Who Should Undergo Diagnostics and When

Hodgkin’s disease, also called Hodgkin lymphoma, is a type of cancer that affects the lymphatic system, which is part of the body’s immune system. This system includes organs, glands, vessels, and small bean-shaped structures called lymph nodes that help the body fight infections and diseases. Knowing when to seek medical attention can make a significant difference in catching this condition early.^[1]

You should consider seeking diagnostic testing if you notice certain warning signs that don’t go away. The most common early symptom is painless swelling of lymph nodes, particularly in the neck, underarm, or groin area. These swollen nodes may feel rubbery when touched. Unlike swelling from infections that usually goes away within a week or two, lymph nodes affected by Hodgkin’s disease remain enlarged or may even grow larger over time.^[2]

Other symptoms that should prompt you to see a doctor include persistent fever without an obvious cause, drenching night sweats that soak your sheets and clothes, and unexplained weight loss. Weight loss is considered significant if you lose 10% or more of your total body weight over six months without trying. Some people also experience extreme tiredness that doesn’t improve with rest, or intense itching of the skin, especially after bathing or drinking alcohol.^[3]

Certain groups of people are at higher risk and should be particularly vigilant. Hodgkin’s disease most commonly affects people in two age groups: young adults between 20 and 39 years old, and older adults over 65. It occurs slightly more often in males than females. If you have had an infection with the Epstein-Barr virus (EBV)—the virus that causes infectious mononucleosis, commonly known as mono—especially during teenage years, your risk is increased. A family history of Hodgkin’s disease also raises your chances of developing this condition.^[3]

People with weakened immune systems, such as those living with HIV/AIDS or taking medications that suppress the immune system, have a higher risk of developing Hodgkin’s disease and should be especially aware of any unusual symptoms. Similarly, individuals with certain autoimmune diseases like rheumatoid arthritis, lupus, or celiac disease may face increased risk.^[6]

If you notice any of these symptoms, don’t panic immediately—many of these signs can be caused by common infections or other less serious conditions. However, if symptoms persist for more than two weeks or worsen over time, it’s important to schedule an appointment with your doctor. Early detection generally leads to better outcomes, as Hodgkin’s disease is highly treatable when caught early.^[1]

Diagnostic Methods for Identifying Hodgkin’s Disease

When you visit your doctor with concerning symptoms, the diagnostic process typically begins with a thorough physical examination and medical history. Your doctor will ask detailed questions about your symptoms, including when they started, how they’ve changed, and whether anything makes them better or worse. They’ll also ask about your medical history, any previous infections, and whether anyone in your family has had lymphoma.^[10]

During the physical exam, your healthcare provider will carefully check for swollen lymph nodes in various parts of your body, including your neck, underarms, and groin. They’ll also feel your abdomen to check for an enlarged spleen or liver, as Hodgkin’s disease can sometimes affect these organs. This hands-on examination helps the doctor understand the extent and pattern of any swelling.^[10]

Blood Tests

Blood tests are often among the first diagnostic procedures performed. While blood tests alone cannot diagnose Hodgkin’s disease, they provide valuable information about your overall health and can reveal signs that something may be wrong. A complete blood count (CBC) measures different types of blood cells, including red blood cells, white blood cells, and platelets. Changes in these counts can indicate the presence of lymphoma or show how well your body is functioning.^[3]

Blood chemistry studies check the levels of various substances in your blood, including proteins and minerals. Your doctor may order a test to measure lactate dehydrogenase (LDH), an enzyme that is often elevated in people with lymphoma. Another test, called the erythrocyte sedimentation rate (ESR), measures how quickly red blood cells settle at the bottom of a test tube. A faster-than-normal rate can indicate inflammation or other problems in the body.^[3]

Blood tests can also check for viruses that may be associated with Hodgkin’s disease. Your doctor might test for the Epstein-Barr virus, HIV, hepatitis B virus, and hepatitis C virus. These infections can increase the risk of developing lymphoma or may affect treatment decisions.^[10]

Imaging Tests

Imaging tests create detailed pictures of the inside of your body, allowing doctors to see the location and size of swollen lymph nodes and determine whether the disease has spread to other areas. These tests are painless and provide crucial information for diagnosis and treatment planning.^[3]

