Diagnosis often starts when someone sees their doctor for specific symptoms, and also has painless, swollen lymph nodes in the neck, collarbone, armpit, or groin. For some, swollen lymph nodes in the chest are found incidentally during a chest x-ray.

There are several noncancerous reasons why lymph nodes maybe swollen. Your doctor will ask about your symptoms, and family and medical history. Lymph nodes throughout the body will be carefully examined. The doctor will check other areas of the body, such as the spleen and liver, for swelling. If there are no obvious reasons for these symptoms, a blood disorder may be suspected.

Diagnosis of Hodgkin Lymphoma

A lymph node biopsy is the only way to confirm a diagnosis. During the biopsy, all or part of a lymph node is removed. The tissue is examined under a microscope to look for a specific cancer cells. The presence of these cells indicate Hodgkin lymphoma. Types of biopsies include:

  • Exisional —Most common. The entire lymph node is removed in an open procedure.
  • Incisional —A small part of the node is removed during an open procedure.
  • Fine needle aspiration —A thin needle is inserted into the lymph node. Lymph tissue and fluid removed with a syringe.
  • Core needle —A larger, hollow needle is inserted into the lymph node. Lymph tissue and fluid are removed with a syringe.

Staging of Hodgkin Lymphoma

If Hodgkin lymphoma is confirmed, the results from the biopsy and new tests will help determine the stage of the cancer. Staging is used to identify characteristics of the cancer. Staging as well as other information like age and overall health will help develop the prognosis and treatment plan.

Staging Tests

Staging is determined by a number of factors. Tests will vary by individual, but may include:

  • Blood tests to look for abnormal numbers of certain blood cells, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function. Inflammation can be measured with an erythrocyte sedimentation rate (ESR) test.
  • Imaging tests may be used to evaluate the extent of cancer and involved organs. Imaging tests may depend on suspected location of cancer based on symptomsb but may include:
  • Biopsies of other tissues to confirm the presence of cancer in a specific location:
  • Ultrasound of the heart— electrocardiogram
  • Pulmonary function tests
  • Rarely, a laparotomy to explore the abdominal cavity

Stages of Hodgkin Lymphoma

Hodgkin lymphoma is staged from 0-4:

  • Stage 1 —Cancer is INSIDE the lymphatic system in one the following places:
    • One lymph node or more than one in the same lymph node cluster
    • Lymphatic tissue in the throat (tonsils and/or adenoids)
    • Thymus
    • Spleen
  • Stage 1E —Cancer is OUTSIDE of the lymphatic system in ONE organ or area.
  • Stage 2 —Cancer is in 2 or more lymph node clusters either above OR below the diaphragm.
  • Stage 2E —Cancer is in one or more lymph node clusters either above OR below the diaphragm AND in a nearby organ or area.
  • Stage 3 —Cancer is in lymph node clusters above AND below the diaphragm.
  • Stage 3E —Cancer is in lymph node clusters above AND below the diaphragm AND in a nearby organ or area.
  • Stage 3S —Cancer is in lymph node clusters above AND below the diaphragm AND in the spleen.
  • Stage 3E, S —Cancer is in lymph node clusters above AND below the diaphragm AND in a nearby organ or area AND in the spleen.
  • Stage 4
    • Cancer is OUTSIDE of the lymph nodes, IN one or more organs AND lymph nodes near those organs OR
    • Cancer is OUTSIDE of the lymph nodes in one organ AND has spread to areas far from the organ OR
    • Cancer is found in the lungs, liver, bone marrow, or cerebrospinal fluid of the brain and spinal cord. The cancer is in these areas, but has not spread there from other nearby sites.

For treatment purposes Hodgkin lymphoma may also be grouped as:

  • Early favorable—stage 1 or 2 with no other factors
  • Early unfavorable—stage 1 or 2 with factors that may include one or more factors, such as a tumor larger than 10 centimeters (cm), cancer in an organ, an ESR blood test that indicates inflammation, or symptoms like night sweats or fever
  • Advanced favorable—stage 3 or 4 with 3-4 factors:
    • Male
    • Aged 45 years and older
    • Stage 4
    • Blood tests that indicate abnormalities in blood cell counts
  • Advanced unfavorable—stage 3 or 4 with 4 or more of any factors listed above

Adult Hodgkin lymphoma treatment (PDQ)—patient version. National Cancer Institute website. Available at: https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq. Accessed January 28, 2021.

Diagnosis. Leukemia & Lymphoma Society website. Available at: http://www.lls.org/lymphoma/hodgkin-lymphoma/diagnosis. Accessed January 28, 2021.

Hodgkin lymphoma. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/hematology-and-oncology/lymphomas/hodgkin-lymphoma. Accessed January 28, 2021.

Hodgkin lymphoma (HL). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114957/Hodgkin-lymphoma-HL. Accessed January 28, 2021.

Tests for Hodgkin lymphoma. American Cancer Society website. Available at: https://www.cancer.org/cancer/hodgkin-lymphoma/detection-diagnosis-staging/how-diagnosed.html. Accessed January 28, 2021.

Last reviewed December 2020 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 1/28/2021