Further tests for Hodgkin's lymphoma

If Hodgkin's lymphoma cells are found in your biopsy, you will need to have other tests to find out whether there is lymphoma in any other areas of your body. Your doctor may ask you to have some of the tests mentioned below. You may have some of these tests again during your treatment, to find out how well the treatment is working. As you will probably have to wait around at the hospital when you are having these tests it is a good idea to take something with you to pass the time.

You will have regular blood tests throughout your treatment. Mostly, this will be to check your blood count. But your doctor can also use blood tests to check how well your liver and kidneys are working. Your doctor will probably also do blood tests called

• Serum albumin level
• ESR (erythrocyte sedimentation rate)
• LDH (lactic dehydrogenase)

These tests are used as ‘prognostic factors’. This means they may indicate how you will respond to treatment. So they are used to help work out how much treatment you are likely to need for a particular stage of Hodgkin's lymphoma.

You may have a chest X-ray to look for enlarged lymph nodes in your chest. In Hodgkin's lymphoma, it is quite common to have very enlarged lymph nodes in the middle of your chest, in an area called the mediastinum.

Finding enlarged lymph nodes helps your doctor to decide what treatment you should have. A chest X-ray can also show if there is any fluid collecting around the lung. This is called a pleural effusion. It is a rare symptom in Hodgkin's lymphoma, but it can happen.

CT scans can show up enlarged lymph nodes in the body. If you have already had a CT scan as part of your tests to diagnose Hodgkin's lymphoma you won't need to have another one. But if your lymphoma was diagnosed by biopsy you may need to have a CT scan to see whether you have enlarged lymph glands in other parts of the body. CT scanners take a series of X-rays of part of your body and feed them into a computer to make a detailed picture. You may be asked to drink a liquid called a contrast medium before the scan. This helps to make the gut show up more clearly. But it may cause diarrhoea afterwards. There is more about having a CT scan in the cancer tests section.

MRI scans use magnetism to build up a picture. They can also pick out enlarged lymph nodes anywhere in the body. MRI scans are particularly good at showing up the soft tissues of the body and are also good for showing up the brain and central nervous system. You cannot have an MRI if there is any metal in your body. So make sure your doctor knows if you have had joint replacement surgery, have a pacemaker or know of any other metal in your body. There is more about having an MRI scan in the cancer tests section.

Your doctor might suggest a PET scan to try to tell whether an enlarged lymph node is scar tissue or lymphoma. A lymph node can sometimes be enlarged because of past infections. For a PET scan you have an injection into a vein of a mildly radioactive substance. Cells that are active take up the radioactivity and show up on the scan. Lymph nodes that are swollen due to past infections are not active and do not show up on the scan. Lymphoma cells do take up the radioactivity. 

PET scans are also sometimes used during or after lymphoma treatment. If it looks as though there are still enlarged nodes after your treatment, a PET scan may be able to show whether this is left over scar tissue or whether there are still live lymphoma cells there. There is information about having a PET scan in the cancer tests section.

A PET-CT scan is a combination of a PET scan and a CT scan. It takes CT pictures of the structures of your body. At the same time, a mildly radioactive drug shows up areas of your body where the cells are more active than normal. The scanner combines both of these types of information. This allows your doctor to see any changes in the activity of cells and know exactly where the changes are happening. PET-CT scans are often used during or after your treatment. There is more information about PET-CT scans in the cancer tests section of CancerHelp UK.

Ultrasound scans use harmless sound waves to build up a picture of the body. Ultrasound is particularly useful for examining the liver and kidneys. There is information about having an ultrasound scan in the cancer tests section.

You will probably have a bone marrow test. About 1 in 25 people with Hodgkin's lymphoma have cancer in their bone marrow when they are diagnosed. It is important to know if Hodgkin's lymphoma cells are in your bone marrow as this affects the treatment that you may need. You usually have the test under local anaesthetic. Children can have a general anaesthetic if necessary. The test can be uncomfortable, or even painful, for a minute or two. For more information about having a bone marrow test look at the cancer tests section of CancerHelp UK.

You may have other tests that are not mentioned here. The exact tests will vary from one person to another depending on their symptoms and exact medical situation.

Your doctor may suggest other tests if you have particular symptoms, for example a urogram, if your urinary system is affected by enlarged nodes. This isn't used often for Hodgkin's lymphoma - only if there is particular reason to do so.

You will be asked to go back to the hospital when your test results have come through. But this is bound to take a little time, even if only a day or two. This is a very anxious time for most people. While you are waiting for results, it may help to talk to a close friend or relative about how you are feeling.  Or you may want to contact a cancer support group to talk to someone who has been through similar experiences.

If you would like to talk to someone outside your own friends and family, look at our counselling organisations page. You can find out about counselling in the counselling section.