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Hodgkin Lymphoma Diagnosis: What You Need To Know

Posted on July 23, 2021
Medically reviewed by
Mark Levin, M.D.
Article written by
Aminah Wali, Ph.D.

If your doctor suspects that you have Hodgkin lymphoma (HL), they will take several steps to confirm a diagnosis. Hodgkin lymphoma (HL), also called Hodgkin disease, is a type of cancer that affects cells of the immune system. The cancer forms in a type of white blood cell called lymphocytes. There are two kinds of lymphocytes, T cells and B cells, both of which protect the body from infection. HL involves B and T cells but differently than does non-Hodgkin lymphoma. Lymphocytes can become cancerous and multiply out of control, crowding out the normal healthy cells and giving rise to lymphoma.

HL forms in tissues of the lymphatic system. The most common site of disease is the lymph nodes, but cancer may also occur in the bone marrow, spleen, or liver.

A person with Hodgkin lymphoma, especially aggressive disease, may experience a common set of symptoms known as B symptoms. B symptoms include unexplained weight loss, fevers, and night sweats. Other common symptoms of HL may include fatigue, shortness of breath, and abdominal pain. Upon experiencing symptoms, a person may follow up with a doctor and start the process of lymphoma diagnosis. Many people only show enlargement of lymph nodes.

Diagnostic Tests for Hodgkin Lymphoma

There are many medical tests that doctors use to diagnose Hodgkin lymphoma. Some tests are required to distinguish Hodgkin lymphoma from non-Hodgkin lymphoma. Additionally, certain tests are needed to determine what particular form (subtype) of HL a person has.

Medical History and Physical Examination

Your doctor will start by looking at your medical history. They will confirm any signs or symptoms of lymphoma and explore potential risk factors. Additionally, they will likely perform a physical exam to check for swollen lymph nodes, particularly in the neck, groin, and armpits.

Lymph Node Biopsy

If a doctor suspects HL following the initial exam, they will typically order a lymph node biopsy to confirm the diagnosis. The biopsy most commonly involves the removal of an entire lymph node (excisional biopsy) but may also take just a portion of a lymph node (incisional biopsy).

If you undergo a biopsy, you will be given either local or general anesthesia, depending on the location of the lymph node. After your doctor obtains the sample, the tissue will then be analyzed under a microscope to look for certain lymphoma cells. Most Hodgkin lymphoma subtypes have a specific type of cancer cells called Reed-Sternberg cells, which are large, abnormal B cells. People with HL also have Hodgkin cells (another type of large cancer cell), although they are not quite as large as Reed-Sternberg cells.

Immunohistochemistry

HL can also be confirmed using immunohistochemistry (IHC). IHC is a lab technique that can identify lymphoma cells by recognizing specific protein markers on the surface of certain cells. CD30 is a marker on the surface of Reed-Sternberg and Hodgkin cells, and it can be found using IHC to confirm a diagnosis of Hodgkin lymphoma.

Staging Tests for Hodgkin Lymphoma

Along with a diagnosis, the doctor will typically assign a stage to describe the extent of the disease. HL can be classified as stages 1 through 4. Stage 1 is the earliest stage and stage 4 is the most advanced and widespread disease. The following tests are used to determine how far cancer has spread.

Blood Tests

Blood tests are routinely performed in the case of suspected HL. Different measurements are taken to get an idea of how advanced the cancer is.

Complete Blood Cell Count

A complete blood cell count measures the levels of red blood cells, white blood cells, and platelets. Normal blood cell counts may be low when advanced HL has cancer cells in the blood or bone marrow.

Erythrocyte Sedimentation Rate

The erythrocyte sedimentation rate (ESR) is a measure of how quickly blood cells will settle to the bottom of a tube. A higher ESR indicates a higher degree of inflammation in the body, which may be caused by HL.

Lactate Dehydrogenase Test

Lactate dehydrogenase (LDH) is a protein that is released into the blood when cells are damaged. In a blood test, higher levels of LDH indicate HL activity, which may suggest more active disease.

Viral Infection Tests

A blood test to look for evidence of hepatitis B virus (HBV) and HIV is also typically required. HBV or HIV infection can affect what treatment options are available to a person diagnosed with HL. Hepatitis tests help plan treatment.

Other Blood Tests

A blood test can also be used to get a readout of liver and kidney function, as HL may affect these organs. A blood test also can detect pregnancy and should be used to inform treatment options for people of reproductive age.

Bone Marrow Test

A person diagnosed with HL may also undergo a bone marrow biopsy and aspiration to determine if there are lymphoma cells in the bone marrow. Bone marrow aspiration is performed using a hollow needle to remove liquid bone marrow, and a biopsy collects a sample of bone marrow tissue. These procedures are not always performed in people with HL but may help determine the spread of the disease. This procedure is performed either by a hematologist or under direct imaging by an interventional radiologist.

Imaging Tests

Imaging tests such as X-rays, CT, positron emission tomography (PET), and MRI allow doctors to take images of tissues in the body. Imaging tests can be used to view:

  • Enlarged lymph nodes
  • Spreading of cancer to other tissues
  • Large tumors present at one or a few sites

X-Ray

A chest X-ray can be used to view enlarged lymph nodes in the chest.

Computed Tomography

CT uses many X-rays to make detailed images inside the body. A CT scan can look for enlarged lymph nodes or affected organs in other parts of the body.

Positron Emission Tomography

A PET scan uses mild radioactivity to detect cancer cells in particular. A PET scan is useful for getting information from larger areas of the body and for detecting small numbers of cancer cells in areas that may look normal on a CT scan. A PET scan may be performed in combination with a CT scan, known as a PET-CT scan. It may be repeated after two or three treatment cycles to determine prognosis and plan future treatment.

Magnetic Resonance Imaging

MRI uses radio waves and magnets to take images of tissues. Although not commonly used for HL, MRI may be recommended in specific cases when there is a concern of cancer spreading to the brain or central nervous system.

Talk With Others Who Understand

MyLymphomaTeam is the social network for people with lymphoma and their loved ones. More than 8,500 members understand what it’s like to face lymphoma and can provide support and answers.

Are you or a loved one newly diagnosed with Hodgkin lymphoma? Share your experience in the comments below, or start a conversation by posting on MyLymphomaTeam.

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Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Aminah Wali, Ph.D. received her doctorate in genetics and molecular biology from the University of North Carolina at Chapel Hill. Learn more about her here.

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