Simone Lawson
A definitive diagnosis of Hodgkin lymphoma is made through a lymph node biopsy, which involves removing some or all of an affected lymph node for examination in a laboratory. A pathologist will then study the tissue sample under a microscope to identify the presence of Reed-Sternberg cells, which are indicative of Hodgkin lymphoma. Further tests, such as blood tests, imaging scans, and bone marrow biopsies, may be necessary to determine the stage of the lymphoma and plan appropriate treatment.
| Characteristics | Values |
|---|---|
| Definitive Diagnosis | Biopsy from a lymph node or suspected organ |
| Biopsy Type | Lymph node biopsy, excisional biopsy, needle biopsy, bone marrow aspiration and biopsy |
| Biopsy Procedure | Removing some or all of an affected lymph node, using a long needle to remove a sample of bone marrow |
| Biopsy Analysis | Checking tissue sample for presence of cancerous cells, specifically Reed-Sternberg cells |
| Further Testing | Blood tests, imaging tests, bone scans, PET-CT scans, MRI scans |
| Staging | Scoring cancer by how far it has spread, ranging from Stage 1 (limited to 1 group of lymph nodes) to Stage 4 (spread to organs or bone marrow) |
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What You'll Learn
Biopsy
A biopsy is a common procedure used to diagnose Hodgkin lymphoma. It involves removing some or all of an affected lymph node, which is then studied in a laboratory. A biopsy is a minor surgical procedure that can often be performed under local anaesthesia. However, in certain cases, general anaesthesia may be necessary if the affected lymph node is not easily accessible.
During the biopsy, a pathologist, who is an expert in examining diseased tissue, will carefully analyse the tissue sample for the presence of cancerous cells. If cancerous cells are detected, the pathologist can also identify the specific type of Hodgkin lymphoma, which is crucial for determining the most effective treatment plan. The pathologist will specifically look for Reed-Sternberg cells, which indicate the presence of Hodgkin lymphoma rather than non-Hodgkin lymphoma.
In some instances, a diagnosis of Hodgkin lymphoma may be established through a biopsy of tissue from other parts of the body, such as the lung, liver, spleen, or bone marrow. This approach is taken when there is a high suspicion of Hodgkin lymphoma, and the affected lymph node is not easily accessible.
After an initial diagnosis of Hodgkin lymphoma, additional tests may be required to determine the stage of the disease, which refers to how far the lymphoma has spread. These tests can include bone marrow aspiration and biopsy, which are performed to ascertain whether the lymphoma has reached the bone marrow. Bone marrow aspiration involves extracting a small sample of liquid bone marrow using a thin, hollow needle, while a bone marrow biopsy involves removing a small piece of bone tissue. These procedures are typically done under local anaesthesia and help doctors assess the extent of the disease and plan the most appropriate treatment.
It is important to note that fine-needle aspiration or core-needle biopsy may not provide conclusive results due to the low ratio of malignant cells and the loss of architectural information. Therefore, an excisional biopsy is recommended if there is a strong suspicion of Hodgkin lymphoma. To establish a definitive diagnosis, the identification of Reed-Sternberg cells or LP cells within the biopsy specimen is essential.
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Staging
The staging process typically involves imaging tests, laboratory tests, and procedural tests. Imaging tests may include a chest X-ray, CT scan of the chest/abdomen/pelvis, and a PET scan. Laboratory tests include a complete blood count (CBC), complete metabolic panel (CMP), erythrocyte sedimentation rate, and tests for Hepatitis B and C, and HIV. Procedural tests may include a bone marrow aspiration and biopsy.
The additional letters used in the Lugano classification are A, B, E, and S. A patient is classified as category A if they do not exhibit B symptoms, which include fever, weight loss, and night sweats. Category B indicates the presence of B symptoms. Category E indicates that the patient has HL cells in organs or tissues outside the lymphatic system, and category S indicates HL cells in the spleen.
For example, a patient with B symptoms in stage I would be classified as stage IB. If there is a tumour over one-third the width of the chest in stage II, the classification would be stage IIX.
