The doctor will ask about your symptoms and medical history and perform a physical exam, paying carefully attention to your lymph nodes. 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.

Lymph Node Biopsy

For a lymph node biopsy, your doctor will remove all or part of one of your lymph nodes. A pathologist will examine this tissue sample under a microscope. The biopsy can show whether or not there is cancer and the type and extent of cancer. A specific type of cell, called Reed-Sternberg cell, is associated with Hodgkin’s lymphoma.

Staging of Hodgkin’s Disease

If cancer is found, your prognosis and treatment depend on the location, size, and stage of the cancer, as well as your general health. Staging is an evaluation to determine whether the cancer has spread and, if it has, what body parts are affected.

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

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
    • Chest x-ray—a test that uses radiation to take a picture of structures inside the chest
    • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the chest, abdomen, and pelvis
    • Ultrasound of the abdomen—a test that uses sound waves to examine the abdomen
    • Gallium (radionuclide) scan—the injection of radioactive material into the body; a machine later scans the body and identifies areas with higher concentrations of the injected material
  • Additional biopsies of lymph nodes
  • Biopsies of the liver, bone marrow, or other tissues
  • Laparotomy (rarely done)—an incision is made through the wall of the abdomen; samples of tissue are 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."

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