Hodgkin Lymphoma (Hodgkin Disease)

A healthcare provider will do a physical examination to look for symptoms that may be signs of Hodgkin lymphoma, such as swollen lymph nodes. They’ll ask you about any changes in your body that you’ve noticed, like a fever that doesn’t go away or if you’ve lost weight without trying. They may do the following tests:

Blood tests

Blood tests give your provider a view of your overall health. They may test your blood for viruses linked to Hodgkin lymphoma, for substances or other characteristics that may be signs of disease. Here’s more information:

• Complete blood count (CBC): This test measures and counts your blood cells.
• Blood chemistry study: This test measures substances that your organs and tissues release into your bloodstream.
• Erythrocyte sedimentation rate (ESR): In this test, providers place erythrocytes (red blood cells) in a test tube and measure how long it takes the cells to settle on the tube’s bottom. Sedimentation rate measures inflammation. High sedimentation rates may be signs of lymphoma.

Imaging tests

• Computed tomography (CT) scan: CT scans make a series of detailed pictures of areas inside the body.
• Positron emission tomography (PET) scan: This test uses a small amount of radioactive tracer to detect tissues that are likely to contain cancer.
• Magnetic resonance imaging (MRI) scan: This test uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside of your body.
• Ultrasound: A procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Other tests

• Lymph node biopsy: Providers may remove all or part of a lymph node to examine the tissue under a microscope for signs of Reed- Sternberg cells. Sometimes, healthcare providers diagnose Hodgkin lymphoma after analyzing biopsy results of tissue taken from another area of your body, such as your lung, liver, spleen or bone marrow.
• Hepatitis B and hepatitis C: Providers may test for hepatitis B and C markers to help plan Hodgkin lymphoma treatment. Markers are virus-specific antigens and/or antibodies. Different markers or combinations of markers show if you’ve been exposed to these viruses.
• Human immunodeficiency virus (HIV):Providers may test for HIV to help them plan Hodgkin lymphoma treatment.

What are the stages of Hodgkin lymphoma?

Once your provider has diagnosed a Hodgkin lymphoma, they use test results to stage the condition. Cancer staging lays the foundation for cancer treatment.

Stage I

• There’s lymphoma in one lymph node area or one lymphoid organ. Your thymus, spleen and bone marrow are lymphoid organs.
• Stage IE: There’s lymphoma in just one area of a single organ outside of the lymph system.

Stage II

• There’s lymphoma in two or more groups of lymph nodes on the same side of (above or below) your diaphragm (the band of muscle separating your chest and belly).
• The lymphoma is part of a group of lymph nodes and is in one area of a nearby organ. In this stage, the lymphoma may also affect other lymph nodes near your diaphragm.

Stage III

• There’s lymphoma in lymph node areas on both sides of (above and below) your diaphragm OR…
• There’s lymphoma in lymph nodes above your diaphragm and in your spleen.

Stage IV

• There’s lymphoma in at least one organ outside of your lymph system, such as your bone marrow, liver or lung.

What are other ways healthcare providers characterize Hodgkin lymphomas?

Providers may place your condition in specific categories as they plan treatment. For example, they may characterize early-stage cancer as favorable or unfavorable. The categories are based on cancer stages and risk factors that may increase the chance the lymphoma may come back after treatment. The more risk factors, the more likely Hodgkin lymphoma will come back.

Understanding cancer staging

Cancer staging is how healthcare providers plan treatment and share information about your situation. Healthcare providers use stages to plan Hodgkin lymphoma treatment. They also evaluate risk factors to place conditions in certain categories that characterize prognosis or expected outcomes.

Some people who have cancer may be confused and intimidated by a system that describes their illness with a formula of letters and numbers or risk factors that place them in one category or another. They may even feel as if their condition’s stage or category defines who they are. If this is your situation, talk to your provider. They’ll understand why you may feel this way and will be glad to answer your questions about cancer staging systems.