Fever { Night sweats { Tiredness { Weight loss { Itchy skin. HL The Lymphoma Guide I page 13 Diagnosis and Staging Having the correct diagnosis is important for getting the right treatment. Some patients may need to get a second medical opinion about the diagnosis before they begin treatment. Talk to the doctor about the tests used to make the diagnosis. Doctors do a test called a “lymph node biopsy” to find out if a patient has Hodgkin lymphoma. How is a Lymph Node Biopsy Done? { A surgeon removes all or part of an enlarged lymph node. { The lymph node is examined under a microscope by a pathologist (a doctor who identifies diseases by studying cells and tissues under a microscope). It may be important to get another opinion about the biopsy results from a second pathologist. The doctor will do other tests to stage the disease (to see how far the disease has spread). See Lymphoma Stages on page 15 for descriptions of the stages. The tests for staging include { Blood tests – to check red blood cell, white blood cell and platelet counts; blood tests are also done to check for other signs of disease { Bone marrow tests – to look for Hodgkin lymphoma cells in the marrow { Imaging tests – to create pictures of the chest and abdomen to see if there are lymphoma masses in the lymph nodes, liver, spleen or lungs. Examples of imaging tests include a { Chest x-ray { CT (computed tomography) scan { MRI (magnetic resonance imaging) { PET (positron emission tomography) scan. HL page 14 I 800.955.4572 I www.LLS.org How are the Blood and Bone Marrow Tests Done? Blood tests. Usually a small amount of blood is taken from the patient’s arm with a needle. The blood is collected in tubes and sent to a lab. Bone marrow aspiration. A liquid sample of cells is taken from the marrow. Bone marrow biopsy. A very small amount of bone filled with marrow cells is taken from the body. Blood and marrow tests may be done in the doctor’s office or in a hospital. A bone marrow aspiration and a bone marrow biopsy are almost always done together. Both tests are done with a special needle. Some patients are awake for the procedure. They get medication first to numb the skin where the procedure will take place. This is usually the area near the patient’s hip bone. The hip bone holds the cells needed to be examined. Some patients are sedated (asleep) for the procedure. Blood and marrow tests may also be done both during and after treatment. The tests are repeated to see if treatment is destroying lymphoma cells. You can view, print or order the free LLS publication Understanding Lab and Imaging Tests to learn more about lab tests and what to expect at www.LLS.org/resourcecenter or contact our Information Specialists for a copy. Want more information? HL The Lymphoma Guide I page 15 Lymphoma Stages Patients are also divided into “A” or “B” categories. “B” category patients have fever, a lot of sweating and/or weight loss. “A” category patients do not. All stages of lymphoma can be treated. Diaphragm Stage I Stage II Stage III Stage IV One lymph node region or a single organ. Two or more lymph node regions on the same side of the diaphragm. Two or more lymph node regions above and below the diaphragm. Widespread disease; multiple organs, with or without lymph node involvement. Hodgkin Lymphoma Subtypes Knowing your subtype helps the doctor make treatment decisions. Below are the names of the different Hodgkin lymphoma subtypes. { Classical Hodgkin Lymphoma – about 95 percent of patients have this type, which has been further subdivided into { Nodular sclerosis { Mixed cellularity { Lymphocyte-depleted { Lymphocyte-rich classical. { Nodular Lymphocyte-Predominant Hodgkin Lymphoma Treatment for these subtypes may vary. For more information, see the Treatment section on page 16 and our free LLS publication Hodgkin Lymphoma. HL page 16 I 800.955.4572 I www.LLS.org Treatment Hodgkin lymphoma can be cured in about 75 percent of all patients. The cure rate in younger patients is over 90 percent. There are different types of HL. Talk to your doctor about the type of Hodgkin lymphoma that you have and your treatment choices. Factors that may affect treatment include { The type of Hodgkin