Diagnosis | Leukemia and Lymphoma Society

Your doctor will take a comprehensive medical history and ask questions regarding your symptoms. A physical examination will include measurement of all ... Skiptomaincontent Lymphoma HodgkinLymphoma SignsandSymptoms Diagnosis HodgkinLymphomaSubtypes HodgkinLymphomaStaging PrognosticFactors Treatment ChildhoodHodgkinLymphoma Non-HodgkinLymphoma GetPersonalizedInformation&Support  1-800-955-4572  LiveChat  Email Havingthecorrectdiagnosisisimportantforgettingtherighttreatment.Hodgkinlymphoma(HL)maybedifficulttodiagnosis. Youmaywanttogetasecondmedicalopinionbyanexperiencedhematopathologistbeforeyoubegintreatment. Ahematopathologistisaspecialistwhostudiesbloodandbonemarrowcellsandothertissuestohelpdiagnosediseasesoftheblood,bonemarrowandlymphsystem. PatientEvaluation Yourdoctorwilltakeacomprehensivemedicalhistoryandaskquestionsregardingyoursymptoms.Aphysicalexaminationwillincludemeasurementofallaccessiblelymphnodegroups(neck,underarmsandgroin)aswellasthesizeofpalpableorganssuchasthespleenandliver. LymphNode Biopsy AbiopsyofanenlargedlymphnodeisneededtodiagnoseHL.Thepreferredandmostcommontypeofbiopsyiscalledan“excisionalbiopsy,”inwhichthewholelymphnodeistypicallyremoved(excised).Ifthelymphnodeisjustundertheskin,thebiopsyprocedureisusuallysimpleandcansometimesbedonewithanumbingmedication(localanesthetic).Ifthelymphnodeisinsidethechestorabdomen(stomacharea),youmaybesedatedorreceivegeneralanesthesia. Thebiopsysampleswillbesenttoahematopathologist,adoctorwhohasspecialtrainingindiagnosingblooddiseasesbystudyingcellsunderamicroscope.Thehematopathologistexaminesthesamplesusingamicroscopetolookforcancercells. Thelymphnode biopsy'spurposeistoconfirma diagnosis and IdentifyyourHodgkinlymphomasubtype Developatreatmentplan ItisimportantthataspecialistwithexperienceindiagnosingHLanalyzesthebiopsytissue.Pathologyslidesmaybesenttoaspecialtycenterforconfirmationofdiagnosis.  Immunophenotyping Thislaboratorytestcandetectspecificcancercellsbasedonthetypesofantigensorproteinsonthesurfaceofthecells.Immunophenotypingisusedtohelpdiagnosespecifictypesofleukemiaandlymphoma. Someofthesetestsmayberepeatedbothduringandaftertherapytomeasuretheeffectsoftreatment. NextGenerationSequencingandLiquidBiopsies Nextgenerationsequencing(NGS)testscanrapidlyexaminestretchesofDNAorRNA.ThistechnologycandetectmutationsandothergeneticabnormalitiesinDNAextractedfrombloodorbonemarrowsamples.DuetothelowabundanceofReed-Sternbergcells,performinggeneticanalysisfromtumorsamplesinHodgkinlymphomacanbedifficult. Thismethodiscurrentlyunderinvestigationinclinicaltrials,anditcouldbecomeacomplementarymethodtotissuebiopsyinthenearfuture.Itcouldbeparticularlyusefulincaseswhereatumormassisdifficulttobiopsyorwhenthereisverylittletissueremovedthroughbiopsy. StagingTests Onceyourhematologist-oncologistconfirmsaHodgkinlymphomadiagnosis,heorsheordersmoreteststostageyourdisease.Stagingidentifiestheextentofyourdiseaseandwhereit'slocatedinyourbody. Stagingtestsinclude: Imagingtests Bloodtests Bonemarrow tests Someofthesetestsmayberepeated,bothduringandaftertherapy,tomeasuretheresponsetotreatment. ImagingTests Imagingtestshelpthedoctorevaluate: Thelocationanddistributionofenlarged lymphnodes Whetherorgansotherthanlymphnodesareinvolved Whetherthereareverylargemassesoftumorsinonesiteoranother Imagingtestsmayinclude: ChestX-ray CT (computedtomography)scan oftheneck,chest,pelvisandabdomen(stomacharea) PET-CTscan(positronemissiontomography-computedtomography)scan,acombinationPETandCTscan,oftheentirebodywith aradioactivetracer Thisisalsoreferredtoasa"FDG-PETscan" (fluorodeoxyglucose[FDG]positronemissiontomography[PET]).  MRI(magneticresonanceimaging),inselectcases   BloodTests Bloodtestsmayinclude  Completebloodcount(CBC). Thistestmeasuresthenumberofbloodcellsinasample,includingredbloodcells,whitebloodcells,andplatelets.Alowlevelofredbloodcells,whitebloodcellsorplateletsmayindicatethatthelymphomaispresentinthebonemarrowand/orblood. Erythrocytesedimentationrate(ESR).Thistestisdonetodeterminetherateatwhichtheredbloodcellssettletothebottomofatube.The“sedimentation”rateisameasureofhowmuchinflammationisinthebody.Inflammationisthebody’sattempttohealitself.TheESRmaybehigherthannormalforsomepeoplewithHL. Lactatedehydrogenase(LDH).Thisisaproteinnormallypresentinmostcellsthatisreleasedintothebloodwhenacellisdamaged.AhighlevelofLDHinthebloodisasignofcelldamage.ThelevelofLDHcanbehigherthannormalinpeoplewithHLwhenthecancerismoreactiveanddoingmoredamagetocells. Liverandkidneyfunctiontests. Thesetestscanhelpdetermineifcancerhasaffectedtheseorgans.  Humanimmunodeficiencyvirus(HIV)andhepatitisBtesting. TestsforbothHIVandhepatitisBshouldbepartofthepretreatmentworkupforpatientswithHL,sincethesediseasescanaffectcancertreatment.  HeartandLungTests SomeHLtreatmentsmayweakenordamagetheheartandlungs.Thehealthcareteammaydecidetotesthowwelltheseorgansworkbeforetreatment,inordertoplanappropriatetreatment. PregnancyTest Somecancertreatmentscanharmanunbornbaby,soapregnancytestmayberequiredforwomenofreproductiveagebeforetheycanstartcertaintreatments.Treatmentoptionsmaydependontheresults.  BoneMarrow Tests SomepatientswhohavebeendiagnosedwithHLmayneedtoundergoabonemarrowaspirationandbiopsy.ThesetestsarenottypicallyusedtodiagnoseHL,buttheymaybedoneafterdiagnosistoseeiftherearelymphomacellsinthebonemarrow.Thedoctorwilldecideiftheseproceduresarenecessary.Also,theneedforabonemarrowbiopsymaybeeliminatedbytheuseofaPETscantoassessthedisease. RelatedLinks LabandImagingTests BloodTests UnderstandingBloodCounts BoneMarrowTests DownloadororderTheLeukemia&LymphomaSociety'sfreebooklet, HodgkinLymphoma. PreviousArticle SignsandSymptoms NextArticle HodgkinLymphomaSubtypes