Lymphoma - Hodgkin - Diagnosis

Approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The following tests may be used to help diagnose Hodgkin lymphoma:

  • Medical history and physical examination. A thorough medical history and physical examination can show evidence of typical symptoms, such as night sweats, fevers, and enlarged lymph nodes or spleen.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but Hodgkin lymphoma can only be diagnosed after a biopsy of an affected tissue, preferably by removal (or excision) of a lymph node. Most commonly, this will be a lymph node affected in the neck, under the arm, or in the groin. If there are no lymph nodes in these areas, a biopsy of other lymph nodes, such as those in the center of the chest, may be necessary. This type of biopsy usually requires minor surgery, although occasionally it is possible to do a biopsy using a core needle during a scan or ultrasound using local anesthesia. Anesthesia is medication to block the awareness of pain. Doctors most commonly use ultrasound or a computed tomography (CT or CAT) scan (see below) to help guide the needle to the correct location.

    A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A hematopathologist is a doctor who has received additional training in blood diseases and blood cancer diagnosis.

    It is important that the biopsy sample is large enough to allow the pathologist to make an accurate diagnosis and determine the subtype of Hodgkin lymphoma. As described in the Introduction, a biopsy of cHL usually has Reed-Sternberg cells. For people with nodular lymphocyte-predominant Hodgkin lymphoma, the Reed-Sternberg cells often look different and are called “LP” cells. In contrast to classic Reed-Sternberg cells, LP cancer cells have a protein on their surface called CD20.

Once Hodgkin lymphoma is diagnosed, other tests can help find out the extent of the disease, the stage, and other information to help the doctors plan treatment. These tests include:

  • Laboratory tests. Blood tests may include a CBC and an analysis of the different types of white blood cells, in addition to the erythrocyte sedimentation rate (ESR or "sed rate") and liver and kidney function tests. Blood tests cannot detect Hodgkin lymphoma.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities, such as enlarged lymph nodes, or tumors. A CT scan of the chest, abdomen, and pelvis can help find cancer that has spread to other parts of the body. A special dye called a contrast medium is usually given before the scan to improve the details of the images. This dye can be injected into a patient’s vein or given as a liquid to swallow. People with a history of kidney disease or poor kidney function should not receive a contrast medium given by IV (vein).

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s vein. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. PET-CT scans may be used to determine the stage of Hodgkin lymphoma. PET scans may also be used to see how the lymphoma is responding to treatment.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow. This test is sometimes used for Hodgkin lymphoma.

  • Lung function tests. Also called pulmonary function tests or PFTs, lung function tests evaluate how much air the lungs can hold, how quickly air can move in and out of the lungs, and how well the lungs add oxygen and remove carbon dioxide from the blood. These tests may be done if a person's treatment plan includes chemotherapy with certain drugs that could affect the lungs.

  • Heart evaluation. A heart evaluation, including an echocardiogram (ECHO) or a multigated acquisition (MUGA) scan, may be used to check the function of the heart if specific types of chemotherapy will be included in a person's treatment plan.

  • Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow is the soft, spongy tissue found inside the center of bones. It has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. A pathologist then analyzes the sample(s). However, bone marrow biopsy is often not necessary if a PET-CT scan has been performed as part of the staging evaluation.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is Hodgkin lymphoma, these results also help the doctor describe the extent of cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.