Diagnosing childhood Hodgkin lymphoma
Diagnosing childhood Hodgkin lymphoma (HL) usually begins with a visit to your child’s doctor. The doctor will ask about any symptoms your child has and do a physical exam. Based on this information, your doctor may refer your child to a specialist or order tests to check for HL or other health problems.
The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as childhood HL. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of childhood HL. If the doctor suspects childhood HL, your child will be managed by a healthcare team that specializes in caring for children with cancer.
The following tests are commonly used to rule out or diagnose childhood HL. Many of the same tests used to diagnose cancer are also used to determine the stage, which is how far the cancer has progressed. Your child’s doctor may also order other tests to check the child’s general health and to help plan treatment.
Your child’s health history is a record of their symptoms, risk factors and all the medical events and problems they have had in the past. The health history of the child’s family may also help the doctor diagnose HL. In taking a health history, the doctor will ask questions about:
- symptoms that suggest HL
- a personal and family history of certain genetic conditions
- a family history of HL
A physical exam allows the doctor to look for any signs of childhood HL. During a physical exam, the doctor may:
- check for swollen lymph nodes
- feel the abdomen to see if the liver or spleen is larger than normal
- check the tonsils to see if they are swollen or if there are growths on them
- listen to the lungs for any breathing problems
Find out more about physical exam.
During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. The report from the lab will confirm whether or not cancer cells are present in the sample.
If the doctor thinks your child might have Hodgkin lymphoma, the pathologist will look for Hodgkin and Reed-Sternberg (HRS) cells in the biopsy sample. HRS cells are much larger than normal lymphocytes. They have a large nucleus or more than one nucleus. Doctors use the presence of HRS cells to tell Hodgkin lymphoma from non-Hodgkin lymphoma.
A lymph node biopsy is the only way to make a definite diagnosis of Hodgkin lymphoma. The type of biopsy done depends on where the lymph nodes are enlarged (swollen). A biopsy may be taken from a lymph node in the neck, under the arm or in the groin. It may also be taken from the chest or abdomen during a CT scan.
Surgical biopsy is usually done to collect samples from lymph nodes. The surgeon may do an excisional biopsy, which removes all of the lymph node. In some cases an incisional biopsy may be used to remove part of a lymph node. If the lymph node is near the surface of the skin, the lymph node biopsy may be done with a local anesthetic (freezing). If it is deeper inside the body and not as easy to get to, then a general anesthetic may need to be used (your child will be unconscious).
Find out more about surgical biopsy.
A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for anemia, or low red blood cell counts, which is common in children with HL. Doctors also use the results of a CBC as a baseline to check against during treatment.
Find out more about complete blood count (CBC).
Doctors may order a blood test to measure the erythrocyte sedimentation rate (ESR). The ESR is a measure of how quickly red blood cells (also called erythrocytes) fall to the bottom of the test tube. It is a general marker of inflammation. The ESR may be higher than normal with HL.
Immunohistochemistry treats a sample of cells from blood or bone marrow with special antibodies. Chemicals are added that make cells change colour if a certain antibody attaches to them. The change in colour can only be seen under a microscope.
Immunohistochemistry helps doctors determine the types of cells present in a sample, including if there are Hodgkin and Reed-Sternberg (HRS) cells. Immunohistochemistry can rule out HL. It can also point to non-Hodgkin lymphoma or other diseases.
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. These tests are also used as a baseline that doctors can check against during treatment.
Find out more about blood chemistry tests.
During a bone marrow aspiration and biopsy, the doctor removes tissues or cells from the bone marrow so they can be tested in a lab. This test may be used to stage Hodgkin lymphoma in children who have signs that the cancer has spread outside the lymphatic system to the lungs, liver, bones or other parts of the body.
Find out more about bone marrow aspiration and biopsy.
An x-ray uses small doses of radiation to make an image of the body’s structures on film. A chest x-ray may be used to check for swollen lymph nodes in the chest.
Find out more about x-ray.
A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.
A CT scan is used to:
- measure the size of a tumour
- check for swollen lymph nodes in the neck, chest, abdomen or pelvis
- see if the cancer has spread to any organs, such as the lungs, liver or spleen
Find out more about CT scan.
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.
An MRI can be used to check for swollen lymph nodes in the chest, abdomen or pelvis.
Find out more about MRI.
A bone scan uses bone-seeking radioactive materials (called radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if childhood HL has spread, or metastasized, to the bones.
Bone metastases are not common in children with HL, so this test is usually only done if the disease seems to be advanced at diagnosis. A bone scan may be done if a child has bone pain or if blood tests suggest a problem with the bones.
Find out more about bone scan.
A gallium scan is a nuclear medicine imaging test used to look for areas of inflammation or infection. It is also used to look for certain tumours, such as Hodgkin lymphoma. A gallium scan uses the radioactive isotope gallium, which is known to build up in inflamed, infected or cancerous tissues. A gallium scan may be used to help diagnose and monitor children with Hodgkin lymphoma.
Find out more about gallium scan.
A positron emission tomography (PET) scan may be used instead of or in addition to a gallium scan. PET scan uses radioactive materials called radiopharmaceuticals to look for changes in metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.
A PET scan can help show if a swollen lymph node contains Hodgkin lymphoma or if the swelling is caused by a non-cancerous condition. It is also used to find Hodgkin lymphoma that has spread to other areas of the body and to measure how well treatment is working.
PET scans may not be available in all cancer treatment centres. Find out more about PET scan.
Questions to ask your healthcare team
A procedure that uses gallium (a radioisotope) to produce images of structures and organs inside the body.
Doctors use gallium scan to look for inflammation, an abscess (collection of pus), tumours or other signs of disease. They may also use gallium scans to measure a person’s response to cancer treatment.
Gallium scan is a type of nuclear scan.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.