Doctors use many tests to find, or diagnose, cancer. A biopsy is the only certain way to confirm a diagnosis of HL. When performing a biopsy, the doctor takes a sample of tissue for testing in a laboratory. It is important that the biopsy sample is large enough to allow the pathologist to make an accurate diagnosis and determine the subtype of Hodgkin lymphoma. Doctors also do “staging” tests to learn if cancer has spread to another part of the body from where it started.3,4
Genomic or Biomarker Testing-Precision Cancer Medicine
The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic and genomic testingincluding DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Hodgkin lymphoma cells may have the biomarkers CD 20 or CD30, which can be targeted by the precision cancer medicines Rituxan (rituximab) and Adcetris (brentuximab vedotin) respectively.5,6
Staging of Hodgkin Lymphoma
It is important to determine how much the cancer has spread before initiating treatment in order to select the best treatment option. Of particular concern is the presence of cancer in lymph nodes, spread of cancer to distant sites or local extension of cancer into surrounding structures. The following diagnostic procedures may be used in addition to a through physical examination to complete the staging evaluation of Hodgkin Lymphoma.1,2
Laboratory Tests: Blood tests may include a complete blood count and an analysis of the different types of white blood cells as well as tests of kidney and liver function.
Positron Emission Tomography (PET): Positron emission tomography scanning is an advanced technique for imaging body tissues and organs. One characteristic of living tissue is the metabolism of sugar. Prior to a PET scan, a substance containing a type of sugar attached to a radioactive isotope (a molecule that emits radiation) is injected into the patient’s vein. The cancer cells “take up” the sugar and attached isotope, which emits positively charged, low energy radiation (positrons) that create the production of gamma rays that can be detected by the PET machine to produce a picture. If no gamma rays are detected in the scanned area, it is unlikely that the mass in question contains living cancer cells.
Computed Tomography (CT) Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the organs and tissues inside the body.
Magnetic Resonance Imaging (MRI): MRI uses a magnetic field rather than X-rays, and can often distinguish more accurately between healthy and lymphoma tissue than a CT. An MRI gives a better picture of cancer located near bone than does CT, does not use radiation, and provides pictures from various angles that enable doctors to construct a three-dimensional image of the cancer.
Bone Marrow Aspiration and Biopsy: Bone marrow is the soft, spongy tissue found inside the center of bones. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. Bone marrow procedures have been mostly replaced with PET-CT scans and are no longer required if the scan has been performed as part of the initial staging evaluation.7
- Pulmonary Function Tests or PFTs: Assessment of lung function may be done if treatment includes certain chemotherapy drugs that could affect the lungs. PFT’s are designed to evaluate how much air the lungs can hold, how quickly air can move in and out of the lungs, and how well the lungs add oxygen and remove carbon dioxide from the blood.
- Heart Evaluation: An echocardiogram or a multi-gated acquisition (MUGA) scan may be used to check the function of the heart if specific types of chemotherapy will be used.
Stages of Hodgkin Lymphoma
Stage I: Cancer is found only in a single lymph node, in the area immediately surrounding that node or in a single organ.
Stage II: Cancer involves more than one lymph node on one side of the diaphragm (the breathing muscle separating the abdomen from the chest).
Stage III: The cancer involves lymph node regions above and below the diaphragm. For example, there may be swollen lymph nodes under the arm and in the abdomen.
Stage IV: Cancer involves one or more organs outside the lymph system or a single organ and a distant lymph node site.
Patients with Hodgkin lymphoma may also experience general symptoms from their lymphoma. Patients with fever, night sweats or significant weight loss are said to have “B” symptoms. Patients who do not experience these specific symptoms are classified as “A”.
Relapsed/Refractory: The cancer has persisted or returned (recurred/relapsed) following treatment.
1 American Cancer Society: Cancer Facts and Figures 2017. Atlanta, Ga: American Cancer Society, 2017. Last accessed October 13, 2017.
2 Brenner H, Gondos A, Pulte D: Ongoing improvement in long-term survival of patients with Hodgkin lymphoma at all ages and recent catch-up of older patients. Blood 111 (6): 2977-83, 2008.
4 Lister TA, Crowther D, Sutcliffe SB, et al.: Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 7 (11): 1630-6, 1989.
5 Gopal AK, Ramchandren R, O’Connor OA, et al.: Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood 120 (3): 560-8, 2012.
6 Younes A, Bartlett NL, Leonard JP, et al.: Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med 363 (19): 1812-21, 2010.
7 Adams HJ, Kwee TC, de Keizer B, et al.: Systematic review and meta-analysis on the diagnostic performance of FDG-PET/CT in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma: is bone marrow biopsy still necessary? Ann Oncol 25 (5): 921-7, 2014.