Having the correct diagnosis is important for getting the right treatment. Hodgkin lymphoma (HL) may be difficult to diagnosis. You may want to get a second medical opinion by an experienced hematopathologist before you begin treatment. A hematopathologist is a specialist who studies blood and bone marrow cells and other tissues to help diagnose diseases of the blood, bone marrow and lymph system.
Your doctor will take a comprehensive medical history and ask questions regarding your symptoms. A physical examination will include measurement of all accessible lymph node groups (neck, underarms and groin) as well as the size of palpable organs such as the spleen and liver.
Lymph Node Biopsy
Diagnosing Hodgkin lymphoma usually involves performing a lymph node biopsy. The entire lymph node or part of the lymph node is surgically removed (called an "excisional biopsy") so that the hematopathologist has enough tissue to make a firm diagnosis. A hematopathologist examines the sample of the lymph node under a microscope to look for the identifying characteristics of Hodgkin lymphoma. If the biopsy confirms that you have Hodgkin lymphoma, the hematopathologist will categorize the Hodgkin lymphoma into one of several subtypes.
The lymph node biopsy's purpose is to confirm a diagnosis and:
- Identify your Hodgkin lymphoma subtype
- Develop a treatment plan
It is important that a specialist with experience in diagnosing HL analyzes the biopsy tissue. Pathology slides may be sent to a specialty center for confirmation of diagnosis.
The hematopathologist may use a lab test called immunophenotyping to distinguish Hodgkin lymphoma from other types of lymphoma or other cancerous or noncancerous conditions based on the antigens or markers on the surface of the cells.
Some of these tests may be repeated both during and after therapy to measure the effects of treatment.
Once your hematologist-oncologist confirms a Hodgkin lymphoma diagnosis, he or she orders more tests to stage your disease. Staging identifies the extent of your disease and where it's located in your body.
Staging tests include:
- Imaging tests
- Blood tests
- Bone marrow tests
Some of these tests may be repeated, both during and after therapy, to measure the response to treatment.
Imaging tests help the doctor evaluate:
- The location and distribution of enlarged lymph nodes
- Whether organs other than lymph nodes are involved
- Whether there are very large masses of tumors in one site or another
Imaging tests may include:
- Chest X-ray
- CT (computed tomography) scan of the neck, chest, pelvis and abdomen (stomach area)
- PET-CT scan (positron emission tomography-computed tomography) scan, a combination PET and CT scan, of the enitre body with a radioactive tracer
- This is also referred to as a "FDG-PET scan" (fluorodeoxyglucose [FDG] positron emission tomography [PET]).
- MRI (magnetic resonance imaging), in select cases
Blood tests are used to:
- Assess blood counts including red blood cells, white blood cells and platelets;
- Determine whether lymphoma cells are present in the blood;
- Determine whether the immunoglobulins (proteins that fight infection) made by lymphocytes are deficient or abnormal;
- Check indicators of inflammation and disease severity such as blood protein levels, including albumin and lactate dehydrogenase (LDH), uric acid levels and erythrocyte sedimentation rate (ESR);
- Lactate dehydrogenase is a protein found in most cells and LDH levels increase when cells and tissues are damaged
- Erythrocyte sedimentation rate is used to determine if there is inflammation.
- Assess kidney and liver functions.
Bone Marrow Tests
Your doctor may decide to examine your bone marrow to see whether the disease has spread to the bone marrow. Your doctor will decide if this procedure is necessary based on certain features such as the location of the disease in your body. Bone marrow testing may not be required for patients with early-stage favorable disease with low-risk clinical features.
- Bone marrow testing involves two steps usually done at the same time in a doctor's office or a hospital:
- A bone marrow aspiration to remove a liquid sample of bone marrow
- A bone marrow biopsy to remove a core of bone containing marrow
Before creating your treatment plan, your doctor will likely order other tests to better understand your overall health. These tests may include the following.
Human immunodeficiency virus and Hepatitis B Testing
Receiving the appropriate treatment for human immunodeficiency virus (HIV) treatment is an important part of HL treatment as it will improve how well the cancer therapy works. Hepatitis B can also affect how well some cancer treatments work. Both tests should be part of the pretreatment workup.
Heart and Lung Tests
Some HL treatments may weaken or damage the heart and lungs. The healthcare team may decide to test how well these organs work before treatment, in order to plan appropriate treatment.
Some cancer treatments can harm an unborn baby, so a pregnancy test may be required for women of reproductive age before they can start certain treatments. Treatment options may depend on the results.