Hodgkin's Lymphoma
Diagnosis

Many of the symptoms of Hodgkin's lymphoma are general in nature and could be caused by other conditions such as infections.

Your child's doctor may request a number of diagnostic tests, including:

  • Computed tomography (CT or CAT) scan — This diagnostic imaging procedure provides detailed images of the body, including the bones, muscles, fat and organs.


  • Positron emission tomography (PET) scan — This is a nuclear medicine test in which a radioactive compound is injected and shows the areas of malignancy in the body.


  • Biopsy — A biopsy, which involves the removal of a sample of tissue to see whether cancer cells are present, is necessary to confirm the diagnosis. There are several kinds of biopsies. Your child's doctor will choose the one best suited for your child. The goal is to get enough tissue to make an accurate diagnosis as quickly as possible with the fewest side effects.
    • Fine Needle Aspiration (FNA) Biopsy— For this test, a very thin needle is used to draw up a small amount of tissue from the tumor. The main advantage of FNA is that it doesn't require surgery; a drawback is that in some cases not enough tissue can be removed.


    • Excisional or Incisional Biopsy — In an excisional biopsy, the surgeon removes the entire lymph node. In an incisional biopsy, the surgeon removes a small part of a large tumor. If the node is near the skin's surface, this is a simple operation that can be done after numbing the skin. If the node is inside the chest or abdomen, then your child will need general anesthesia, medicine that causes your child to sleep.


    • Bone Marrow Aspiration and Biopsy — This test involves obtaining a small amount of bone marrow tissue and fluid. Usually the sample is taken from the back of the pelvic bone. The bone is numbed and the child is given medicine to reduce pain or even cause sleep. A needle is put through the outer bone into the marrow and the sample is removed. This test can be used to see if cancer is present and also to help see how far the cancer has spread.


    • Chest (Pleural) or Abdominal (Peritoneal) Fluid Examination — If the lymphoma has spread to the membranes that line the chest or abdominal cavities, fluid can build up. This fluid can be removed by placing a needle through the skin into the chest, for a pleural examination, or abdomen, for a peritoneal examination. The fluid is checked to see if cancer cells are present. The skin is numbed before the test is done.

Staging

The following stages are generally used for childhood lymphomas:

  • Stage I — Cancer is found in only one lymph node area or in only one area or organ outside of the lymph nodes.


  • Stage II — Cancer is found in two or more lymph node areas on the same side of the diaphragm, the thin muscle under the lungs that helps with breathing, or cancer is found in only one area or organ outside the lymph nodes and in the lymph nodes around it.


  • Stage III — Cancer is found in lymph node areas on both sides of the diaphragm. The cancer also may have spread to an area or organ near the lymph node or to the spleen.


  • Stage IV — Cancer has spread in more than one spot to one or more organs outside of the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs and may even involve lymph nodes far from the organ involved.


  • Recurrent — Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

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