How Is Hodgkin's Lymphoma Diagnosed?

If Hodgkin's lymphoma is suspected, the doctor asks about the person's medical history and performs a physical examination to check general signs of health. The examination includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. The doctor may order blood tests.

The doctor may also order tests that produce pictures of the inside of the body. These may include:

• X-rays - High-energy radiation used to take pictures of areas inside the body, such as the chest, bones, liver, and spleen.
• CT (or CAT) scan - series of detailed pictures of areas inside the body. The pictures are created by a computer linked to an x-ray machine.
• MRI (magnetic resonance imaging) - Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.
  

The diagnosis depends on a biopsy. A surgeon removes a sample of lymphatic tissue (part or all of a lymph node) so that a pathologist can examine it under a microscope to check for cancer cells. Other tissues may be sampled as well. The pathologist studies the tissue and checks for Reed-Sternberg cells, large abnormal cells that are usually found with Hodgkin's lymphoma.

A patient who needs a biopsy may want to ask the doctor some of the following questions:

• Why do I need to have a biopsy?
• How long will the biopsy take? Will it hurt?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?
  

If the biopsy reveals Hodgkin's lymphoma, the doctor needs to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Treatment decisions depend on these findings.

The doctor considers the following to determine the stage of Hodgkin's lymphoma:

• The number and location of affected lymph nodes
• Whether the affected lymph nodes are on one or both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen)
• Whether the disease has spread to the bone marrow, spleen, or places outside the lymphatic system, such as the liver

In staging, the doctor may use some of the same tests used for the diagnosis of Hodgkin's lymphoma. Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. Rarely, an operation called a laparotomy may be performed. During this operation, a surgeon makes an incision through the wall of the abdomen and removes samples of tissue. A pathologist examines tissue samples under a microscope to check for cancer cells.