Last reviewed:September 2019
Last updated:October  2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • lymphadenopathy

Other diagnostic factors

  • unexplained fevers
  • night sweats
  • weight loss
  • dyspnoea
  • cough
  • chest pain
  • superior vena cava syndrome
  • abdominal pain
  • generalised pruritus
  • alcohol-induced pain at involved sites
  • hepatomegaly and/or splenomegaly
  • tonsillar enlargement

Risk factors

  • history of Epstein-Barr virus (EBV) infection
  • family history of Hodgkin's lymphoma
  • young adults from higher socio-economic class
  • HLA types
  • Jewish ancestry

Diagnostic investigations

1st investigations to order

  • FBC with differential
  • metabolic panel
  • erythrocyte sedimentation rate (ESR)
  • CXR
  • PET-CT scan
  • gallium scan
  • contrast CT neck, chest, and abdomen/pelvis
  • excisional lymph node biopsy
  • immunohistochemical studies
Full details

Investigations to consider

  • bone marrow biopsy
  • thyroid function tests
  • echocardiogram or multi-gated acquisition (MUGA) scan
  • pulmonary function tests
Full details

Treatment algorithm


Assistant Attending

Lymphoma Service

Memorial Sloan-Kettering Cancer Center

New York City



AM has received honoraria for serving on advisory boards for Seattle Genetics, BMS, Merck, and Erytech. She has received honoraria from Seattle Genetics and Takeda for educational lectures.

Dr Alison Moskowitz would like to gratefully acknowledge Dr Chris R. Kelsey, Dr Leonard R. Prosnitz, and Dr Timothy M. Zagar, the previous contributors to this topic.

Peer reviewersVIEW ALL

Radiation Oncologist

Director of Postgraduate Education

Department of Radiation Oncology

Memorial Sloan-Kettering Cancer Center

New York



JY declares that he has no competing interests.

Chief Fellow

Section of Hematology and Oncology

Department of Internal Medicine

Wake Forest University Baptist Medical Center




RC declares that she has no competing interests.

Consultant Haematologist

University College London Hospitals




KA declares that he has no competing interests.

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