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Diagnosis of Hodgkin lymphoma
Diagnosis is the process of finding out the cause of a health problem. Diagnosing Hodgkin lymphoma (HL) usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you 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 HL. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of HL.
The following tests are usually used to rule out or diagnose HL. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.
Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:
- symptoms that suggest HL
- infection with the Epstein-Barr virus (which causes mononucleosis) or HIV
- autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus or ulcerative colitis
- smoking tobacco
Your doctor may also ask about a family history of HL.
A physical exam allows your doctor to look for any signs of HL. During a physical exam, your doctor may:
- feel the lymph nodes in the neck, under the jaw, above the collarbone, in the armpit and in the groin to see if they are larger than normal, or enlarged
- feel the abdomen to check for any enlarged organs, such as the liver or spleen
- listen to the lungs
Find out more about a physical exam.
During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will confirm the diagnosis and the type of HL.
The type of biopsy that doctors do depends on where they find the enlarged lymph nodes. They may remove all or part of a lymph node in the neck, armpit or groin. They may also take a sample from a lymph node in the chest or abdomen. They may use a CT scan to guide them during a lymph node biopsy in these areas.
There are 2 types of surgical biopsy:
- Excisional biopsy removes all of the lymph node.
- Incisional biopsy removes part of the lymph node.
Find out more about a surgical biopsy.
Core needle biopsy
A core needle biopsy uses a hollow needle to remove a sample from a lymph node. Find out more about a core needle biopsy.
The erythrocyte sedimentation rate (ESR) is a measure of how quickly red blood cells fall to the bottom of a test tube. It is a general marker of inflammation. The ESR may be higher than normal in some people with HL.
Immunohistochemistry, or immunocytochemistry, uses a very specific antigen-antibody reaction to identify proteins in a sample of cells from the blood or bone marrow. Chemicals are added to the sample to make the 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 in the sample, including if there are Hodgkin and Reed-Sternberg (HRS) cells. It may rule out HL or may point to non-Hodgkin lymphoma (NHL) or other diseases.
Find out more about cell and tissue studies, including immunohistochemistry.
A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to help rule out infection. It also gives doctors a baseline to check against future blood cell counts taken during and after treatment.
Find out more about a complete blood count (CBC).
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests used to help stage HL include the following.
Lactate dehydrogenase (LDH) is a test that can be used to measure liver function but also shows cell damage. Levels can be higher than normal in lymphoma when the cancer is more active and causing destruction of cells.
Alanine aminotransferase (ALT) and aspartate transaminase (AST) may be measured to check liver function. Higher than normal levels of ALT or AST may mean that HL has spread to the liver.
Alkaline phosphatase may be measured to check liver function and the bones. A higher than normal level of this enzyme may mean that HL has spread to the liver or the bones.
Serum creatinine may be measured to check kidney function. A higher than normal level of creatinine in the blood may mean that HL has damaged the kidney.
Find out more about a blood chemistry test.
An HIV blood test may be done if doctors think that HL is related to HIV infection. This test measures the level of HIV antibodies in the blood. A high level of these antibodies means the body is infected with HIV.
An x-ray uses small doses of radiation to make an image of parts of the body on film. A chest x-ray is used to check for larger than normal, or enlarged, lymph nodes in the chest. It is also used to see if HL has spread to the lungs.
Find out more about an x-ray.
Bone marrow aspiration and biopsy remove a small amount of bone marrow and bone so they can be looked at under a microscope. This procedure may be done after diagnosis to find out if the HL has spread to the bone marrow.
Find out more about a bone marrow aspiration and biopsy
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:
- assess enlarged lymph nodes
- examine organs such as the kidneys, liver and spleen
- monitor response to treatments for HL and as part of follow-up care
Find out more about a CT scan.
A bone scan uses bone-seeking radioactive materials (called radiopharmaceuticals) and a computer to create a picture of the bones. It is used to find out if HL has damaged the bones. It may be done if someone with HL has bone pain or blood tests suggest that HL has spread to the bones.
Find out more about a bone scan.
An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to:
- check if the liver or spleen is swollen or if there are other signs that HL is in these organs
- help guide doctors during a biopsy
Find out more about an ultrasound.
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 is used to find out if HL has spread to the spinal cord or brain.
Find out more about an MRI.
A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the 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 is used to:
- find out if an enlarged lymph node contains HL
- identify areas in the body that are affected by HL
- help doctors tell if HL is responding to treatment
- find out if HL has come back (relapsed, or recurred)
Find out more about a PET scan.
Questions to ask your healthcare team
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