Diagnosing Hodgkin's Disease
Diagnosing Hodgkin's disease often begins with a review of the patient's medical history, followed by a physical exam. Imaging tests may be used to help diagnose Hodgkin's disease; however, when diagnosing Hodgkin's disease, only a biopsy can tell a doctor for sure whether a person has the disease or not.
In order to diagnose Hodgkin's disease, the doctor will usually begin by asking a number of questions about a person's medical history and performing a physical exam to check the patient's overall health. The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. The doctor may also order tests (such as blood tests), recommend certain procedures, or both.
When diagnosing Hodgkin's disease, the doctor may order tests that produce pictures of the inside of the body. These may include:
- CT scans
- MRI scans.
Hodgkin's disease can only be positively diagnosed through a biopsy. During this procedure, a surgeon removes a sample of lymphatic tissue (part or all of a lymph node) so that a pathologist (someone who studies diseases) can examine it under a microscope to check for cancer cells. Other tissues may be sampled as well.
The pathologist studies the tissue and checks for Reed-Sternberg cells, which are large, abnormal cells that are usually associated with Hodgkin's disease.
If the biopsy results in a Hodgkin's disease diagnosis, the doctor needs to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Hodgkin's lymphoma treatment decisions depend on these findings.
The doctor considers factors such as the following to determine the stage of Hodgkin's disease:
- The number and location of affected lymph nodes
- Whether the affected lymph nodes are on one or both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen)
- Whether the disease has spread to the bone marrow, spleen, or places outside the lymphatic system, such as the liver.
In staging, the doctor may use some of the same tests used in diagnosing Hodgkin's disease.
Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone.
Rarely, an operation called a laparotomy may be performed. During this operation, a surgeon makes an incision through the wall of the abdomen and removes samples of tissue. A pathologist then examines the tissue samples under a microscope to check for cancer cells.
(For more information about the stages of Hodgkin's disease, see the eMedTV article Stages of Hodgkin's Lymphoma.)