Hodgkin lymphoma - Diagnosing Hodgkin lymphoma

If you go to see your GP concerned about symptoms of Hodgkin lymphoma, they will ask about your health and carry out a simple physical examination.

If necessary, your GP will refer you to hospital for further tests. In hospital it is likely that a biopsy will be carried out, as this is the only way to confirm a diagnosis of Hodgkin lymphoma.

Biopsy

A biopsy involves removing some or all of an affected lymph node, which is then studied in a laboratory.

Biopsies are small operations that can often be carried out under a local anaesthetic (where the area is numbed), although there may be some cases where the affected lymph node is not easily accessible and a general anaesthetic may be required (where you are asleep).

A pathologist (expert in the study of diseased tissue) will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of Hodgkin lymphoma you have, which is an important factor in planning your treatment.

Further testing

If a biopsy confirms a diagnosis of Hodgkin lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma.

Further tests may include:

• blood tests – samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidneys are working
• bone marrow sample – another biopsy may be carried out to see if the cancer has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic
• chest X-ray – this can check whether the cancer has spread to your chest or lungs
• computerised tomography (CT) scan – this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread of the cancer
• magnetic resonance imaging (MRI) scan – this scan uses strong magnetic fields to build up a detailed picture of areas of your body to check the spread of the cancer
• positron emission tomography (PET) scan – this is a type of scan that measures the activity of cells in different parts of the body and can check the spread of the cancer and the impact of treatment; it is usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working

Stages of Hodgkin lymphoma

When the testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far it has spread.

The main stages of Hodgkin lymphoma are:

• stage 1 – the cancer is limited to one group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs)
• stage 2 – two or more lymph node groups are affected, either above or below the diaphragm
• stage 3 – the cancer has spread to lymph node groups above and below the diaphragm 
• stage 4 – the cancer has spread through the lymphatic system and is now present in organs or bone marrow

Health professionals also add the letters "A" or "B" to your stage to indicate whether or not you have certain symptoms.

"A" is put after your stage if you have no additional symptoms other than swollen lymph nodes. "B" is put after your stage if you have additional symptoms of weight loss, fever or night sweats.