The most common initial feature of Hodgkin disease is painless, asymmetrical enlargement of cervical lymph nodes. Symptoms may also originate from compression of neighboring structures by growing tumor masses. For example, cough, dyspnea, dysphagia, and upper extremity edema may result from a mediastinal mass impinging on the tracheobronchial tree, esophagus, or superior vena cava. Edema of lower extremities and urinary or gastrointestinal disturbances may result from retroperitoneal lymphatic involvement. Splenomegaly is present in about half of the cases.