Diagnosis of Hodgkin Lymphoma

Diagnosis of Hodgkin Lymphoma

The following tests and procedures may be used to diagnose Hodgkin lymphoma:
  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s past illnesses and treatments will also be taken.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the sample made up of red blood cells.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
  • Lymph node biopsy: The removal of all or part of a lymph node. One of the following types of biopsies may be done:
    • Excisional biopsy: The removal of an entire lymph node.
    • Incisional biopsy: The removal of part of a lymph node.
    • Core biopsy: The removal of part of a lymph node using a wide needle.
A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.
  • Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.
Factors Affecting Prognosis and Treatment Options The prognosis (chance of recovery) and treatment options for Hodgkin lymphoma depend on the following:
  • The patient’s symptoms.
  • The stage of the cancer.
  • The type of Hodgkin lymphoma.
  • Blood test results.
  • The patient’s age, gender, and general health.
  • Whether the cancer is recurrent or progressive.
For Hodgkin lymphoma during pregnancy, treatment options also depend on:
  • The wishes of the patient.
  • The age of the fetus.

Stages of Adult Hodgkin Lymphoma

The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For adult Hodgkin lymphoma, CT scans of the neck, chest, abdomen, and pelvis are taken.
  • PET-CT scan: A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself. A PET scan is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
For pregnant women with Hodgkin lymphoma, staging tests that protect the fetus from the harms of radiation are used. These include:
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Cancer spreads in the body through tissue, blood or the lymph system. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. Stages of adult Hodgkin lymphoma may include A, B, E, and S. Adult Hodgkin lymphoma may be described as follows:
  • A: The patient has no symptoms.
  • B: The patient has symptoms such as fever, weight loss, or night sweats.
  • E: “E” stands for extra nodal and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas.
  • S: “S” stands for spleen and means the cancer is found in the spleen.
The following stages are used for adult Hodgkin lymphoma:

Stage I

Stage I is divided into stage I and stage IE.
  • Stage I: Cancer is found in one or more lymph nodes in one lymph node group.
  • Stage IE: Cancer is found outside the lymph nodes in one organ or area.

Stage II

Stage II is divided into stage II and stage IIE.
  • Stage II: Cancer is found in two or more lymph node groups above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
  • Stage IIE: Cancer is found in one or more lymph node groups above or below the diaphragm and outside the lymph nodes in a nearby organ or area.

Stage III

Stage III is divided into stage III, stage IIIE, Stage IIIS, and stage IIIE+S.
  • Stage III: Cancer is found in one or more lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
  • Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
  • Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
  • Stage IIIE+S: Cancer is found in lymph node groups above and below the diaphragm, in a nearby organ or area, and in the spleen.
Stage III is also divided into stage III(1) and stage III(2) as follows:
  • Stage III(1): Cancer is found only in the upper abdomen above the renal vein.
  • Stage III(2): Cancer is found in lymph nodes in the pelvis and/or near the aorta.

Stage IV

In stage IV, the cancer:
  • is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
  • is found outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ; or
  • is found in the lung, liver, or bone marrow.
If you have symptoms associated with Hodgkin lymphoma, contact us to request an appointment with our oncology specialists to begin diagnostic testing.