Hodgkin lymphoma diagnosis
How is Hodgkin lymphoma diagnosed?
General examination and blood tests
At a general examination a doctor will look and feel for any swelling of the glands in your neck, armpits and groin. Your abdomen and chest will also be examined for any signs of enlarged organs or fluid collection. The doctor will also ask you about any other symptoms you might have. At this stage some blood samples may be taken to check how well your bone marrow, liver and kidneys are functioning. If the doctor suspects that you might have Hodgkin lymphoma, further testing will need to be done to help confirm the diagnosis.
A biopsy involves removing a lymph node or a sample of tissue from a suspicious lump for examination in the laboratory. There are different types of biopsies. A core or fine needle biopsy involves inserting a needle into a lymph node or lump and removing a sample of tissue. This is usually done under local anaesthetic, while you are awake.
If the affected lymph node is deep inside the body the biopsy may be done with the help of ultrasound or specialised x-ray (imaging) guidance. You will need a general anaesthetic for this and you will have a few stitches afterwards.
If the swollen gland is in the abdomen or pelvis, a surgical procedure called a laparoscopy is performed in which a narrow tube with a microscope attached is inserted through a small cut in the skin. It allows the surgeon to see the inside of your abdomen or pelvis, and to take a biopsy if needed. This is done under general anaesthetic and you will have a few stitches afterwards.
Once the tissue samples are removed they are examined in the laboratory by a pathologist. It can take a few days for the final results of the biopsy to come through. Knowing the exact type of lymphoma you have is important because it provides information on the most likely course of your disease and the best way to treat it.
Further tests after diagnosis
Once a diagnosis of Hodgkin lymphoma is made further tests need to be done to find out the extent to which the disease has spread in your body (the stage), and the effect it is having on important body organs. These tests include:
Blood tests are important because they provide a baseline set of results regarding your disease and general health. These results can be compared with later results to assess how well you are progressing.
CT scans (computerised tomography)
CT scans of the chest, abdomen and pelvis are often used to assess the spread of lymphoma in the body.
MRI (magnetic resonance imaging)
An MRI may be done when the doctor needs very clear pictures of the brain and spinal cord, to see if these areas are affected by cancer.
This is an imaging technique that involves the use of radioactive gallium (a type of metal in a liquid form). The gallium is injected into a vein in your hand or arm at the nuclear medicine department of the hospital. You leave the unit and return 24-48 hours later by which time your body is scanned from several different angles, to detect the presence of lymphoma.
PET scanning (positron emission tomography)
A PET scan uses radioactive glucose, which is injected into a vein in your hand or arm. Using this technology slow-growing lymphomas can be distinguished from fast-growing ones because of the rate at which the glucose is used by the different cells.
Bone marrow biopsy
If the results of your blood tests suggest that you might have lymphoma, a bone marrow biopsy may be required to help confirm the diagnosis. A bone marrow biopsy involves taking a sample of bone marrow (usually from the back of the hip bone) and sending it to the laboratory for examination under the microscope. The bone marrow biopsy may be done in the haematologist’s rooms, clinic or day procedure centre and is usually performed under local anaesthesia with sedation given either by tablet or through a small drip in your arm. The sample of bone marrow is examined in the laboratory to determine the number and type of cells present and the amount of haemopoiesis (blood forming) activity taking place there.