A computed tomography (CT) scan uses X-rays taken from many different angles and combines them with computer processing to create detailed cross-sectional images of your body. This test can show lymph nodes in the chest, abdomen, and pelvis that cannot be felt during a physical exam. CT scans help doctors understand exactly where the lymphoma is located and how large the affected areas are.^[10]

A positron emission tomography (PET) scan uses a small amount of radioactive sugar that is injected into your vein. Cancer cells absorb more of this sugar than normal cells because they grow faster and use more energy. The PET scanner then detects where this radioactive sugar has collected, creating images that highlight areas of active disease. PET scans are particularly useful because they can distinguish between lymph nodes that are simply enlarged and those that actually contain lymphoma cells.^[10]

Sometimes CT and PET scans are combined into a single test called a PET-CT scan, which provides both detailed anatomical images and information about cell activity. This combined approach gives doctors the most complete picture of the disease.^[3]

Biopsy: The Definitive Test

While physical exams, blood tests, and imaging studies can suggest the presence of Hodgkin’s disease, a biopsy is the only way to confirm the diagnosis with certainty. A biopsy involves removing a small sample of tissue, usually from a swollen lymph node, and examining it under a microscope in a laboratory. This allows pathologists to look for specific cancer cells that are characteristic of Hodgkin’s disease.^[10]

The most common type of biopsy is called an excisional biopsy, where the entire lymph node is removed. This is often done through a small incision in the skin while you’re under local or general anesthesia. Removing the whole node gives pathologists the best chance of making an accurate diagnosis because they can see the entire structure and architecture of the tissue.^[10]

In the laboratory, specialists look for distinctive abnormal cells called Reed-Sternberg cells. These are large, unusual-looking cells that are surrounded by other inflammatory cells. Finding Reed-Sternberg cells is a key feature in diagnosing classic Hodgkin lymphoma, which accounts for about 95% of all Hodgkin’s disease cases. The pathologist can also determine which specific subtype of Hodgkin’s disease you have, which helps guide treatment decisions.^[4]

Sometimes doctors perform a core needle biopsy, where a hollow needle is used to remove a small cylinder of tissue from a lymph node. This procedure is less invasive than removing the entire node but may not always provide enough tissue for a complete diagnosis. If the results are unclear, an excisional biopsy may still be needed.^[10]

Depending on your symptoms and imaging test results, biopsies may be taken from other parts of your body. For example, if imaging shows abnormalities in your chest, a procedure called mediastinoscopy might be performed. This involves making a small incision at the base of the neck and inserting a thin tube with a camera to take samples from lymph nodes in the chest.^[10]

Bone Marrow Examination

In some cases, doctors may recommend a bone marrow aspiration and biopsy. This test checks whether Hodgkin’s disease has spread to the bone marrow, which is the soft, spongy tissue inside certain bones where blood cells are made. The procedure typically involves taking a sample from the back of the hip bone. A thin needle is inserted through the skin to remove a small amount of liquid bone marrow (aspiration) and a small piece of bone with marrow inside it (biopsy).^[10]

While this test may sound uncomfortable, it provides important information about the extent of the disease. Doctors use local anesthesia to numb the area, and the procedure is usually completed in about 10 to 15 minutes. Knowing whether the bone marrow is affected helps determine the stage of your disease and guides treatment planning.^[10]

Determining the Stage of Disease

Once Hodgkin’s disease is confirmed through biopsy, additional tests help determine the stage of the disease. Staging describes how far the lymphoma has spread through your body. This is crucial information because treatment strategies differ based on the stage.^[11]

Staging involves combining information from all your tests—physical exam, blood tests, imaging studies, and biopsies. Doctors look at how many lymph node groups are affected, whether the disease is on one side or both sides of the diaphragm (the muscle that separates your chest from your abdomen), and whether it has spread to organs outside the lymphatic system like the liver, lungs, or bone marrow.^[11]

Hodgkin’s disease is typically divided into four stages, numbered I through IV. Early stages (I and II) mean the disease is limited to one or a few lymph node areas, while advanced stages (III and IV) indicate more widespread involvement. Doctors also note whether you have B symptoms—which include fever, night sweats, and weight loss—as these can affect treatment decisions and prognosis.^[11]

Diagnostics for Clinical Trial Qualification

Clinical trials are research studies that test new treatments or new ways of using existing treatments. These trials play a vital role in advancing medical knowledge and improving care for Hodgkin’s disease. However, not everyone with Hodgkin’s disease is eligible for every clinical trial. Each study has specific requirements, called inclusion and exclusion criteria, that determine who can participate.^[11]

