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Hodgkin’s Lymphoma Diagnosis and Treatment - A Detailed Guide

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Patients should not ignore symptoms that indicate Hodgkin’s lymphoma and should consult a specialist for a proper evaluation. Hodgkin’s lymphoma cancer treatment will often need a comprehensive approach wherein specialists carefully study the case, understand the individual case parameters, and devise an individualized treatment plan.

Hodgkin’s Lymphoma Diagnosis Tests

Doctors recommend multiple tests for Hodgkin’s lymphoma diagnosis. Along with confirming the diagnosis, these tests also help specialists stage the disease and devise treatment plans accordingly. The commonly recommended tests for Hodgkin’s lymphoma diagnosis include:

Imaging Tests for Hodgkin’s Lymphoma

X-Ray Scan

Patients with Hodgkin’s lymphoma usually have enlarged or swollen lymph nodes in the center of the chest (mediastinum). The X-ray scan assists the clinicians in determining the course of treatment. It also provides information about fluid accumulation in the pleural cavity (pleural effusion). Pleural effusion is a rare symptom of Hodgkin’s lymphoma. Some of the findings on the chest X-ray that indicate Hodgkin’s lymphoma are osteolytic and expandible ribs, involvement of the sternum and mediastinal nodes, and the presence of mass.

MRI Scan

MRI is not the preferred imaging method for Hodgkin’s lymphoma diagnosis. However, oncologists may recommend it in certain situations to obtain additional information or detect disease characteristics. It assists clinicians in evaluating soft tissues. It is also recommended when there is suspicion about the involvement of the chest or spinal cord.

CT Scan

CT is a preferred imaging modality for Hodgkin’s lymphoma diagnosis. It assists the clinicians in diagnosing, staging, and monitoring the disease. A CT scan helps detect lymph node involvement and its extent in individuals suspected of Hodgkin’s lymphoma. Along with diagnosing Hodgkin’s lymphoma, a CT scan also determines the size and location of the lymph nodes to determine staging. It also identifies disease-related complications, such as blood vessel blockage, compression of nearby tissues, and fluid accumulation. A CT scan also helps guide the instruments, such as the needle, during the biopsy (CT-guided biopsy).

PET or PET-CT Scan

A PET scan involves using radioactive sugar analogs that allow clinicians to determine areas of high metabolic activity. Like other malignant cells, the cells of Hodgkin’s lymphoma have a higher metabolic rate than normal, healthy cells. A PET-CT scan provides detailed information about the cellular function and anatomy of the lymph nodes. The PET scan also determines the disease stage and assesses the patient’s response to therapy.

Bone Scan

A bone scan is not a common imaging technique employed for Hodgkin’s lymphoma diagnosis. Although Hodgkin’s lymphoma commonly affects the lymph nodes, bone involvement may be seen in some cases. If specialists suspect bone involvement, they recommend a bone scan to detect the location and extent of the disease. Bone scans also help evaluate bone health during treatment, as certain therapies, such as chemotherapy, may affect bone mineral density.

Blood Test for Hodgkin’s Lymphoma

Blood tests are not recommended for the diagnosis of Hodgkin’s lymphoma, as they cannot indicate the presence of the disease. However, they are recommended to determine the levels of different blood cells, examine liver and kidney functions, and look for the presence of lymphoma cells or other abnormal cells. Commonly recommended blood tests for Hodgkin’s lymphoma diagnosis include:

Complete Blood Count (CBC)

A complete blood count (CBC) in patients suspected of Hodgkin’s lymphoma provides valuable information about the individuals' overall health and the disease's impact on blood cells. The blood components analyzed include white blood cells, lymphocytes, platelets, and red blood cells. The abnormal levels of one or more of the blood cells suggest bone marrow involvement in these individuals.

Blood Chemistry Study

Blood tests may also be recommended to determine the functioning of the body's different organs and to diagnose and monitor Hodgkin’s lymphoma. These tests include kidney function tests, liver function tests, blood urea nitrogen, and a complete metabolic panel including glucose levels and electrolyte concentration, C-reactive protein, lactate dehydrogenase, and levels of albumin and total protein in the blood.

