function ■ Excisional, incisional, or core needle biopsy ■ Bone marrow aspiration and/or biopsy is not routinely performed in adults (it may be used in select cases), although it is done routinely in pediatric patients with intermediate- and high-risk disease Many of these tests—including a CBC with differential, ESR, and the different types of biopsies—were described in Chapter 3; the rest are discussed in this chapter. What Is Performance Status? Performance status (PS) is a numerical rating of patients’ general health and their ability to carry out normal daily activities (such as getting washed and dressed, going to work/school, and doing chores). As shown in Table 4.1 on the next page, PS is graded on a scale of 0–4, with the lower numbers indicating better health. Note that in younger patients, other PS scales may be used. 33 Understanding Hodgkin Lymphoma Table 4.1. The Eastern Cooperative Oncology Group Performance Status Scale What Is a Comprehensive Metabolic Panel? A comprehensive metabolic panel measures the levels of certain chemicals in the blood to see whether the HL is causing any abnormalities in the main organs of the body. The comprehensive metabolic panel usually includes 14 or more specific tests that measure liver and kidney function, electrolytes, acid/base balance, and the levels of blood sugar and other blood proteins. Testing is also often done for uric acid and lactate dehydrogenase (LDH); high levels of LDH are associated with fast-growing lymphomas. The results from these tests can help patients and their doctors choose between different treatments. Many of these blood tests may be repeated several times during the course of treatment to see how the treatment and the lymphoma are affecting the patient’s body functions. Grade Description 0 ■ Fully active and able to carry on all pre-disease activities without restriction 1 ■ Cannot perform taxing physical activities, but can move around (ambulatory) and carry out light work (such as light house work) or do things that can be done while seated (such as office work) 2 ■ Can move around and take care of oneself, but unable to do any work; up and about for more than half of awake hours 3 ■ Can only partially take care of oneself; confined to a bed or chair for more than half of awake hours 4 ■ Completely disabled; cannot take care of oneself; completely confined to a bed or chair Learning the Basics 34 Part 1 What Is the Purpose of Testing For Hepatitis Virus and HIV? It is important to determine whether patients with HL are infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or HIV, because the presence of these viruses in the body may affect the type of treatments given. What Types of Imaging Tests May Be Used? A doctor will order imaging tests to help identify areas of the body where the lymphoma has spread, and, later on, to determine how well treatment is working. Most of these tests are painless and require no anesthetic. Several types of imaging procedures (described in Table 4.2) may be needed to thoroughly evaluate the extent of disease. Table 4.2. Types of Imaging Tests Chest X-Ray ■ X-rays use radiation to take pictures of areas inside the body. The amount of radiation used in most diagnostic tests is so small that it poses little risk to the patient. ■ Findings from a chest X-ray may indicate whether a tumor is “bulky” (greater than 10 centimeters in adults or greater than six centimeters in children), located in the mediastinum, or measures more than one-third of the diameter of the chest cavity. ■ A chest X-ray is the only imaging test conducted while the patient is standing up. Computed Tomography (CT) Scan ■ A CT scan takes X-rays from many different angles around the body. A computer combines the pictures obtained from these different angles to give a detailed image of organs inside the body. ■ Patients with HL often have CT scans of the neck, chest, abdomen, and pelvis to find out how many lymph nodes are involved and how enlarged they are, as well as whether any internal organs are affected by the disease. ■ Before a CT scan, the patient may be asked to drink a contrast liquid and/or get an intravenous (IV) injection of a contrast dye that will more clearly outline any abnormal areas in the body. 35 Understanding Hodgkin