If you’re interested in joining a clinical trial, you’ll need to undergo additional diagnostic tests beyond those used for standard diagnosis. These tests ensure that you meet the trial’s requirements and establish a baseline against which your response to treatment can be measured. The specific tests required vary depending on the trial, but there are some common elements across most studies.^[11]

Confirming the Diagnosis and Stage

Clinical trials typically require recent confirmation of your Hodgkin’s disease diagnosis through biopsy. The tissue samples from your biopsy may be reviewed again by pathologists to confirm the specific type and subtype of Hodgkin’s disease you have. This is important because many trials focus on specific subtypes, such as classic Hodgkin lymphoma or nodular lymphocyte-predominant Hodgkin lymphoma.^[4]

Complete staging information is essential for trial enrollment. You’ll need up-to-date imaging studies, typically including PET-CT scans, to document exactly where the disease is located in your body and how extensive it is. Trials often specify which stages of disease are eligible—for example, some trials may only accept patients with early-stage disease, while others focus on advanced or recurrent disease.^[11]

Baseline Health Assessments

Before starting any clinical trial, researchers need to understand your overall health status. Comprehensive blood tests are performed to check your blood cell counts, liver function, kidney function, and levels of various chemicals and proteins in your blood. These baseline measurements help researchers monitor how the experimental treatment affects your body and distinguish treatment effects from pre-existing conditions.^[11]

Your heart function may be evaluated through tests like an electrocardiogram (ECG), which records the electrical activity of your heart, or an echocardiogram, which uses sound waves to create moving pictures of your heart. These tests are particularly important if the trial involves treatments that might affect the heart. Similarly, lung function tests may be required to ensure your lungs are healthy enough to tolerate certain treatments.^[11]

Prior Treatment History

Clinical trials have different requirements regarding previous treatments. Some trials only accept patients who have never been treated before (called treatment-naive patients), while others specifically look for patients whose disease has come back after initial treatment (relapsed disease) or hasn’t responded to standard therapies (refractory disease). You’ll need to provide detailed documentation of any previous treatments you’ve received, including the specific drugs used, doses, and dates.^[11]

If you’ve had prior treatment, additional tests may be needed to assess any lasting effects. For example, if you previously received chemotherapy drugs that can affect the heart, you might need cardiac testing to ensure your heart function is adequate. If you had radiation therapy, imaging studies might be done to evaluate any changes in the treated areas.^[11]

Specialized Tests for Targeted Therapies

Some clinical trials test treatments that target specific characteristics of cancer cells. These trials may require specialized laboratory tests on your biopsy tissue to determine whether your lymphoma has the particular features the treatment is designed to attack. For example, some immunotherapy trials look for the presence of certain proteins on the surface of lymphoma cells.^[11]

Molecular and genetic testing of your lymphoma cells may also be required. These sophisticated laboratory analyses examine the DNA and proteins inside the cancer cells to identify specific mutations or patterns that might predict how well you’ll respond to an experimental treatment. These tests are becoming increasingly important as researchers develop more personalized approaches to cancer treatment.^[11]

Performance Status Assessment

Clinical trials typically require that participants are well enough to participate in the study and complete the planned treatments. Doctors assess your performance status—a measure of how well you can perform ordinary daily activities. This is usually rated on a standard scale that ranges from 0 (fully active, able to carry on all activities without restriction) to 4 (completely disabled, unable to carry out any self-care).^[11]

Most trials require a certain minimum performance status level. This isn’t meant to exclude people, but rather to ensure that participants can safely undergo the experimental treatment and that researchers can accurately measure the treatment’s effects without confounding factors from severe underlying health problems.^[11]

Exclusion Criteria Testing

Clinical trials also have exclusion criteria—conditions or circumstances that would make it unsafe for someone to participate or that might interfere with interpreting the study results. Common exclusions include active infections, pregnancy, certain other medical conditions affecting vital organs, or current use of medications that might interact with the experimental treatment.^[11]

You may need tests to rule out these exclusion factors. For example, women of childbearing age typically need pregnancy tests before enrolling in trials. Tests for HIV, hepatitis B, and hepatitis C might be required, depending on the nature of the experimental treatment. These tests protect both you and the integrity of the research.^[11]