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ADULT HODGKIN'S DISEASE
DIAGNOSIS

Making the diagnosis of Hodgkin's Disease is often very hard for a doctor without an x-ray or scan of the body. In most cases, it is the patient that is the first to detect that something may be seriously wrong due to the very prevalent side effects that Hodgkin's may expose. The most common side effects of Hodgkin's Lymphoma are first night sweats and itching, and later on chills and fever. Some patients experience symptoms that may be more severe, like weight loss and pain.

Surgical Diagnosis

To check for the presence of Reed-Sternberg cells, a biopsy is is often taken from one of the lymph nodes. Reed-Sternberg cells are the cells that are specific to Hodgkin's Disease. A whole lymph node is usually needed to be removed to have a definite diagnosis.

Reed-Sternberg Cell   A Hodgkin's Lymph Node from lymphomainfo.net

Other Common Test

There are other tests that can be used to help determine if a patient has Hodgkin's Disease. Usually the most common of these is a physical examination and and a blood work up including a complete blood count (CBC) and a erythrocyte sedimentation rate (ESR) to check for abnormalities.

Once a diagnosis is made, other tests are usually used to help doctors determine the specifics of the disease like stage and area of involvement. These tests include a computerized tomography scan (CT), or a magnetic resonance imaging scan (MRI) of the upper body. Gallium scanning is also used to check for radioactive intake of gallium in the lymph system of the body. This intake indicates swelling which could ultimately be disease. Finally, a bone marrow aspiration can be taken to determine presence of Hodgkin's Disease in the bone marrow.

Some tests were used in addition the other common tests to determine diagnosis. Most of these tests are no longer used. These tests include exploratory surgery with possible removal of the spleen and lymphangiograms.

Staging Hodgkin's Disease

The biopsies and other tests help doctors to determine the stage of the disease. Staging is important because it helps the oncologist determine how the disease should be treated. Staging for Hodgkin's is separated into the following four types:

STAGE I
Involvement in one lymph node region on one side of the body.

STAGE II
Involvement of two+ regions of lymph nodes on the same side of the body.

STAGE III
Involvement on both sides of the diaphragm and usually in more then one region of lymph nodes.

STAGE IV
Involvement in other organs then the lymph node. This can include lungs, testes, and bone marrow.

RECURRENT DISEASE
Relapsed disease usually re-appears in the area of first detection. Hodgkin's cells in relapse patients may also be found in new parts of the body. These are known as clone Hodgkin's cells according to the New England Journal of Medicine and are currently being researched. 

Symptoms also help to stage patients. The symptoms that help to determine more specific staging include fever, weight loss, and night sweats. Patients with one or more of these symptoms are classified as grade "B." Patients with none of these symptoms are classified as grade "A".

Specific Typing of Hodgkin's

The following classifications are made of the cells after biopsy. These classifications are made by the pathologist. There are four different common types of Hodgkin's Disease.

NODULAR SCLEROSIS
Lymph nodes in the neck, chest and collarbone contain normal and reactive lymphocytes and Reed-Sternberg cells separated by bands of scar-like tissues. Nodular Sclerosis is found in 60-70% of patients.

LYMPHOCYTE PREDOMINANCE
Lymph nodes composed mostly of reactive lymphocytes and malignant L&H cells. These cells have a noted "popcorn" appearance with very few Reed-Sternberg cells. Lymphocyte Predominance makes up 5% of Hodgkin's cases. Men are more affected by Lymphocyte Predominance than women.

MIXED CELLULARITY
Lymph nodes contain Reed-Sternberg cells along with various inflammatory cells. Mixed Cellularity accounts for 20-30% of Hodgkin's patients.

LYMPHOCYTE DEPLETED
Lymphocyte Depletion can be classified various ways. One way is with sheets of differing malignant cells. The other was is with very little Reed-Sternberg cells and lymphocytes that contain scar-like tissue. These classifications make up about about 5% of all Hodgkin's cases.

2000 Matt Terry. Copyright Pending