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Blood tests
Complete blood count (CBC) is a common test that measures the number of blood cells in a sample, including red blood cells, white blood cells, and platelets. A low level of red blood cells, white blood cells, or platelets may indicate that lymphoma is present in the bone marrow and/or blood. People with Hodgkin lymphoma can sometimes exhibit abnormal blood counts, such as anemia, due to the invasion of the bone marrow, where new blood cells are produced.
Blood chemistry studies are another type of blood test used to measure electrolyte levels and assess organ function, such as that of the liver and kidneys. These tests measure the substances released by organs and tissues into the bloodstream, which may indicate tissue damage.
Erythrocyte sedimentation rate (ESR) is also measured during blood testing. This test can indicate how advanced the cancer is and how well a patient might respond to certain treatments.
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Imaging tests
X-rays
X-rays use small amounts of radiation to capture images of the inside of the body, particularly the bones. They can reveal changes caused by cancer or other medical conditions. In Hodgkin lymphoma, enlarged lymph nodes in the middle of the chest (mediastinum) are common, and x-rays can help detect this. Additionally, x-rays can show if there is fluid collecting around the lungs (pleural effusion), which is a rare symptom in Hodgkin lymphoma. However, x-rays may not be necessary if a patient has already undergone a PET CT or CT scan.
CT Scans (Computerized Tomography)
CT scans involve taking multiple X-rays from different angles to create a detailed 3D image of the inside of the body. They can help detect enlarged lymph nodes, abnormalities in organs like the liver and spleen, lung nodules, and the presence of fluid in the lungs. CT scans are valuable for assessing the spread of cancer.
PET-CT Scans (Positron Emission Tomography-Computed Tomography)
PET-CT scans combine PET and CT technologies. A slightly radioactive form of sugar is introduced into the patient's blood, and it accumulates in highly active cells, such as cancer cells. A special camera then captures images of the areas where the radioactivity has accumulated. While the images are not as detailed as CT or MRI scans, they provide valuable whole-body information. PET-CT scans can help determine if enlarged lymph nodes contain Hodgkin lymphoma and identify small spots that may indicate lymphoma, even if they appear normal on a CT scan. These scans are now considered essential for the initial staging of Hodgkin lymphoma, as they can distinguish between viable tumours and residual masses that may remain after treatment.
MRI Scans (Magnetic Resonance Imaging)
MRI scans use strong magnetic fields and radio waves instead of X-rays to create detailed images of soft tissues in the body. This type of scan is rarely used in Hodgkin lymphoma, but it can be very useful if there is concern about the spread of cancer to the spinal cord or brain.
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Bone marrow aspiration
During a bone marrow aspiration, a small incision is made at the site, and a special biopsy needle is inserted into the bone. A small syringe attached to the needle is used to remove liquid bone marrow. The procedure may be performed using palpation-guided or computed tomography-guided (CT-guided) approaches. The bone marrow aspiration is usually performed immediately before the biopsy.
In the context of Hodgkin lymphoma, bone marrow aspiration and biopsy are not typically used for diagnosis. However, they may be performed after diagnosis to determine whether lymphoma cells are present in the bone marrow. This information is important for staging the disease, which identifies the extent and location of the disease in the body. Staging helps determine how advanced the cancer is, how quickly it may spread, and the most effective treatments.
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Frequently asked questions
A physical exam is first carried out by a healthcare provider to look for signs of Hodgkin Lymphoma, such as swollen lymph nodes. They will also ask about any changes the patient has noticed, such as unexplained weight loss or fever.
A biopsy is the only way to confirm a diagnosis of Hodgkin Lymphoma. This involves removing some or all of an affected lymph node, which is then studied in a laboratory. A pathologist will then check the tissue sample for the presence of cancerous cells, specifically Reed-Sternberg cells, which indicate Hodgkin Lymphoma.
Further testing is required to determine the stage of the lymphoma, i.e., how far it has spread. This includes blood tests, bone marrow biopsies, chest X-rays, and CT scans.
