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Hodgkin lymphoma

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Diagnosing Hodgkin lymphoma

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for Hodgkin lymphoma (HL) are usually done when:

  • the symptoms of HL are present
  • the doctor suspects HL after talking with a person about their health and completing a physical examination
  • routine blood tests or chest x-ray suggest a problem

Many of the same tests used to initially diagnose cancer are used to determine 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. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person’s family may also help the doctor to diagnose HL.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • infection with the Epstein-Barr virus
    • infectious mononucleosis
    • immunodeficiency disorders
    • autoimmuneautoimmuneA disorder in which the immune system attacks healthy tissues in the body. disorders
  • a family history of HL
  • signs and symptoms that may suggest HL

A physical examination allows the doctor to look for any signs of HL. During a physical examination, the doctor may:

  • feel the lymph nodeslymph nodesA small, bean-shaped mass of lymphatic tissue along lymph vessels (tubes through which lymph fluid travels in the body). Lymph nodes store lymphocytes (a type of white blood cell that fights germs, foreign substances or cancer cells) and filters bacteria and foreign substances (including cancer cell in the neck, under the jaw, above the collarbone, in the armpit and in the groin to see if they are enlarged
  • examine the abdomen to check for any enlarged organs, such as an enlarged liver (hepatomegaly) or spleen (splenomegaly)
  • listen to the lungs
  • check for signs of infection that may cause lymph nodes to swell
  • check the abdomen and legs for swelling that may be caused by extra fluid if swollen lymph nodes are blocking the flow of lymph fluid

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Lymph node biopsy

During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. A lymph node biopsy is done to diagnose HL and to determine the subtype. All or part of a lymph node may be removed. The type of biopsy done depends on where the enlarged lymph nodes are:

  • surgical biopsy
    • excisional biopsy – removes the entire lymph node and is the preferred method, whenever possible
    • incisional biopsy – removes part of the lymph node
  • core needle biopsy – removes tissue from a lymph node with a hollow needle

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 computed tomography (CT) scan. If the lymph node is near the surface of the skin, the lymph node biopsy may be done with a local anesthetic. If it is deeper inside the body and not as easy to get to, then a general anesthetic may need to be used.

The pathology report from the laboratory will confirm whether or not cancer cells, especially Hodgkin and Reed-Sternberg cells, are present in the sample.

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Erythrocyte sedimentation rate

A blood test is used to measure the erythrocyte sedimentation rate (ESR). The 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 HL.

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Immunohistochemistry

Immunohistochemistry (or immunocytochemistry) treats a sample of cells from blood or bone marrow with special antibodiesantibodiesA type of protein made by the immune system that disarms or destroys a specific foreign substance (antigen) when it appears in the body.. Chemicals are added that make the cell change colour if a certain antibody attaches to it. The change in colour can only be seen under a microscope. Immunohistochemistry helps determine the types of cells that are present, including Hodgkin and Reed-Sternberg cells. Immunohistochemistry may rule out HL or may point to non-Hodgkin lymphoma or other diseases.

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Complete blood count

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:

  • help rule out infection
  • assess how well the blood-forming organs (such as the bone marrow and spleen) are working and to see if HL cells have spread to the bone marrow
  • provide a baseline for future blood counts taken during and after treatment

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to help stage HL.

  • Increased lactate dehydrogenase (LDH)lactate dehydrogenase (LDH)An enzyme that is involved in energy production in cells. may indicate advanced HL that has spread to the liver.
  • Increased alanine aminotransferase (ALT) and aspartate transaminase (AST) may indicate liver damage from HL.
  • Increased alkaline phosphatase may indicate that HL has spread to the bone or the liver.
  • Increased serum creatinine may indicate that the kidneys have been affected by HL.

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HIV blood test

An HIV blood test may be done if doctors suspect that the 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 has been infected with HIV.

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X-ray

An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to:

  • look for enlarged lymph nodes in the chest
  • look for bone damage if the person is having bone pain or if blood test results suggest that the HL has spread to the bones

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Bone marrow aspiration and biopsy

A bone marrow aspiration and biopsy is a procedure in which a small amount of bone marrow and bone is removed for microscopic examination. This may be done sometimes after diagnosis to determine if the HL has spread to the bone marrow.

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • look for enlarged lymph nodes in the chest, abdomen or pelvis
  • see if internal organs, such as the kidneys, liver or spleen, have been affected by the HL
  • monitor the person’s response to therapy after treatment
  • monitor the person as part of follow-up care

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Bone scan

A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. HL occasionally causes bone damage, which may be seen on a bone scan. A bone scan is usually only done very rarely for patients with HL if they have bone pain or blood test results suggest that the HL has spread to the bones.

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Ultrasound

Ultrasound uses high-frequency sound waves to make images of structures in the body. It may be used:

  • to check for a swollen liver or spleen
  • as guidance during a biopsy

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It may be used if it suspected that HL has spread to the spinal cord or brain.

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Positron emission tomography (PET) scan

A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. It is used to:

  • identify areas in the body that are affected by HL
  • help monitor response to treatment
  • detect recurrences

PET scans are not available in all treatment centres.

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See a list of questions to ask your doctor about diagnostic tests.

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