Diagnosing Hodgkin's Lymphoma

A diagnosis of Hodgkin's lymphoma often begins with the patient experiencing non-specific signs and symptoms of the disease.

These non-specific symptoms include:

• Swollen, painless lymph nodes
• Fevers
• Fatigue
• Unexplained weight loss
• Drenching night sweats
• Unexplained itching
• Unexplained lower back pain
• Pain in the lymph nodes on consuming alcohol

Again, these are non-specific symptoms, meaning that for the most part, they could be symptoms of things other than Hodgkin's lymphoma. For this reason, experiencing some of these symptoms is reason to see a doctor.

Clinical Exam

A clinical exam is what the doctor takes you through while you're there in his or her exam room. This should include a physical examination of lymph node regions in the neck and clavicle, as well as physical exams of the spleen and liver.

Doctors will also collect a medical history as well as a history of symptoms. Doctors try to rule out as much as possible before arriving at a suspected diagnosis. This is a process of elimination known as differential diagnosis, and it includes both the clinical exam as well as the lab tests and scans.

Lab Tests

In an effort to rule out other potential diagnoses, a doctor will order some lab tests. As part of the essential work-up of Hodgkin's lymphoma, according to the guidelines set forth by the National Comprehensive Cancer Network, the doctor should order the following:

Blood Tests

A Complete Blood Count (CBC) measures red blood cells, white blood cells, hemoglobin, hematocrit, average red blood cell size (MCV), hemoglobin amount per red blood cell (MCH), platelets count and the amount of hemoglobin relative to the size of the cell (hemoglobin concentration) per red blood cell (MCHC).

Other blood tests, which are part of a comprehensive metabolic panel (CMP) include:

• ESR (Erythrocyte sedimentation rate, sometimes called a 'sed rate'). This is a blood test that indirectly measures inflammation in the body
• LDH (lactate dehydrogenase) test. This is a liver function test that measures how much of the protein LDH is in the blood and is a measure of tissue damage
• Albumin test. This is another liver function test. Albumin is a protein made by the liver and a drop in levels of this protein in the blood can have prognostic significance.
• BUN test. This stands for blood urea nitrogen. Urea nitrogen is the product of protein breakdown. It, along with a creatinine blood test are used to assess kidney function

None of these tests, individually, will be good enough to diagnose Hodgkin's lymphoma. They are used as investigational techniques to give a physician potential prognostic indicators.

Scans

Continuing the process of differential diagnosis for Hodgkin's lymphoma, a doctor will likely order:

• A chest X-ray
• A PET-CT scan

Biopsy

The biopsy - or surgical removal of tissue from the body - is the gold standard in cancer diagnosis. In the case of Hodgkin's, this means an excisional biopsy, or the complete removal of a whole lymph node suspected of being cancerous (don't worry, you have hundreds of lymph nodes). A pathologist will examine the node for the presence of what are called Reed-Sternberg cells. These cells are the hallmark of Hodgkin's lymphoma.

You might wonder why a doctor doesn't jump right to the biopsy if there is such a thing as a hallmark of a disease like this, but Hodgkin's lymphoma is a very rare disease, and many of the symptoms can mean many other things. It would be irresponsible to go straight to such a surgical procedure, because the odds are that most patients will not have Hodgkin's lymphoma, even if they are showing some of the early symptoms.