Erythrocyte sedimentation rate (ESR)

ESR is not specific for Hodgkin’s lymphoma and may be recommended along with various other tests for Hodgkin’s lymphoma diagnosis, such as imaging tests. ESR provides information about the body's inflammatory status and assists in evaluating the progression of the disease. Patients in the active phase of Hodgkin’s lymphoma may have altered levels of ESR.

Biopsy

A biopsy may help in the definitive diagnosis of Hodgkin’s lymphoma. In this method, the clinicians withdraw the sample from the abnormal or suspected site for Hodgkin’s lymphoma and send the sample to the laboratory for a comprehensive evaluation. The presence of malignant cells in the sample confirms the diagnosis of Hodgkin’s lymphoma. There are types of biopsies available for Hodgkin’s lymphoma diagnosis, and they include:

Excision biopsy

This procedure is recommended when the patient has enlarged lymph nodes. During this procedure, the surgeon cuts the skin and obtains the complete lymph node (excisional biopsy) or a part of the lymph node (incisional biopsy).

Core needle biopsy

During a core needle biopsy, the doctor inserts a needle through the skin into a swollen lymph node to collect the tissue sample. A core needle biopsy is relatively less invasive than an excisional biopsy. However, the sample obtained in a core needle biopsy is comparatively less than that obtained through an excisional biopsy.

Lung Function Tests

These tests are also known as pulmonary function tests. These tests are not the primary tests for Hodgkin’s lymphoma diagnosis. However, the doctor may recommend lung function tests in specific conditions, such as mediastinal involvement, as revealed in the imaging tests, and in cases where patients have serious breathing problems. Lung function tests may include spirometry, evaluation of diffusion capacity, and lung volume tests.


Cardiac Evaluation

In patients diagnosed with Hodgkin’s lymphoma, the doctor may recommend a comprehensive evaluation of heart function, as certain chemotherapy medications may affect heart health. The tests include a multigated acquisition (MUGA) scan and an echocardiogram.

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Hodgkin’s Lymphoma Treatment

Hodgkin’s lymphoma treatment often demands a multidisciplinary team approach, where specialists from different disciplines carefully go through the patient information and individual case parameters and devise a personalized care plan that meets their health requirements and helps them return to the best state of health possible. The following are the commonly recommended Hodgkin’s lymphoma treatment options:

Stem Cell Transplant

A stem cell transplant is predominantly recommended for patients with difficult-to-treat Hodgkin’s lymphoma or Hodgkin’s lymphoma that is not responding to conventional treatments, such as chemotherapy or radiation therapy. It is also recommended for patients with disease recurrence. There are two types of stem cell transplants: autologous stem cell transplant and allogeneic stem cell transplant. This treatment approach involves delivering high-dose chemotherapy and radiation therapy before transplanting healthy stem cells. Currently, the stem cells are usually taken from the blood (the other option is from the bone marrow), known as peripheral stem cell transplantation.

Hodgkin’s Lymphoma Radiation Therapy

Radiation therapy is an effective Hodgkin’s lymphoma treatment option. Radiotherapy for Hodgkin’s lymphoma is usually recommended after chemotherapy. It is commonly recommended for patients with classic Hodgkin’s lymphoma, particularly when the patients have a large tumor. Radiation therapy is also helpful in the management of nodular lymphocyte-predominant Hodgkin’s lymphoma. Although radiation therapy for Hodgkin’s lymphoma is effective, chemotherapy is usually preferred by oncologists due to the long-term side effects of the radiation. Radiation therapy for Hodgkin’s lymphoma is usually delivered in low doses.

Immunotherapy

Immunotherapy is a systemic therapy wherein the patient’s immune system is re-engineered to identify cancer cells and kill them. Systemic medications are administered as a part of immunotherapy. These include monoclonal antibodies that attack specific targets present on the surface of lymphocytes. Immune checkpoint inhibitors belong to another class of immunotherapy drugs. These drugs work by blocking the proteins that stop the immune system from identifying and attacking cancer cells.

