching (sometimes severe) Unknown cause but often associated with “B symptoms” or reactivation of viruses Coughing, trouble breathing, or chest pain or pressure Lymphoma in the chest, which may press on the windpipe or bronchi (tubes leading to the lungs) Pleural effusion (fluid surrounding the lungs) Feeling tired Anemia (low red blood cell count) Increased sensitivity to alcohol, or pain in the lymph nodes after drinking alcohol Poorly understood cause, but thought to be due to increased blood flow through the lymph nodes in response to alcohol 21 Understanding Hodgkin Lymphoma What Does the Doctor Look for During the Visit? During their visit, patients should describe all of their symptoms to the doctor. The doctor will ask questions about their medical history and perform a complete physical examination, during which the doctor is likely to: ■ Ask about “B symptoms” (unexplained fever, unexplained weight loss, and night sweats) ■ Ask about pain in the lymph nodes after drinking alcohol ■ Ask about itching ■ Ask about any other pain the patient may be experiencing ■ Measure blood pressure and pulse ■ Listen to the heart and lungs ■ Look for any physical signs of infection or any other cancers, especially on the skin ■ Check for swollen lymph nodes under the chin, in the neck and tonsil area, above the shoulders, on the elbows, in the underarms, and in the groin ■ Examine other parts of the body to look for swelling or fluid that may be caused by swollen lymph nodes ■ Examine the abdomen to see whether the liver and/or spleen are enlarged and to feel for masses If the doctor suspects HL after reviewing the symptoms reported and the signs discovered during the examination, he or she will order tests to confirm the diagnosis. Learning the Basics 22 Part 1 These tests include a complete blood count (CBC) with differential and a biopsy; they may also include specific laboratory tests, chest X-rays, computed tomography (CT) scans or other imaging tests, bone marrow evaluation, and heart and lung function tests. Depending on the type and location of the suspected HL, other tests may be required. However, a diagnosis of HL cannot be established without evaluating a sample of the involved tissue. These tests and procedures are discussed in more detail in Chapters 3 and 4. 23 Understanding Hodgkin Lymphoma Chapter 3: Receiving a Diagnosis Doctors need the results of various diagnostic tests to determine accurately whether a patient has Hodgkin lymphoma (HL). This chapter explains the purpose of each test and describes what to expect during and after the test procedures. Before agreeing to any procedure, patients should make sure they understand the reasons for the procedure and what will be involved. Here is a list of questions patients may want to ask their doctor. Part 1 — Learning the Basics PATIENT T Questions to Ask Before PI Having a Diagnostic Procedure ■ Why is this procedure necessary? ■ What will the procedure tell us about my condition? ■ Can the same information be obtained in another way? ■ What is involved in this procedure? ■ What are the possible risks, complications, and side effects? ■ Where will I have the procedure done? ■ Will I have to do anything to prepare for the procedure? ■ How long will the procedure take? Will I be awake? Will I feel pain? ■ How long will it take for me to recover from the procedure? ■ May someone else be present when I have the procedure? ■ Will I need someone to take me home afterward? ■ When will I get the results? ■ When will we discuss the results? Learning the Basics 24 Part 1 How Is HL Diagnosed? A tissue biopsy is the test required to establish an initial diagnosis of HL. After that, one or more of the following tests may also be used to help with the HL diagnosis: ■ Complete blood count (CBC) with