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Hodgkin’s Lymphoma Diagnosis and Stages

The lymphatic system plays an essential role in fighting off infections and keeping the body healthy and it consists of lymph nodes, lymphatic organs, and lymphatic vessels. In some cases, the healthy cells found in the lymphatic system can grow uncontrollably and form a tumor.

This tumor is what causes cancer of the lymphatic system, once known as Hodgkin’s disease, and is now called Hodgkin’s lymphoma. This cancer typically starts in the lymph nodes and can affect both adults and children.

If a doctor suspects the presence of Hodgkin’s lymphoma, they will go through all the necessary steps to determine its diagnosis and staging.

Hodgkin's Lymphoma Diagnosis

To make a diagnosis of Hodgkin’s lymphoma, the doctor in charge of the patient’s case will perform the following tests.

Physical Exam and Medical History

Performing a physical exam and reviewing a patient’s medical history can help the doctor get an initial assessment and narrow down what could be causing issues. For Hodgkin’s lymphoma in particular, they will look for any symptoms that may indicate the presence of this cancer.

Some of the most common early symptoms of Hodgkin’s lymphoma include a high fever, night sweats, unexplained weight loss and sudden changes in appetite. However, the most telling symptom that indicates this particular cancer is enlarged lymph nodes or spleen.

Lymph Node Biopsy

A biopsy is a diagnostic test performed for patients who have a tumor, and it involves removing a piece of the tumor and then analyzing the taken sample under a microscope. In the case of Hodgkin’s lymphoma, the tumor sample for the biopsy will be removed from a lymph node.

After performing a lymph node biopsy, a medical professional will be able to diagnose Hodgkin’s lymphoma and determine what subtype of this cancer the patient is suffering from.

Blood Tests

Blood tests aren’t used to diagnose Hodgkin’s lymphoma but instead to determine how much the disease has advanced and also to check the patient’s liver and kidney functions.

The most common blood tests that are performed include:

  • Complete blood count (CBC), which can show whether the patient has an elevated white blood cell count, which can sometimes happen when someone is suffering from Hodgkin’s lymphoma.

  • Erythrocyte sedimentation rate (ESR), which shows the level of inflammation in the patient’s body, and this could be elevated in Hodgkin’s lymphoma patients.

Imaging Tests

Imaging tests such as MRIs and CT scans are often used after it’s been determined that the patient is suffering from Hodgkin’s lymphoma. They are typically performed to determine which lymph nodes exactly are affected by the cancer and whether the lymphoma has spread further throughout the patient’s body.

Computed Tomography (CT) Scan

A CT scan is an imaging test that takes 3D images of the patient’s body from multiple angles with the use of X-rays. This scan can show the tumor itself but it can also help the doctor determine whether there are any abnormalities and if the cancer has spread to other parts of the body.

Magnetic Resonance Imaging (MRI)

An MRI takes 3D pictures of the entire body with the use of magnets and radio waves, and it’s used similarly to a CT scan and is primarily used to check whether the Hodgkin’s lymphoma has spread to other parts of the body.

Positron Emission Tomography (PET) Scan

A PET scan is an imaging test during which a small amount of slightly radioactive sugar is injected into the patient’s bloodstream. Over time, this substance starts collecting in very active cells, such as cancerous cells.

Once the cells have absorbed the radioactive material, a doctor will take a picture of the patient’s body using a special camera that is able to detect all the places where the radioactivity has been collected.

With a PET scan, the doctor can tell whether a lymph node is infected with Hodgkin’s lymphoma, how the cancer is responding to treatment, and determine if the tumor is cancerous or not.


An X-ray scan works by using high-energy waves that take pictures throughout the patient’s body. For Hodgkin’s lymphoma patients, an X-ray is done to check for swollen lymph nodes in the chest, see if there are any problems with the patient’s bones, and check the condition of the lungs and heart before proceeding with certain treatments.

Bone Marrow Aspiration and Biopsy

During this procedure, a medical professional extracts some bone marrow liquid during the aspiration and then removes a thin piece of the bone marrow during the biopsy. Then these samples are examined under a microscope so the medical professional can check for cancerous cells within the bone marrow.

Hodgkin's Lymphoma Staging

Just like all other tumors, doctors use staging to determine the severity of a disease. The stages go from 1 to 4, from least to most severe. To determine staging, the doctor has to take all the different staging modifiers into consideration.

Staging Modifiers

Staging modifiers are used to better understand the severity of a certain condition and they’re essential in determining the exact stage of the patient’s tumor/cancer. There are three staging modifiers used when diagnosing Hodgkin’s lymphoma.

Lymphatic vs. Extralymphatic

Hodgkin’s lymphoma can be either lymphatic or extralymphatic. If it’s lymphatic, that means that the tumor is affecting the organs and nodes inside the lymphatic system. These are known as lymphatic sites and they include the lymph nodes, spleen and thymus to name a few.

Extralymphatic, also known as extranodal or extralymphatic, are sites where a Hodgkin’s lymphoma developed outside of the lymphatic system. This can happen in sites such as the bone marrow, blood, lungs, liver, kidney, brain and spinal cord.

A vs. B Symptoms

Hodgkin’s lymphoma patients can be both asymptomatic and symptomatic, and those patients are divided into two categories: A and B.

If a patient gets put into the A category, that means they have no symptoms, and their disease is still mild. Those in the B category however are experiencing symptoms such as a persistent high fever, unexplained weight loss and night sweats.

Bulky Hodgkin’s Lymphoma

This staging modifier signifies how big the affected lymph node is. A bulky Hodgkin’s lymphoma is typically 10 cm or more.


Staging represents how much the tumor has spread, and there are four stages in total:

  • Stage 1 Hodgkin's Lymphoma: The lymphoma is only located in one lymph node region or a single extralymphatic site. It’s very rare to get a diagnosis this early on while the disease is still confined to one area.

  • Stage 2 Hodgkin's Lymphoma: When it enters stage 2, the lymphoma is located in multiple lymph nodes or perhaps in one organ and the organ’s regional lymph nodes. In some cases, this is also a bulky Hodgkin’s lymphoma.

  • Stage 3 Hodgkin's Lymphoma: In stage 3, the lymphoma is located in lymph nodes that are above and below the diaphragm.

  • Stage 4 Hodgkin's Lymphoma: When it reaches stage 4, the lymphoma has spread to other organs, such as the liver, lungs or bone marrow.

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