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 spread). 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 and risks 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
• Epstein-Barr virus (EBV) infection
• HIV or AIDS

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:

• check if any lymph nodes are larger than normal (enlarged)
• feel the abdomen to see if the liver or spleen is larger than normal
• listen to the lungs for any breathing problems

Find out more about physical exams.

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 an 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)..

Doctors may order a blood test to measure the erythrocyte sedimentation rate (ESR). The ESR measures how quickly red blood cells (also called erythrocytes) 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.

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. Blood chemistry tests used to help stage HL include the following.

Lactate dehydrogenase (LDH) can be used to measure how well the liver is working, but it also shows cell damage. Levels can be higher than normal in HL when the cancer is more active and damaging cells.

Alanine aminotransferase (ALT) and aspartate transaminase (AST) may be measured to check how well the liver is working. Higher than normal levels of ALT or AST may mean that HL has spread to the liver.

Alkaline phosphatase may be measured to check how well the liver is working and to check 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 how well the kidneys are working. A higher than normal level of creatinine in the blood may mean that HL has damaged the kidney.

Find out more about blood chemistry tests.

An HIV test may be done if doctors think that HL is related to an HIV (human immunodeficiency virus) infection. An HIV test is a blood test that measures the level of HIV antibodies in the blood. A high level of these antibodies means the body is infected with HIV.

Blood tests for hepatitis B and hepatitis C may be done because having either one can affect how treatments work. Certain chemotherapy drugs could cause problems if you have these infections. If you have hepatitis B or hepatitis C, your healthcare team can make changes to your treatment plan to make it safer.

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 lymph nodes in the chest. It is also used to see if HL has spread to the lungs.

Find out more about x-rays.

A computed tomography (CT) scan uses special x-ray equipment to make 3D 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 may be used to check for enlarged lymph nodes or a mass in the neck, chest, abdomen or pelvis. It also allows doctors to see if a tumour is pressing on any organs or large blood vessels and if there is any disease in the brain or near the spinal cord. A CT scan may also be used to see if the cancer has spread to any organs, such as the lungs, liver or spleen.

Usually a CT scan is combined with a PET scan (called a PET-CT scan) to find more information about the cancer.

Find out more about CT scans.

A positron emission tomography (PET) scan uses a type of radioactive sugar to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan may be used to look for HL that has spread from where it started to other areas of the body or to measure how well treatment is working. It is typically combined with a CT scan for a more complete picture and 3D assessment of the disease.

Find out more about PET scans.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to examine the abdomen and organs that may be affected by HL, such as the kidneys, spleen or liver.

Find out more about ultrasounds.

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 3D pictures.

An MRI can be used to check for enlarged lymph nodes in the chest, abdomen or pelvis. It can also be used to see if the cancer has spread to the brain or spinal cord. MRI scans are not usually necessary to assess HL but may be used to see if cancer has spread to bone or muscle tissue.

Find out more about MRIs.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. The report from the lab will show whether or not cancer cells are found in the sample.

A biopsy may be done on an enlarged lymph node in the neck, under the arm or in the groin. A biopsy sample may also be taken from a tumour in the chest or abdomen. Doctors may use a CT scan to guide them during a lymph node biopsy in these areas.

The type of biopsy done depends on where the doctors need to collect the samples from.

A surgical lymph node biopsy is usually done to collect samples from lymph nodes. The surgeon may do an excisional biopsy, which removes all of a lymph node. In some cases, doctors may use an incisional biopsy to remove part of a lymph node.

A core needle biopsy may be used for some types of tumours, such as a large tumour in the chest or a tumour in the bone. The surgeon may use a CT scan to guide the needle to the tumour during the biopsy.

Find out more about a surgical biopsy and core needle biopsy.

Immunophenotyping is the study of proteins expressed by cells. It uses a very specific antigen-antibody reaction to identify proteins in tissues or cells. It uses monoclonal antibodies marked with a fluorescent label or specific enzyme label that binds only to specific antigens (proteins). The fluorescent or enzyme label allows doctors to see the lymphoma cells so they can tell the type of HL.

Immunohistochemistry is a method commonly used in immunophenotyping. It uses a microscope to view the fluorescent labels. It also allows doctors to examine cells and their surroundings. Immunohistochemistry helps doctors determine the types of cells in a sample, including if there are Hodgkin and Reed-Sternberg (HRS) or LP cells. Immunohistochemistry can rule out HL. It can also point to non-Hodgkin lymphoma or other diseases.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.