Checking for Hodgkin lymphoma usually involves a number of tests. The only way to confirm a diagnosis of Hodgkin lymphoma is with a biopsy. You will have further tests to see if the cancer has spread (metastasised).
Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a health professional, or call Cancer Council 13 11 20.
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Biopsy
The most common way to diagnose and classify Hodgkin lymphoma is to remove some cells and tissue from an enlarged lymph node. This is called a biopsy and it is done in one of two ways.
Excision biopsy |
Core biopsy |
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Waiting for biopsy results
The biopsy sample is sent to a laboratory for examination under a microscope by a specialist doctor called a pathologist. If cancer cells are found, the pathologist can tell which type of Hodgkin lymphoma it is.
The results will probably be ready in 7–10 days. This waiting period can be an anxious time, and it may help to talk to a supportive friend, relative or health professional about how you are feeling. You can also call Cancer Council 13 11 20 for help during this time.
My diagnosis was made after the biopsy. I felt relieved to finally have a label for my illness.
Dee
Further tests
If the biopsy of the enlarged lymph node shows that you have Hodgkin lymphoma, you will have several follow-up tests to find out whether the cancer has spread to other areas of your body. This is known as staging.
The following pages describe tests that are commonly used to help stage Hodgkin lymphoma. You will probably not need to have all of these tests – most people will have blood tests and a PET–CT or CT scan. Some tests may be repeated during or after treatment to see how well the treatment is working.
Because some types of treatment can affect the way your heart and lungs work, you may also have heart and lung tests before, during and after treatment.
Blood tests
Hodgkin lymphoma cannot be diagnosed with a blood test (when a sample of blood is removed from a vein in your arm using a needle). However, once Hodgkin lymphoma has been diagnosed, you will have regular blood tests to check how the treatment is affecting the levels of blood cells in your body.
A test known as a full blood count (FBC) estimates your total number of red blood cells, white blood cells and platelets. Your results will be compared against the normal ranges, which are known as reference ranges or intervals. Reference ranges depend on many factors, including your age and gender, and the test method and laboratory. Talk to your treatment team about the reference ranges they are using for you.
Blood is also taken to see how well your bone marrow, kidneys and liver are working. If you are likely to have treatment that will affect your immune system, the blood sample will be checked for hepatitis and HIV.
In the hours leading up to your blood test, drink plenty of water as this can help your veins to show up and make the procedure easier.
Imaging tests
You will usually have at least one of the imaging tests or scans described below.
PET-CT scan
- This specialised test combines a positron emission tomography (PET) scan with a computerised tomography (CT) scan to produce a 3-dimensional colour image. It is available at many major hospitals, and can show whether the lymphoma has spread to the bone marrow, lymph nodes or other organs. A PET–CT scan can also be used later to check how the lymphoma has responded to treatment.
- You will be asked not to eat or drink anything for several hours before the scan. The scanners look like a large box with a hole in the middle, and you will need to lie on a table that moves in and out of the scanner. Let your doctor know if you are claustrophobic, as the scanner is a confined space.
- For the PET scan, you will be injected with a glucose (sugar) solution containing a small amount of radioactive material. Cancer cells show up brighter on the scan because they take up more glucose solution than the normal cells do.
- You will be asked to sit quietly for 30–90 minutes while the glucose moves around your body, then the PET scan itself will take about 30 minutes. The radiation absorbed into your body during a PET scan is generally not harmful and will leave your body within a few hours.
- The CT scan (see below) is used to help work out the precise location of any abnormalities revealed by the PET scan.
CT scan
- This scan uses x-rays and a computer to create a detailed picture of an area inside the body.
- If a PET–CT scan is not available, you will have a CT scan of your neck, chest and abdomen to help work out how far the Hodgkin lymphoma has spread.
- Before a CT scan, you may have a special dye called contrast injected into a vein to help make the pictures clearer. It might make you feel hot all over and leave a strange taste in your mouth for a few minutes.
- The CT scanner is large and round like a doughnut. You will lie on a table that moves in and out of the scanner.
- The scan is painless and the whole procedure takes around 30–45 minutes.
- Most people are able to go home as soon as the scan is over.
Ultrasound
- This test is most commonly used to help find swollen lymph nodes or other lumps in the body, and to guide the needle to the correct lymph node during a core biopsy.
- A gel is spread over the skin, and a small device called a transducer is passed over the area. The transducer creates soundwaves. When soundwaves meet something dense, such as an organ or tumour, they produce echoes. A computer turns the echoes into a picture on a computer screen.
- This painless test takes only a few minutes.
Before having scans, tell the doctor if you have any allergies or have had a reaction during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant or breastfeeding.
Bone marrow biopsy
Very rarely, you may need a biopsy to check whether the bone marrow contains cancer cells. For this type of biopsy, you will lie on your side while a local anaesthetic is injected into your pelvis (hip). You may also be offered medicine to help you relax (light sedation).
A bone marrow biopsy is done in 2 steps:
Bone marrow aspiration – First, the doctor uses a needle to remove a small sample of fluid from the bone marrow in your hip.
Bone marrow trephine – Next, the doctor uses another needle to take a matchstick-width sample of both bone and bone marrow tissue.
You could feel some pressure or discomfort during the biopsy. If you feel uncomfortable after the biopsy, talk to a member of your health care team about pain relief options.
→ READ MORE: Staging and prognosis for Hodgkin lymphoma
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Prof Mark Hertzberg AM, Head, Department of Haematology, Prince of Wales Hospital; Dr Puja Bhattacharyya, Haematology Staff Specialist, Western Sydney Local Health District – Blacktown Hospital; A/Prof Susan Carroll, Senior Staff Specialist, Radiation Oncology, Royal North Shore Hospital and University of Sydney; Gerry Flanagan, Consumer; Alisha Ganesh, Haematology Clinical Nurse Consultant, Concord Repatriation General Hospital; Kelly King, Cancer Council Liaison, Central Coast Cancer Centre; Ilana Krug, Social Worker – Haematology and Oncology, Gosford Hospital; Amy McGee, Consumer.
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