Further tests for Hodgkin lymphoma
If the biopsy shows that Hodgkin lymphoma is present, your specialist will arrange further tests to see if the lymphoma is in other parts of the body. The results of these tests will tell your specialist more about the stage of the lymphoma.
Once your specialist knows where the Hodgkin lymphoma is in your body, and whether or not you have symptoms, they can plan the most effective treatment for you.
The tests to find out the stage may include any of the following:
Blood samples will be taken throughout your treatment to check your general health, the levels of red cells, white cells and platelets in your blood, and your liver and kidney functions.
Some people may have a sample of bone marrow taken, usually from the back of the hip bone (pelvis). This is examined to see if it contains any lymphoma cells. The test can be done on the ward or in the outpatient department.
Before the sample is taken, a local anaesthetic is used to numb the area. A needle is then passed through the skin into the bone marrow (see diagram below). A tiny piece of the bone and bone marrow is taken to be examined under the microscope. A small dressing is applied to the area after the procedure. The test can be painful and you may have some discomfort that may last for a few days. This can be eased with mild painkillers. If you’re anxious about having the test, a mild sedative may help. You can ask your doctor or specialist nurse about this.
You may have an x-ray to see if the lymphoma is in the lymph nodes in the chest.
CT scan (computerised tomography scan)
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A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection. You’ll probably be able to go home when the scan is over.
The following tests are less commonly done but may be needed for some people:
PET (positron emission tomography) scan
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A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body.
A very small amount of a mildly radioactive substance is injected into a vein, usually in the arm. A scan is then taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue and show up on the scan.
It can be used to find out whether or not a lymphoma has spread beyond the original area of the body. It can also show how quickly the lymphoma cells disappear after treatment, and can be used to examine any lumps that remain after treatment to see if they contain scar tissue or cancer cells.
PET scans are now being used more often to help diagnose Hodgkin lymphoma. You may have to travel to a specialist centre to have one.
This is a combination of a CT scan and a PET scan. PET/CT scans give more detailed information about the part of the body being scanned. They are a new type of scan so you may have to travel to a specialist centre to have one.
You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done about an hour after the injection is given and usually takes 30-90 minutes. You should be able to go home after the scan.
MRI (magnetic resonance imaging) scan
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MRI scans are not commonly used to diagnose Hodgkin lymphoma, but some people may need to have one. This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips or bone pins.
You should also tell your doctor if you’ve ever worked with metal or in the metal industry, as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it’s likely that you won’t be able to have an MRI scan. In this situation another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan show up more clearly.
During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
It will probably take several days for the results of your tests to be ready. A follow-up appointment will be arranged before you go home. Obviously this waiting period is an anxious time and it may help to talk things over with a relative or close friend. You can also call our cancer support specialists or contact a useful organisation.