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. Use the menu to see other pages.
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 if 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 section describes options for diagnosing Hodgkin lymphoma. Your doctor may consider these factors when choosing a diagnostic test:
The type of cancer suspected
Your signs and symptoms
Your age and general health
The results of earlier medical tests
The following tests may be used to help diagnose Hodgkin lymphoma. Not all tests listed below will be used for every person.
- Medical history and physical examination. The doctor will ask detailed questions about your medical history and do a physical examination, which can identify whether the person has experienced some typical symptoms of Hodgkin lymphoma, 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 an affected 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 using a procedure called mediastinoscopy. A thin, lighted tube with a camera and a cutting tool on the end is inserted into the chest through a small cut made just above the breastbone. It may also be possible to do a biopsy using a core needle. 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 tissue 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. If the first biopsy does not have enough tissue to diagnose lymphoma, a second larger biopsy may be needed. 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 complete blood count (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 alone cannot detect Hodgkin lymphoma.
Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image 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, along with an oral liquid to swallow to help take images of the stomach and intestines. People with a history of kidney disease or poor kidney function should not receive a contrast medium given into a vein (intravenously or IV).
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-CT 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. 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). These bone marrow procedures have been mostly replaced with PET-CT scans, but they may still be done in certain situations.
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. Use the menu to choose a different section to read in this guide.