Tests and diagnosis for Hodgkin lymphoma
It’s really important to have the tests you need to investigate your condition and get a clear diagnosis before you start any treatment.
At any time, you can ask your healthcare team to tell you why you’re having a certain test and what the results mean.
Tests to diagnose Hodgkin lymphoma
If your GP suspects you might have Hodgkin lymphoma, they’ll refer you to hospital for more tests. These can include:
- blood tests
- a chest x-ray to look at your general health
- a lymph node biopsy to show if your sample contains Reed-Sternberg cells and confirm that you have Hodgkin lymphoma
- a PET-CT scan.
We have more information on general tests for blood cancer and how they are done.
If the lump is in your chest, you may need a different type of biopsy called a mediastinoscopy. Your doctor will pass a thin tube with a tiny camera on the end through a small cut at the base of your neck. This allows them to have a look inside your chest and take a biopsy at the same time. You’ll have a general anaesthetic so you’ll be asleep and won’t feel anything.
Staging describes how far a person’s disease has spread. Your healthcare team will use a system based on the Roman numbers from one to four (I, II, III, IV) to categorise the stage of the lymphoma.
Staging for Hodgkin lymphoma is based on the symptoms you have and how many sites in your body are affected by lymphoma. For any stage of Hodgkin lymphoma, a letter ‘A’ or a ‘B’ can be added. These letters indicate whether you have certain symptoms or not. So your diagnosis might be IA or IIB, for example. Stages I and IIA are called early stage disease. Stages IIB, III(A or B) and IV(A or B) are called advanced disease. The treatment you receive will depend on the stage of the Hodgkin lymphoma.
Stages of Hodgkin lymphoma
Only one group of lymph nodes is affected, in one place in your body.
More than one group of nodes is affected but all of them are on the same side of the diaphragm, either above or below. The diaphragm is a sheet of muscle separating your chest from your stomach and hip areas (abdomen and pelvis).
Lymph nodes on both sides of the diaphragm are affected, or the lymphoma has spread from the lymph nodes into organs close to the affected node or nodes.
The lymphoma has spread to other organs, such as the lungs, liver or bone marrow.
No B symptoms
B symptoms are present:
- fever (higher than 38ºC)
- drenching night sweats
- unexplained weight loss in the last six months (at least 10% or a tenth of your previous weight).
As well as putting an A or a B after the stage, sometimes an ‘X' is added. This describes bulky disease, which means that the lumps caused by the lymphoma are quite large. Whether or not you have bulky disease can also be important in deciding which treatment you should have.
Further tests after diagnosis
After you’ve been diagnosed, you’ll have further tests so your healthcare team can find out which areas of your body are affected by Hodgkin lymphoma, and the stage of the disease. You may have the following tests:
- PET-CT scan to stage the lymphoma, support decisions about your treatment, and confirm that you have no active cancer (you’re in remission) when you’ve finished treatment
- MRI scan to look for affected lymph nodes in soft tissues (non-bony parts) around your body.
Other tests you may have
You may have a range of other tests, which will help your healthcare team check your general health and assess how well you might respond to certain treatments. These may include:
- a full blood count
- tests on your heart, lungs, kidneys, liver and thyroid (a gland that plays an important part in turning food into energy)
- tests for HIV and two types of liver disease: hepatitis B and hepatitis C
Find out more about tests for blood cancer.
Find answers to some of the most frequently asked questions