For Professionals

Making the Diagnosis:

Once the medical team has a suspicion of Hodgkin's Lymphoma, if the lymph nodes don't feel normal when examined by a doctor, the doctor may need to extract a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.  The cells they look for are Reed-Sternberg cells, a cell specific to Hodgkin's Disease.

• A physical exam including examining the lymph nodes
• Collecting a medical history and history of symptoms
• A complete blood work-up including checks for abnormal  blood cell count, blood chemistry, and abnormal sedimentation rate
• A chest x-ray to view lymph nodes and to see if other organs are involved
• A computerized tomography (CT or CAT) scan, positron emission tomography (PET) scan and/or magnetic resonance imaging (MRI) scan of the chest, pelvis, and abdomen to determine the possible spread of the disease
• A gallium scan to check for radioactive intake of gallium in the lymph system indicating swelling and ultimately disease
• A bone marrow aspiration and biopsy to determine if the bone marrow has been affected by lymphoma; in this procedure the hip is numbed (ask for EMLA cream or similar to numb the site beforehand at home) and a needle is inserted into the bone; liquid bone marrow and a bone chip are extracted and the tissue is examined under a microscope

Certain medical centers may perform additional tests, including

• Exploratory surgery (staging laparotomy) to determine the extent of the disease. In some cases the spleen is removed if it is the only organ affected.  A tissue sample may also be taken of the liver. The child may receive medicine to prevent infection.
• A lymphangiogram, a procedure during which a radio-opaque liquid is injected into the lymph system through the feet; the fluid travels throughout the lymph system and remains visible by x-rays for up to six months

Most centers will not perform these procedures, especially on children.

Examination Tip

There is a cream called EMLA that is used to dull skin pain.  It is often used prior to pediatric biopsies and even some injections.  It may not be routinely offered but it is worth asking for.

Once a biopsy sample is taken, it is classified into one of five types of Hodgkin's shown below. This typing is called the histology of the disease.

Types of Hodgkin's Lymphoma:

• Nodular sclerosis (NS). The lymph nodes in the lower neck, chest and collarbone usually contain normal and reactive lymphocytes and Reed-Sternberg cells separated by bands of scar-like tissues.
• Lymphocyte predominance (LP). The lymph nodes are composed largely of reactive lymphocytes and malignant L&H cells which have a "popcorn" appearance and very few Reed-Sternberg cells.
• Mixed cell (MC). The lymph nodes usually contain Reed-Sternberg cells and inflammatory cells.
• Lymphocyte depleted (LD). There are two different variations of this classification: one with sheets of differing malignant cells; the other with few Reed-Sternberg cells and lymphocytes with scar-like tissue.
• Nodular lymphocyte predominance Hodgkin's lymphoma

The medical team will also stage the spread of the lymphoma. There are four stages which depend on how far the cancer has spread through the body:

Stages of Hodgkin's Lymphoma:

Staging is also dependent on whether the child has had a group of symptoms including night sweats, fever, or weight loss. A child who has had one or more of these are grade "B" while patients who have none grade "A". Itching and back pain are not symptoms which rate the "B" designation but can be common in many cases where "B" symptoms are evident.

The letter "E" is used when the disease has spread to other organs such as the bone marrow, lung, spleen, etc.

Please look at the treatment and resource sections for more information on Childhood Hodgkin's Lymphoma. Note - physician information is often technical. Take the information you find to discuss with your doctor and medical team. A glossary is available if terms are unfamiliar.

For more information on Childhood Hodgkin's Lymphoma, please see the following pages:

• Childhood Hodgkin's Lymphoma: Treatment
• Childhood Hodgkin's Lymphoma: Chemotherapy
• Childhood Lymphoma: Radiotherapy
• Childhood Hodgkin's Lymphoma: Introduction
• Childhood Lymphoma: Resources
• Childhood Lymphoma: Just for Kids & Teens

Other pages you may want to visit: