Clinical manifestations and natural history of Hodgkin's lymphoma

Hodgkin's lymphoma usually presents with typical lymphadenopathy that has been detected either incidentally by the patient or by imaging procedures performed for assessment of other conditions. Occasionally, it may be detected when investigation of nonspecific symptoms, such as fever, fatigue, or unexplained pain prompt assessment that, in turn reveals a mass lesion. The diagnosis must be confirmed with an appropriate biopsy. Nowadays, clinicians usually have little difficulty making the diagnosis of Hodgkin's lymphoma. Knowledge of the usual pattern of spread of this lymphoma, with its orderly progression through lymph node groups and its typical forms of extranodal involvement, facilitates timely diagnosis, staging, and treatment planning. Rare manifestations due to involvement of unusual sites or presentation with paraneoplastic organ dysfunction can prove challenging but a search for mass lesions and an appreciation of these uncommonly encountered findings as potential clues to the presence of Hodgkin's lymphoma usually prompts appropriate investigation and correct diagnosis. Finally, an understanding of the usual pattern and timing of relapse and knowledge of the typical types of late toxicity expected after successful eradication of the lymphoma allow the patient's physicians to detect recurrence in a timely fashion and to identify or prevent secondary complications enabling appropriate management plans to be developed.