Making the Diagnosis
To diagnose Hodgkin's disease, a doctor will need to perform a thorough physical exam, checking the lymph nodes carefully for signs of swelling. In some cases, an abnormal mass can be detected just by feeling the nodes. Some nodes are deep in the body, so they can't be easily felt.
Occasionally, the spleen enlarges (under the left rib cage) and can be felt by the doctor. A lymph node biopsy (the removal of some lymph node tissue for analysis in the laboratory) is necessary to determine the cause of enlarged lymph nodes and to confirm the diagnosis of cancer.
Other possible tests that may be needed include blood and urine tests, as well as special scans like a computed tomography (CT) scan or positron emission tomography (PET) scan. These scans help doctors find out if the cancer has spread to other areas of the body.
A bone marrow biopsy may also be done. Bone marrow is the spongy material in the center of most bones. This test is done to see if the lymphoma has spread to the bone marrow.
All these tests are useful for the purpose of "staging the cancer." This means determining the extent of the cancer to see if it's in an early or advanced stage. Staging is important for planning the course of treatment.
There are four stages of Hodgkin's disease. Stage 1 is the mildest and stage 4 is the most severe.
- stage 1: the cancer is still localized in one lymph node region, which means that it has not spread
- stage 2: the cancer has spread to a small extent to nearby lymph areas, on the same side of the diaphragm (the muscle that separates the areas of the chest from the abdomen)
- stage 3: the cancer has spread to lymph node regions both below and above the diaphragm
- stage 4: the cancer has spread to organs outside of the lymph system - common areas of spread are the liver and bone marrow