Diagnosing Hodgkin lymphoma accurately is the first crucial step in managing this type of cancer. The process typically begins when a healthcare professional notices signs or symptoms, often prompting a series of examinations and tests to confirm the diagnosis. This article will guide you through the typical diagnostic journey for Hodgkin lymphoma, outlining the procedures and tests involved.
Initial Steps in Hodgkin’s Lymphoma Diagnosis: Physical Exam and Symptom Review
The diagnostic process for Hodgkin lymphoma frequently starts with a comprehensive physical examination. Your doctor will carefully assess your overall health and specifically look for key indicators of lymphoma. This initial exam is often triggered by you noticing symptoms or during a routine check-up.
Thorough Physical Examination
During the physical exam, a healthcare professional will:
- Discuss your symptoms: You’ll be asked detailed questions about any symptoms you’ve been experiencing, such as unexplained fevers, night sweats, unintentional weight loss, fatigue, and itching. It’s important to be as detailed as possible about when symptoms started, how often they occur, and their severity.
- Review your medical history: Your doctor will inquire about your past illnesses, treatments, and any family history of cancer or immune system disorders. This information helps to build a broader picture of your health context.
- Check for swollen lymph nodes: A hallmark of Hodgkin lymphoma is the enlargement of lymph nodes. The doctor will gently palpate (feel) lymph node areas, including your neck, armpits (underarms), and groin, to check for any swelling. They may also check other areas where lymph nodes are located throughout the body. You should inform your doctor if you have noticed any lumps or areas of tenderness.
Blood Tests: An Early Indicator in Hodgkin’s Lymphoma Evaluation
Blood tests are a standard part of the diagnostic workup for many conditions, including Hodgkin lymphoma. While blood tests alone cannot definitively diagnose Hodgkin lymphoma, they provide valuable information about your overall health and can offer clues that suggest the need for further investigation.
What Blood Tests Reveal
A blood sample is sent to a laboratory for analysis. These tests may include:
- Complete Blood Count (CBC): This test measures different types of blood cells, such as red blood cells, white blood cells, and platelets. Abnormalities in these counts can sometimes be associated with lymphoma or other conditions.
- Blood chemistry tests: These tests evaluate the function of your organs, such as the liver and kidneys, and can detect abnormalities that might be related to lymphoma or other health issues.
- Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP): These are markers of inflammation in the body. Elevated levels can sometimes be seen in Hodgkin lymphoma and other conditions.
- Lactate dehydrogenase (LDH): LDH is an enzyme found in many body tissues. Elevated LDH levels can be found in some lymphoma cases, as well as other conditions.
It’s important to remember that abnormal blood test results don’t automatically mean you have Hodgkin lymphoma. They simply indicate that further testing is necessary to determine the cause of these abnormalities.
Biopsy: The Definitive Test for Hodgkin’s Lymphoma Diagnosis
A biopsy is the cornerstone of Hodgkin lymphoma diagnosis. It is a procedure that involves removing a tissue sample for microscopic examination by a pathologist. This is the only way to definitively confirm the presence of Hodgkin lymphoma and to distinguish it from other conditions.
Types of Biopsies for Hodgkin Lymphoma
For Hodgkin lymphoma, the most common type of biopsy is a lymph node biopsy, as Hodgkin lymphoma typically originates in the lymph nodes. However, biopsies can also be taken from other areas if lymphoma involvement is suspected there.
- Excisional biopsy: This involves the surgical removal of an entire lymph node. It is often the preferred method because it provides the pathologist with the most tissue to examine.
- Incisional biopsy: In this procedure, only a portion of a lymph node is removed. This may be done if the lymph node is very large or in a location where removing the entire node is not feasible.
- Needle biopsy: A needle biopsy uses a thin needle to extract a small sample of tissue from a lymph node or other suspicious area. There are two main types:
- Fine-needle aspiration (FNA) biopsy: Uses a very thin needle to draw out fluid and cells.
- Core needle biopsy: Uses a larger needle to remove a small cylinder (core) of tissue.
The choice of biopsy type depends on factors such as the location and size of the affected lymph node and the preference of your healthcare team.
What Happens After a Biopsy?
The tissue sample obtained during the biopsy is sent to a pathology lab. Pathologists are doctors who specialize in diagnosing diseases by examining tissues and cells under a microscope. For Hodgkin lymphoma diagnosis, pathologists will:
- Examine the tissue under a microscope: They will look for specific types of abnormal cells, particularly Reed-Sternberg cells, which are characteristic of Hodgkin lymphoma.
- Perform special tests: Immunohistochemistry and flow cytometry are common special tests performed on biopsy samples. These tests help to identify specific markers on the surface of the lymphoma cells, which aids in confirming the diagnosis and classifying the subtype of Hodgkin lymphoma.
- Determine the type of Hodgkin lymphoma: There are different subtypes of Hodgkin lymphoma, such as classical Hodgkin lymphoma (which includes nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted subtypes) and nodular lymphocyte-predominant Hodgkin lymphoma. Identifying the subtype is important for treatment planning.
Imaging Tests: Locating Lymphoma and Assessing Extent
Once Hodgkin lymphoma is diagnosed, imaging tests are crucial to determine the extent of the disease within the body. These tests help to visualize lymph nodes and other organs, allowing doctors to see if and where lymphoma is present beyond the initial biopsy site.
Common Imaging Tests Used in Hodgkin Lymphoma Diagnosis and Staging
- Chest X-ray: A chest X-ray can help to identify enlarged lymph nodes in the chest area (mediastinum), which is a common site of involvement in Hodgkin lymphoma.
- Computed Tomography (CT) scan: CT scans use X-rays to create detailed cross-sectional images of the body. They are very helpful in visualizing lymph nodes in the chest, abdomen, and pelvis, as well as assessing involvement of organs like the liver and spleen.
- Magnetic Resonance Imaging (MRI) scan: MRI uses magnetic fields and radio waves to create detailed images of the body’s soft tissues. MRI can be used to evaluate lymph nodes and organs and is particularly useful for assessing the spinal cord and brain if there is suspicion of lymphoma involvement in these areas (which is less common in Hodgkin lymphoma).
- Positron Emission Tomography (PET) scan: A PET scan uses a radioactive tracer to detect areas of increased metabolic activity in the body, which is characteristic of cancer cells. PET scans are highly sensitive for detecting Hodgkin lymphoma and are frequently used for staging and assessing treatment response. Often, PET scans are combined with CT scans (PET-CT) to provide both functional and anatomical information.
Bone Marrow Aspiration and Biopsy: Assessing Bone Marrow Involvement
In some cases of Hodgkin lymphoma, particularly in more advanced stages or certain subtypes, there may be a need to evaluate whether the lymphoma has spread to the bone marrow. Bone marrow is the spongy tissue inside bones where blood cells are made.
The Bone Marrow Exam Procedure
A bone marrow aspiration and biopsy are typically performed together. The procedure usually takes place in the hip bone (pelvis).
- Bone marrow aspiration: A healthcare professional uses a thin needle to withdraw a small amount of liquid bone marrow.
- Bone marrow biopsy: Often done immediately after aspiration, this involves using a slightly larger needle to remove a small core of bone tissue and the marrow within it.
The samples are sent to a lab to be examined for Hodgkin lymphoma cells and to assess the overall health of the bone marrow.
Hodgkin Lymphoma Staging: Defining the Extent of the Cancer
After all diagnostic tests are completed, the results are used to determine the stage of the Hodgkin lymphoma. Staging is a critical process that describes how far the lymphoma has spread. The stage is a major factor in determining the prognosis and guiding treatment decisions.
The Staging System for Hodgkin Lymphoma
Hodgkin lymphoma staging is based on the Lugano classification system, which is a modification of the Ann Arbor staging system. It uses stages 1 through 4, with higher numbers indicating more advanced disease:
- Stage 1: Lymphoma is limited to one lymph node region or lymphoid organ (like the thymus or spleen).
