Biopsy

The only way your specialist can tell whether you have Hodgkin lymphoma is to take out part or all of a lymph node so that it can be looked at under a microscope. This test is called a biopsy. It is normally quite straightforward, and can be done under local or general anaesthetic. If you have Hodgkin lymphoma the Reed-Sternberg cell will be visible when the lymph node is examined.

If you do have Hodgkin lymphoma your doctor will arrange some more tests to find out which parts of your body are affected. These tests will include:

Blood test

Your doctor will use this test to find out your blood count – the number of red cells, white cells and platelets in your blood.

Chest X-ray

This is to see whether you have any enlarged lymph nodes in your chest.

Bone marrow test

You may have this test to see if Hodgkin lymphoma has affected your bone marrow. Bone marrow is a spongy substance inside the body's large bones.

The doctor usually takes some bone marrow from the back of the pelvis. Most patients have a local anaesthetic for this, but it can be done with a sedative injection. The injection makes you feel sleepy and relaxed, and you are unlikely to remember the test later on.
 

The doctor uses a fine needle to take the sample. It can be a bit painful for a little while afterwards, but normal painkillers should help.

Computerised tomography (CT or CAT scan)

This is a type of X-ray that creates a picture of the inside of the body. You lie on a couch while it passes through a large, hollow ring. The doctor uses the CT scan to measure the size of the lymph nodes and decide whether any of them have been affected by Hodgkin lymphoma.

Staging

After all the tests have been done, your doctor will be able to work out the stage your disease is at.

Stage I
One group of lymph nodes is affected, and the disease is only one side of the diaphragm (above or below it).

Stage II
Two or more groups of nodes are affected, and the disease is on only one side of the diaphragm (above or below it).

Stage III
The disease is in the lymph nodes above and below the diaphragm.

Stage IV
The disease has spread beyond the lymph nodes – for example to the bone marrow or the liver.