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Tests and diagnosis
By Mayo Clinic staffBecause the symptoms of Hodgkin's lymphoma are similar to those of other disorders, such as influenza, the disease can be difficult to diagnose. Some distinctive characteristics help diagnose Hodgkin's lymphoma, and these include:
- Orderly spread to lymph nodes. The pattern of spread is orderly, progressing from one group of lymph nodes to the next.
- Only rare 'skipping' of lymph nodes. The disease rarely skips over an area of lymph nodes as it spreads.
These tests and procedures help diagnose Hodgkin's lymphoma.
- Biopsy. Taking a tissue sample (biopsy) of an enlarged lymph node is the most common way to make a definite diagnosis. Once a sample is removed, the tissue is examined for malignant cells.
- Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
- X-rays. These pictures can reveal swollen lymph nodes in the body.
- Computerized tomography (CT) scan. This is a series of pictures of the inside of your body, usually the chest, abdomen and pelvis. You usually swallow a dye or it's injected into your veins so that your organs and tissues will show up more clearly.
- Magnetic resonance imaging (MRI). A device that uses a magnet, radio waves and computer provides your doctor with a series of detailed pictures of the inside of your body.
- Positron emission tomography (PET) scan. A small amount of radioactive glucose (sugar) is injected into your vein. Glucose becomes more concentrated around cancerous cells, so when a scanner takes pictures of your body it can reveal where the cancer is located.
- Bone marrow aspiration and biopsy. A small amount of bone marrow, blood and bone are removed through a needle and are examined for signs of cancer.
- Blood tests. A sample of your blood is examined in a lab to see if anything in your blood indicates the possibility of cancer.
Staging Hodgkin's lymphoma
Once the diagnosis is confirmed, doctors "stage" the disease. Staging is how doctors determine the extent of the disease, which will affect your treatment options.
- Stage I. The cancer is limited to one lymph node region or a single organ.
- Stage II. In this stage, the cancer is in two different lymph nodes or the cancer is in a portion of tissue or an organ and nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
- Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
- Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.
Additional definitions of the cancer
Additionally, your doctor may use the letters A, B, E and S to help define the extent of your cancer and the treatment needed:
- The letter A means that you don't have any significant symptoms as a result of the cancer.
- The letter B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.
- The letter E stands for extranodal, which means that the cancer has spread beyond your lymph nodes.
- The letter S designates a cancer that has spread into your spleen.
The letters B, E and S indicate potentially more serious disease.
- What you need to know about Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/hodgkin/allpages. Accessed June 4, 2009.
- Overview: Hodgkin disease. American Cancer Society. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=84. Accessed June 4, 2009.
- Gottschalk SM, et al. Overview of Hodgkin lymphoma in children and adolescents. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Mauch PM. Clinical presentation and patterns of disease distribution on Hodgkin lymphoma in adults. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Horwitz S, et al. Treatment of advanced stage (stage III-IV) Hodgkin lymphoma. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Bartlett, NL. Modern treatment of Hodgkin lymphoma. Current Opinion in Hematology. 2008;15:408.
- General information about adult Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/adulthodgkins/Patient. Accessed June 7, 2009.
- Ng AK, et al. Late effects of Hodgkin's disease and its treatment. The Cancer Journal. 2009;15:164.
- Complementary and alternative therapies. American Cancer Society. http://www.cancer.org/docroot/ETO/ETO_5.asp?sitearea=ETO. Accessed June 7, 2009.
- Stages of adult Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/adulthodgkins/Patient/page2. Accessed June 7, 2009.
- Ansell SM (expert opinion.) Mayo Clinic, Rochester, Minn. June 12, 2009.
