Doctors use many tests to diagnose cancer and determine the extent of the disease. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. Your doctor may consider these factors when choosing a diagnostic test:
- Age and medical condition
- The type of cancer suspected
- Severity of symptoms
- Previous test results
The following tests may be used to 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 and fevers, and affected or 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 the diagnosis of Hodgkin lymphoma can only be made after a biopsy of an affected piece of tissue. Most commonly, this will be a lymph node 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 obtain a biopsy using a needle under local anesthesia, while the patient is undergoing a scan (most commonly a computed tomography [CT or CAT] scan, see below). The CT scan is used to help make sure the biopsy is taken from the appropriate place.
The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). As described in the Overview, a biopsy of CHL usually has Reed-Sternberg cells. Reed Sternberg cells are often absent in the nodular lymphocyte predominant Hodgkin lymphoma, which usually has a different type of cancerous cell, called the L & H or popcorn cell.
Once a diagnosis has been made, other tests can help determine the extent of the disease or stage and other information to help doctors plan treatment. These tests include the following:
Laboratory tests. Blood tests may include a complete blood count and analysis of the different types of white blood cells, in addition to liver function tests. The doctor may also test for the erythrocyte sedimentation rate (ESR), also called the "sed rate."
Imaging tests. To determine where the cancer is located and whether it has spread, the doctor may use the following imaging tests:
CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (special dye) is injected into a patient’s vein to provide better detail. A CT scan of the chest and abdomen can help find cancer that has spread to the lungs, lymph nodes, and liver.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. This is sometimes used in Hodgkin lymphoma.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. PET scans may be used to determine the stage of Hodgkin's lymphoma, although they should always be done in conjunction with a CT scan. PET scans may also be used to see how well the Hodgkin's disease is responding to treatment.
Bone marrow biopsy. In a bone marrow biopsy, a needle is inserted through the skin into the back of the pelvic (hip) bone. A small amount of bone and bone marrow are taken, either under local anesthesia to numb the area or with sedation. The small amount of bone and bone marrow are examined under a microscope. The decision regarding the need for a bone marrow biopsy depends on the extent of the disease, and the results of certain laboratory tests.
To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.
To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.
Last Updated: September 23, 2008
