HL - Diagnosis

Imaging tests are used for both diagnosis and staging. If your medical history and physical exam suggest a possible diagnosis of HL, your physician may order an imaging test to be performed. Imaging tests can include an X-ray of the chest, a CT scan of the chest, pelvis, and abdomen, a magnetic resonance imaging (MRI) scan, a positron emission tomography (PET) scan, or a fluorodeoxyglucose PET (FDG-PET) scan of the entire body with a radioactive tracer.

The purpose of these imaging tests is to look for:

• The location and distribution of swollen lymph nodes 
• Tumor masses outside the lymph nodes in the lung, bone, or other body tissues
• To see if the disease has possibly affected other organs such as the lungs or liver

Diagnosing HL usually involves taking a biopsy of the lymph node(s). If the biopsy confirms that you have the disease, your physician performs additional tests in order to stage the lymphoma. The purpose of the biopsy is to confirm the diagnosis and identify your HL subtype in order to create a treatment plan.

After your doctor takes a biopsy of your lymph node(s), your sample will be sent to a hematopathologist (a specialist who studies blood cell diseases), and your cells will be examined under a microscope to look for biological signs of HL. If the cells are characteristic of HL, the hematopathologist is able to confirm your diagnosis and identify your HL subtype. The hematopathologist may use a lab test called immunophenotyping to identify Reed-Sternberg and Hodgkin cells that distinguish HL from other types of lymphoma and other types of noncancerous conditions.

Since HL can be a difficult disease to diagnose, you might want to get a second medical opinion from an experienced hematopathologist before you start a proposed treatment. HL can sometimes be confused with some types of Non-Hodgkin Lymphoma. The right treatment depends on having the right diagnosis.

Once your hematologist oncologist confirms a HL diagnosis, he or she orders more tests in order to stage your disease. Staging identifies how much disease is present and where it is located in your body.

Staging tests include blood tests, bone marrow tests, and imaging tests.

After your blood is drawn, it will be sent to a lab for a complete blood count (CBC) and additional blood work. Your blood is measured for:

• Levels of red blood cells, white blood cells and platelets
• Blood-protein levels
• Uric acid levels
• Erythrocyte sedimentation rate (the speed that red cells settle at the bottom of a test tube - an increased rate can indicate cancer)
• Liver function

Your physician might decide to conduct a bone marrow examination to see whether the disease has spread. You may not need this test if your disease is at an early stage and/or if some symptoms are not present.

Bone marrow testing involves two steps performed simultaneously in a physician's office or hospital. The first step is a bone marrow aspiration (performed to remove a liquid marrow sample) and the second step is a bone marrow biopsy (performed to remove a small portion of bone filled with marrow).