Diagnosis
If a person has symptoms of Hodgkin lymphoma, a doctor should take his or her medical history and conduct a physical exam to determine what might be causing them. During the physical exam, a doctor should thoroughly examine the lymph nodes If the doctor suspects Hodgkin lymphoma, he or she should order further evaluation which may include laboratory tests (bloodwork), imaging with ultrasound or CT scan and ultimately a lymph node biopsy to be certain. Here are some of the procedures the doctor may recommend to diagnose Hodgkin lymphoma:lymphoma:
Fine Needle Aspiration/Core Needle Biopsy
The doctor may first recommend a fine needle aspiration biopsy or a core needle biopsy to diagnose the cause for an enlarged lymph node or lump found on examination, although fine needle aspiration alone is not adequate to establish a diagnosis of Hodgkin lymphoma. In both procedures, a radiologist may use a CT scan or an ultrasound examination to guide a needle to the abnormal lymph node and extract a tissue sample. Fine needle aspirations obtain less tissue than a core needle biopsy provides. Sometimes, if the node can be easily felt, a surgeon may perform this test without using any X-ray tests. The doctor should send this sample to a pathologist, who will examine it under a microscope and make a diagnosis. Sometimes, these tests can diagnose the presence of Hodgkin lymphoma, but sometimes this type of test is not completely accurate in making a diagnosis. If the doctor still suspects Hodgkin lymphoma, he or she will most likely recommend an excisional or incisional biopsy, as the needle biopsies may not provide a large enough tissue sample to provide a definitive diagnosis. However, after making a certain diagnosis of Hodgkin lymphoma, the doctor may recommend additional needle biopsies to check for spread of this cancer to another part of the body.
Excisional/Incisional Lymph Node Biopsy
The doctor may recommend that a surgeon remove either an entire swollen lymph node (excisional biopsy) or a small piece of it (incisional biopsy) and have it sent to a lab to be examined under a microscope for signs of Hodgkin lymphoma. A pathologist will examine the size, shape, and arrangement of the cells in the tissue sample to determine if Reed-Sternberg cells are present and to identify the specific type of Hodgkin lymphoma. An excisional biopsy is the most reliable method of diagnosing this disease, although an incisional biopsy can be enough in cases where the node is very large.
Immunophenotyping and Immunohistochemistry
Diagnosing Hodgkin lymphoma can be difficult and sometimes examination of the cells under a microscope is not enough to provide a definitive diagnosis. The pathologist may use special stains to identify certain proteins found on cells of the different types of Hodgkin lymphoma to help diagnose the disease.
Blood Tests
The doctor may recommend blood tests such as a complete blood count (CBC) with differential to determine the levels of different cells in the blood, or a blood chemistry test to monitor protein levels, and liver and kidney function. They may also recommend an erythrocyte sedimentation rate (ESR) which can be useful as both a prognostic marker and in following response to therapy. These tests are not used to diagnose the disease, but can help with determining risk scores for prognosis, detect problems caused by disease involvement and are also useful in monitoring the side effects of therapy.
Echocardiogram (or MUGA):
Certain chemotherapy drugs commonly used to treat Hodgkin lymphoma can cause heart damage. An ultrasound of the heart is called an echocardiogram. Ultrasounds bounce sound waves off of your internal organs in order to create echoes that form a picture. The doctor may obtain regular echocardiograms while on these medications to monitor the size and function of the heart. Some doctors will order nuclear medicine scans (MUGA) for cardiac function just to give ejection fraction.
Pulmonary Function Test (PFT)
Certain chemotherapy drugs used to treat Hodgkin lymphoma can damage the lungs. PFTs measure how efficiently lungs inhale air and distribute oxygen throughout the body. In this test, the patient breathes in through a mouthpiece as deeply as possible and exhales for as long as possible. The doctor may recommend regular PFTs while on these medications to monitor lung function.
Bone Marrow Aspiration & Biopsy
The doctor performs this procedure to get a sample of the patient's bone marrow for further testing. This is only recommended in certain situations. For this test, a doctor or nurse will numb the patient's hip bone and use a needle to extract a small fragment of solid bone marrow and some liquid bone marrow. This test can be done in the hospital or doctor’s office, and most patients can go home right after the test. The doctor will then use a microscope to examine the bone marrow tissue and determine if there are lymphoma cells, and if so, how many.
Chest X-ray
X-rays use electromagnetic radiation to produce images of the inside of the body. The doctor may order a chest X-ray to see whether the cancer has spread to the lungs, or to evaluate the size of nodes in the chest.
Computed Tomography (CT) Scan
A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan reveals the presence of tumors and whether or not the cancer has spread to other parts of the body. After treatment is finished, doctors have found that CT scans often have some leftover tissue that can be seen on this type of scan. Studies have shown that often these leftover findings are scar tissue, and are not active cancer.
Magnetic Resonance Imaging (MRI) Scan
Magnetic resonance imaging (MRI) uses radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body. Doctors use MRIs to assess cancer spread and the bones. MRI can also evaluate the brain and spinal cord, although these are very rare sites of involvement in Hodgkin lymphoma.
Positron Emission Tomography (PET) Scan
Doctors use PET scans to better evaluate the location of Hodgkin lymphoma. These pictures on a PET scan are not quite as detailed as those on a CT scan, but instead show more general images of the whole body. Studies have shown that PET scans are often better than CT scans at finding Hodgkin lymphoma. In certain circumstances, PET scans are used in the middle of treatment to decide if changes to treatment need to be made. Also, after finishing treatment for Hodgkin lymphoma doctors will monitor with the PET scan to ensure it shows no signs of the disease, especially in cases where the CT scan still shows enlargement of nodes or possible scar tissue. Often times a combined PET/CT is used.