Targeted Therapy

Targeted therapy works by specifically targeting cellular pathways or proteins associated with cancer cells that help them divide, grow, and proliferate. These targets are specific to cancer cells, so the therapy has fewer side effects than conventional chemotherapy. Targeted therapy is recommended in cases where patients have refractory or relapsed Hodgkin’s lymphoma.

Chemotherapy for Hodgkin’s lymphoma

Chemotherapy is the preferred Hodgkin’s lymphoma treatment option in most cases. It involves the administration of powerful anti-cancer drugs orally or intravenously. The doctor will prescribe a combination of two or more Hodgkin’s lymphoma medications as part of chemotherapy. These drugs attack different cell cycle phases. For Hodgkin’s, chemotherapy drugs are delivered in multiple cycles with a resting period between the cycles.

Palliative care

Palliative care is usually recommended for severely ill patients. The goal of palliative care is to enhance the patient's quality of life by improving their physical and psychological health. Palliative care is not essentially end-of-life care. It may be used along with life-prolonging or curative treatments.

Why Choose HCG for Treatment and Diagnosis of Hodgkin’s Lymphoma?

Hodgkin’s lymphoma should be diagnosed early and appropriately treated for better health outcomes, fewer complications, and enhanced survival. As one of the best cancer hospitals in India, HCG has modern diagnostic and treatment solutions to facilitate the effective management of Hodgkin’s lymphoma. The medical and paramedical staff at HCG are extensively trained and experienced in managing simple to complex cases of Hodgkin’s lymphoma.

Conclusion

Commonly recommended tests for Hodgkin’s lymphoma diagnosis include imaging techniques such as CT scans, chest X-rays, MRIs, PET scans, PET-CT scans, bone scans, and biopsies. Additionally, the doctors may also recommend blood tests, metabolic panels, pulmonary function tests, and heart evaluations. Hodgkin’s lymphoma therapy or treatment predominantly involves chemotherapy, radiation therapy, immunotherapy, and targeted therapy. Stem cell transplants may also be recommended as Hodgkin’s lymphoma treatment.

Frequently Asked Questions

What is the lifespan of Hodgkin's lymphoma?

The life of patients after Hodgkin’s lymphoma depends on several factors, such as the extent of tumor spread, patient age, complications, underlying medical conditions, and response to treatment. The health outcomes of Hodgkin’s lymphoma treatment are excellent if the condition is diagnosed and treated in its early stages.

If Hodgkin’s lymphoma is diagnosed at an early stage, it is possible to treat it successfully, and patients are often able to live near-to-full lives. That said, continuous monitoring or follow-up plays a pivotal role in ensuring the well-being of patients after their treatment and detecting recurrences in the early stages.

Hodgkin’s lymphoma diagnosis can become challenging in some cases, as some of its symptoms overlap with the symptoms of various less-serious health conditions. However, we have advanced diagnostic facilities available today, and these help in the accurate diagnosis of Hodgkin’s lymphoma.

Hodgkin’s lymphoma arises from B-lymphocytes, a type of white blood cell that produces antibodies. Certain mutations in the DNA of B-lymphocytes can cause these cells to undergo uncontrolled division and form a mass. Although Hodgkin’s lymphoma may occur in any part of the body, it usually starts in the lymph nodes present in the upper parts of the body.

Like most other cancers, the diagnosis of Hodgkin’s lymphoma is confirmed by performing a biopsy.

We are yet to identify a particular treatment as a Hodgkin’s lymphoma cure. Some treatments work well for some patients, while for others, they don’t. Often, Hodgkin’s lymphoma will need a multimodal treatment, where multiple types of treatments are recommended by specialists for its effective management.

It is important to note that each case of Hodgkin’s lymphoma is unique, and so is each patient. Specialists will chart a personalized care plan for each patient based on the individual case parameters. This has a significant impact on the patient’s recovery. For all these reasons, one treatment cannot be considered a cure for Hodgkin’s lymphoma.