How is Hodgkin's disease diagnosed?

If Hodgkin's disease is suspected, the doctor will ask about your medical history and will do a thorough physical exam. Blood tests and x-rays of the chest, bones, liver and spleen will also be done.

Tissue from an enlarged lymph node will be removed. This is known as a biopsy. It is the only sure way to tell if cancer is present. A pathologist will look at the tissue under the microscope for Reed-Sternberg cells, abnormal cells that are usually found with Hodgkin's disease.

When Hodgkin's disease is diagnosed, the doctor needs to know the stage, or extent, of the disease. Knowing the stage is very important for planning treatment. The stage indicates where the disease has spread and how much tissue is affected. In staging, the doctor checks:

• The number and location of affected lymph nodes
• Whether the affected lymph nodes are above, below or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen)
• Whether the disease has spread to the bone marrow, to the spleen or to places outside the lymphatic system, such as the liver

In staging, the doctor usually orders several tests, including biopsies of the lymph nodes, liver and bone marrow. Many patients have lymphangiograms, x-rays of the lymphatic system using a special dye to outline the lymph nodes and vessels. Another test is computed tomography (also called CT or CAT Scan), a series of x-rays of cross-sections of the body.

Staging Hodgkin's:

Each stage for Hodgkin's disease is further divided by an "A" or "B," based on whether there are certain symptoms called B symptoms. B symptoms include the following:

• Loss of more than 10 percent of weight in the previous six months
• Fever without any known cause other than Hodgkin's disease
• Night sweats that leave the body soaked

For example, if a patient had stage I disease without any B symptoms, the patient would have stage IA disease; if the patient had stage I disease with B symptoms, the patient would have stage IB disease.