The diagnosis and prognosis of Hodgkin's disease includes the following:

Review of Medical History

The doctor will ask about your symptoms and medical history. He or she will inquire about past infections and if you have had an organ transplant. People with decreased immune function are at greater risk of developing Hodgkin’s lymphoma. Drugs ordered after an organ transplant to reduce the chance of rejection decrease immune function. Hodgkin’s disease also seems to occur in people who are infected with the human immunodeficiency virus (HIV) or who have been infected with the Epstein-Barr virus, which causes infectious mononucleosis.

The doctor also will ask about any nonspecific symptoms you may be having. For instance, feeling tired, changes in appetite, or sweating at night.

Physical Exam

The doctor will perform a physical exam, including a check of your temperature. He or she will carefully palpate, which means feel while applying pressure to, the areas where lymph nodes are found. Most enlarged or swollen lymph nodes are caused by an infection, not lymphomas. If infection is suspected, you may be given an antibiotic medication and instructed to return for re-examination. If swelling persists, your doctor may order a lymph node biopsy.

Diagnostic Testing

The main test done to check for Hodgkin's lymphoma is a lymph node biopsy. This involves the removal of all or part of one of your lymph nodes. Then, a pathologist will examine this tissue sample under a microscope. The biopsy can show whether or not there is cancer and what type of cells are present.

Cytology

Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.

A specific type of cell, called Reed-Sternberg cell, is associated with Hodgkin’s lymphoma. Several other types of cells are usually present as well. The pathologist will look for Reed-Sternberg cells within the sample. In a rare type of the disease called lymphocyte-predominant Hodgkin's disease, fewer Reed-Sternberg cells are present than are found in traditional Hodgkin’s disease.

Staging

Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (e.g., surgery vs. chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0 – 1) imply a favorable prognosis, whereas high staging classifications (4 – 5) imply an unfavorable prognosis.

Your doctor considers the following factors to determine the stage of Hodgkin's disease:

  • The number and location of lymph nodes affected
  • Whether the affected lymph nodes are on one or both sides of the diaphragm (the thin muscular sheet that separates the chest from the abdomen)
  • Whether the disease has spread to other lymphatic tissues such as the spleen
  • Whether the disease has spread to the bone marrow, liver, or other places outside the lymphatic system
  • If you have systemic symptoms, such as night sweats, fever, fatigue, or decreased appetite

Tests to Determine Staging

Additional tests to determine staging may include:

  • Blood tests – such as complete blood count, sedimentation rate, blood chemistries, and liver and kidney function tests.
  • Imaging studies to look for enlarged lymph nodes, such as:
    • Chest x-ray – a series of standard x-ray images of your chest.
    • CT scan of the chest, abdomen, and pelvis – a type of x-ray that uses a computer to produce cross-sectional images of the inside of the body.
    • Ultrasound of the abdomen – the use of sound waves and the characteristic patterns they make bouncing off of various structures in the body to identify tumors and other conditions.
    • Gallium scan – a radioactive compound called Gallium-67 is injected into one of your veins. A day or two later, you'll lie on an examining table while a special machine scans up and down your body taking pictures. The Gallium-67 makes it easier for tumors to be seen.
    • Positron emission tomography (PET) – a test that assesses metabolic activity in the tissue. Cancer cells typically generate more activity than non-cancerous cells. A nurse or technologist administers a radioactive substance. This may be done through an injection, or in some cases, you will be asked to breathe in a gas with the substance. The compound travels through the blood to the area of the body under study. It takes between 30 and 90 minutes for the substance to be absorbed by the tissue under study. You lie on a table and are moved into a machine that looks like a large, square-shaped doughnut. This machine detects and records the energy levels emitted from the substance that was injected earlier. The images are viewed on a nearby computer monitor.
  • Additional biopsies of lymph nodes, to check if cancer cells are present in adjacent lymph nodes.
  • Biopsies of the liver, bone marrow, or other tissues, to check if cancer cells are present. A bone marrow biopsy may be ordered if you are anemic, have a low red blood cell count, fever, or night sweats.
  • (Rarely) Laparotomy – an incision is made through the wall of the abdomen. Samples of tissue are then removed and examined under a microscope to check for cancer cells.

Stages of Hodgkin’s Disease

Stage I – cancer is found only in a single lymph node area, in the area immediately surrounding that node, or in a single organ.

Stage II – cancer involves more than one lymph node area on one side of the diaphragm.

Stage III – cancer involves lymph node regions above and below the diaphragm.

Stage IV – cancer involves one or more organs outside the lymph system or a single organ and a distant lymph node site.

Stages have an “A” and a “B” level. In Stage B, a person with Hodgkin's lymphoma experiences general symptoms from the disease—fever, night sweats, or significant weight loss. If these specific symptoms are not present the classification is "A."

An “X” after the stage number refers to bulky disease. This means the cancer is 1/3 the width of the mediastinum, an area in the chest; or the cancerous lymph node is greater than 10 centimeters (cm) across.

An “E” is added after the stage number if the disease has spread to an adjacent organ.

Relapsed/Refractory – this is the term used for a cancer that has persisted or returned following treatment.

Prognosis

Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation.

A lower stage usually means a better prognosis. The five-year survival rates for each stage are as follows:

  • Stage Iand II – 90% to 95%
  • Stage III – 85% to 90%
  • Stage IV – about 80%