Types of Hodgkin’s Lymphoma
Hodgkin’s lymphoma is actually a group of similar diseases that doctors often classify into two main types:
- Classic Hodgkin’s lymphoma
- Nodular lymphocyte-predominant Hodgkin’s lymphoma
Classic Hodgkin’s lymphoma
Most Hodgkin’s lymphomas are the classical type that is broken down into four subtypes:
- Nodular sclerosing Hodgkin’s lymphoma (most common)
- Mixed cellularity Hodgkin’s lymphoma
- Lymphocyte depletion Hodgkin’s lymphoma
- Lymphocyte-rich classical Hodgkin’s lymphoma
Nodular lymphocyte predominant Hodgkin’s lymphoma
Nodular lymphocyte predominant Hodgkin’s lymphoma is a rare type. It is marked by the presence of a type of cell called a popcorn cell, which is different from the typical Reed-Sternberg cell found in classical Hodgkin’s lymphoma. This type of Hodgkin’s lymphoma may change into diffuse large B-cell lymphoma.
Hodgkin’s Lymphoma Diagnosis
Tests that examine the lymph nodes are used to detect (find) and diagnose Hodgkin’s lymphoma. The following tests and procedures may be used:
Complete blood count
Complete Blood Count (CBC)
A complete blood count (CBC) measures the size, number, and maturity of the different blood cells in a specific volume of blood. This is one of the most common tests performed.
- Red blood cells are important for carrying oxygen and fighting anemia and fatigue. The hemoglobin portion of the CBC measures the oxygen carrying capacity of the red blood cells while the hematocrit measures the percentage of red blood cells in the blood.
- White blood cells fight infection. Increased numbers of white blood cells, therefore, may indicate the presence of an infection. Decreased levels may indicate certain rheumatic diseases or reaction to medication.
- Platelets prevent the body from bleeding and bruising easily. It is usually performed to check for a blood infection.
Lymph node biopsy
Blood chemistry studies
Blood Chemistry Study
A blood chemistry study is a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
Physical Exam and History
Physical exam and history is an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Please provide your medical records to us before your appointment. At the visit itself, the nurses and doctors will ask additional questions and carry out a detailed physical exam.
A sample of blood is checked for the rate at which the red blood cells settle to the bottom of the test tube.
Hodgkin’s Lymphoma Staging
Staging is the process of determining with specific tests whether cancer has spread and, if so, how far. It is important to know the stage of the disease in order to plan treatment and this also helps to predict outcome, or prognosis.
Stage I (1) Hodgkin's Lymphoma
Cancer is only in one group of lymph nodes, or it has started in one organ and has not moved to another part of the body.
Stage II (2) Hodgkin's Lymphoma
Cancer shown in two or more groups of lymph nodes and on the same side of the diaphragm in the body; all disease is in either the upper or lower half of the body. This means that if the lymph nodes in the neck and underarms both show cancer, it is stage II (2). However, if the lymph nodes in the groin and neck show cancer, it is not stage II (2), because those two parts of the body are on different sides of the diaphragm.
Cancer that is in one group of lymph nodes and extends directly into a nearby organ is also stage II (2).
Stage III (3) Hodgkin's Lymphoma
Cancer shown in two or more groups of lymph nodes on different sides of the diaphragm, such as the neck and groin. There might also be spread of the cancer from the lymph nodes to nearby organs.
Stage IV (4) Hodgkin's Lymphoma
Cancer has spread widely through distant organ(s) outside of the lymphatic system. Other lymph nodes in the body may or may not show signs of the cancer. Typical stage IV (4) disease is when Hodgkin’s lymphoma is found in the bone marrow or in organs (lung, stomach, liver, bone).
Symptoms used in staging
Additional Symptoms of Hodgkin’s Lymphoma Used in Staging
Hodgkin’s lymphoma stages are also noted by the presence or absence of certain symptoms of the disease:
- The letter “B” is added (i.e., stage IIB) is added if the person has any B symptoms (fever, night sweats, weight loss).
- If a person does not have these B symptoms, the letter “A” is added after the Roman numeral.
- If the Hodgkin’s disease has spread from a lymph node to a nearby organ, the letter “E” is added.
- If it involves the spleen, the letter “S” may be added.
- The letter “X” may be added if a person has bulky disease. This means a tumor in the chest is at least one-third as wide as the chest, or a tumor in another area is at least 10 centimeters (about 4 inches) across. Bulky disease may require more intensive treatment.
For example, stage IIIB is disease that is symptomatic, involves lymph node regions or structures on both sides of the body, and is further classified depending on the organs and areas involved.
Tests used in staging
Tests and Procedures Used in Staging of Hodgkin’s Lymphoma
The following tests and procedures may be used in the staging process for Hodgkin’s lymphoma:
- CT scan
- PET-CT scan
- Bone marrow aspiration and biopsy