There are approximately 8,000 new cases of Hodgkin's disease every year, according to Carol Portlock, M.D., attending physician of the Lymphoma Service at the Memorial Sloan-Kettering Cancer Center in "The Merck Manual for Healthcare Professionals." Hodgkin's lymphoma is a cancer that involves the lymph nodes, bone marrow, liver and spleen. Because the disease can affect so many organs, there are several tests involved in establishing the diagnosis and in determining the stage of this disease.
Blood Cell Tests
People being tested for Hodgkin's disease will have several blood tests, according to Dr. Portlock in "The Merck Manual for Healthcare Professionals." They will have a CBC, or a complete blood count, to check the level of their red blood cells, white blood cells and platelets. A low number of red blood cells or a high number of white blood cells can be a sign of advanced Hodgkin's disease. An ESR, or erythrocyte sedimentation rate, checks how fast the red blood cells settle. Red blood cells are called erythrocytes, and they settle faster during inflammation.
Blood Chemistry Tests
As listed by Dr. Portlock, these blood tests check on the status of the liver and kidneys, and see whether cancer has spread to the bones. Alkaline phosphatase is checked because this is a protein which increases during liver or bone disease. The liver function tests check on the status of the liver. How well the kidneys are functioning is checked through the amount of BUN and creatinine in the bloodstream. BUN stands for blood urea nitrogen, while creatinine is produced when the skeletal muscle breaks down creatine phosphate for energy. If the kidneys are failing, they will not excrete as they should and there will be a high amount of urea, nitrogen and creatinine in the bloodstream.
Radiology
Hodgkin's disease starts in one group of lymph nodes, and as it progresses, it keeps moving to the next group. An X-ray of the chest is done to see whether there are any large lymph nodes in the chest. A computed tomography scan, or a CT scan, takes X-rays as the machine rotates around the person lying down. A computer then takes the images and combines them. It can show detail and see if there are any large lymph nodes or organs. A CT scan of the chest, abdomen and pelvis is done, writes Gary Shi, M.D., of the University of Texas MD Anderson Cancer Center in the "MD Anderson Manual of Medical Oncology."
Biopsies and Aspirations
A lymph node biopsy is performed if the CT scan shows large lymph nodes. The physician may remove just a small part of the lymph node or an entire node. In an aspiration, the physician takes a small sample of tissue. In the bone marrow biopsy, a small amount of bone marrow and bone is removed, while the bone marrow aspiration takes a small sample of liquid bone marrow to see if the disease has spread to the bones. The diagnosis is made when a hematopathologist reviews the biopsy samples and finds the disease, according to Dan Longo, M.D. of the National Institutes of Health in "Harrison's Principles of Internal Medicine." A hematopathologist is a pathologist who is an expert in blood and lymphoid tissue diseases.
References
- "Harrison's Principles of Internal Medicine"; Anthony Fauci, M.D., Dennis Kasper, M.D., Dan Longo, M.D. et al.; 2008
- "MD Anderson Manual of Medical Oncology"; Hagop Kantarjian, M.D., Robert Wolff, M.D., Charles Koller, M.D.; 2006
- The Merck Manual for Healthcare Professionals: Hodgkin Lymphoma