- Stage 2: Lymphoma is in two or more lymph node regions on the same side of the diaphragm (either above or below the diaphragm).
- Stage 3: Lymphoma is in lymph node regions on both sides of the diaphragm (above and below).
- Stage 4: Lymphoma has spread widely to involve one or more extranodal organs (outside the lymph nodes), such as the liver, lungs, or bone marrow, in addition to lymph node regions.
In addition to the stage number, letters are used to further describe the lymphoma:
- A: Indicates the absence of significant systemic symptoms (B symptoms).
- B: Indicates the presence of one or more B symptoms:
- Unexplained fever (higher than 100.4°F or 38°C)
- Drenching night sweats
- Unintentional weight loss of more than 10% of body weight over 6 months
The stage and presence or absence of B symptoms are crucial factors in determining the appropriate treatment approach for Hodgkin lymphoma.
Conclusion: Navigating the Hodgkin’s Lymphoma Diagnosis Journey
Receiving a diagnosis of Hodgkin lymphoma involves a series of steps, starting with a physical exam and symptom review, followed by blood tests, biopsies, imaging scans, and potentially a bone marrow exam. Each test plays a vital role in confirming the diagnosis, determining the extent of the disease, and ultimately guiding the development of an effective treatment plan tailored to your specific situation. Understanding this diagnostic process can empower you as you navigate your healthcare journey.
References
- Lymphoma — Non-Hodgkin. Cancer.Net. https://www.cancer.net/cancer-types/41246/view-all. Accessed Dec. 18, 2023.
- Hodgkin lymphoma treatment (PDQ) — Patient version. National Cancer Institute. https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq. Accessed Feb. 2, 2024.
- Lymphoma — Patient version. National Cancer Institute. https://www.cancer.gov/types/lymphoma. Accessed Feb. 2, 2024.
- Aster JC, et al. Pathogenesis of Hodgkin lymphoma. https://www.uptodate.com/contents/search. Accessed Feb. 5, 2024.
- Hoffman R, et al. Hodgkin lymphoma. In: Hematology: Basic Principles and Practice. 8th ed. Elsevier; 2023. https://www.clinicalkey.com. Accessed Feb. 5, 2024.
- Ansell SM. Hodgkin lymphoma: 2023 update on diagnosis, risk-stratification and management. American Journal of Hematology. 2022; doi:10.1002/ajh.26717.
- Side effects of chemotherapy. Cancer.Net. https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/side-effects-chemotherapy. Accessed Feb. 6, 2024.
- Side effects of radiation therapy. Cancer.Net. https://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/side-effects-radiation-therapy. Accessed Feb. 6, 2024.
- Side effects of a bone marrow transplant (stem cell transplant). Cancer.Net. https://www.cancer.net/navigating-cancer-care/how-cancer-treated/bone-marrowstem-cell-transplantation/side-effects-bone-marrow-transplant-stem-cell-transplant. Accessed Feb. 6, 2024.
- Distress management. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1431. Accessed Jan. 3, 2024.
- Laurent C, et al. Impact of expert pathologic review of lymphoma diagnosis: Study of patients from the French Lymphopath Network. Journal of Clinical Oncology. 2017; doi:10.1200/JCO.2016.71.2083.
- Goyal G, et al. Association between facility volume and mortality of patients with classic Hodgkin lymphoma. Cancer. 2020; doi:10.1002/cncr.32584.
- Member institutions. Alliance for Clinical Trials in Oncology. https://www.allianceforclinicaltrialsinoncology.org/main/public/standard.xhtml?path=%2FPublic%2FInstitutions. Accessed Feb. 7, 2024.
- Membership institution lists. NRG Oncology. https://www.nrgoncology.org/About-Us/Membership/Member-Institution-Lists. Accessed Feb. 7, 2024.
- Hodgkin lymphoma. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1439. Accessed Feb. 5, 2024.
