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.
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 lymphoma cells, they will go on to identify exactly which type of Hodgkin lymphoma you have, which is an important factor in planning your treatment.
If the biopsy confirms a diagnosis of Hodgkin lymphoma, the next step is to check how far the lymphoma has spread. This is important as it allows a doctor to determine the stage of your lymphoma.
This is done by a process called imaging. These techniques show us where the lymphoma may be in the body. These tests are normally done as an outpatient and may include some of the tests outlined below;
- X-ray – produce pictures of the structures in the body.
- Computerised tomography (CT) scan – this scan takes a series of X-rays that build up a 3D picture of the inside of the body and provide a more detailed picture than an x-ray.
- magnetic resonance imaging (MRI) scan – this scan uses strong magnetic fields to build up a detailed picture of particular areas of your body.
- positron emission tomography (PET/CT) scan – Used in combination with CT scans and involves an injection of sugar (glucose) labelled with a small amount of radioactivity which goes to parts of the body that use glucose for energy. Areas of uptake on PET/CT scan can be used to assess the presence, location and severity of cancers.
The team will also require some further blood tests, it is common to have blood tests whilst on treatment. These tests can give information regarding 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.
Once all the test results are complete, it is possible to determine the stage of your lymphoma. Staging tells us which parts of the body are affected by the lymphoma and this is important when planning your treatment.
The 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" after 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 any one of the following; unexplained weight loss greater than 10% of your body weight in the preceding 6 months, unexplained fevers over 38 C or drenching night sweats.