How is Hodgkin's lymphoma diagnosed?
If your doctor suspects that you may have a Hodgkin's lymphoma you will be referred to a specialist. A specialist will normally arrange a biopsy of one of the swollen glands (nodes). During a biopsy procedure a small sample of tissue is removed from a part of the body. The sample is then looked at under the microscope to look for abnormal cells. Usually an entire lymph gland is removed to look at under the microscope.
In Hodgkin's lymphoma, a cell called the Reed-Sternberg cell is seen when the biopsy sample is examined under the microscope. (This cell is named after the two doctors who first described it. The Reed-Sternberg cell is a B lymphocyte that has become cancerous.) The presence of the Reed-Sternberg cell confirms the diagnosis, as it is only found in Hodgkin's lymphoma. Only about 1 in 1,000 of the cells in a Hodgkin's lymphoma are Reed-Sternberg cells. There are various other cells which make up the tumour. However, Reed-Sternberg cells are the characteristic cancerous cells found in this condition.
There are various subtypes of Hodgkin's lymphoma. The cells in the biopsy sample can be tested in various other ways to find out exactly which type it is. However, all types include the characteristic Reed-Sternberg cell, and the treatment and outlook are similar for all the types of Hodgkin's lymphoma.
How do you assess the extent and spread of the lymphoma?
If the biopsy confirms that you have a Hodgkin's lymphoma then further tests are usually advised. For example, you may have a computerised tomography (CT) scan, a magnetic resonance imaging (MRI) scan, a positron emission tomography (PET) scan, blood tests, a bone marrow biopsy or other tests. (See separate leaflets which describe each of these tests in more detail.) This assessment is called 'staging'. The aim of staging is to find out how much the lymphoma has grown and whether it has spread to other lymph nodes or to other parts of the body. The staging system that is commonly used for Hodgkin's lymphoma is:
- Stage I - the lymphoma affects one group of lymph nodes only.
- Stage II - the lymphoma affects two or more groups of lymph nodes. However, they are all on the same side of the diaphragm. (The diaphragm is the large muscle that separates the chest from the tummy (abdomen) and helps us to breathe. So, for stage II, all the affected nodes will either be above or below the diaphragm.)
- Stage III - the lymphoma affects nodes on both sides of the diaphragm.
- Stage IV - the lymphoma affects parts of the body outside of the lymphatic system.
Each stage is also divided into A or B. A means that you do not have symptoms of night sweats, high temperature (fever) or weight loss. B means that you do have one or more of these symptoms.
As an example, if you have Stage IIB, it means that you have two or more groups of lymph nodes affected; however, both are either above or below the diaphragm and you also have one or more of night sweats, fevers or weight loss.
By finding out the stage of the lymphoma it helps doctors to advise on the best treatment options. See separate leaflet called Staging and Grading Cancer for more detail.
Did you find this information useful?
- Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis treatment and follow-up; European Society for Medical Oncology (2014)
- Guideline on the Management of Primary Resistant and Relapsed Classical Hodgkin Lymphoma; British Committee for Standards in Haematology and the British Society of Blood and Marrow Transplantation (2013)
- Classical Hodgkin Lymphoma - First Line Management; British Committee for Standards in Haematology (2014)
- Ansell SM; Hodgkin lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016 Jun 91(4):434-42. doi: 10.1002/ajh.24272.
- Gobbi PG, Ferreri AJ, Ponzoni M, et al; Hodgkin lymphoma. Crit Rev Oncol Hematol. 2013 Feb 85(2):216-37. doi: 10.1016/j.critrevonc.2012.07.002. Epub 2012 Aug 4.
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