Hodgkin lymphoma

The first step in treating your child is forming an accurate and complete diagnosis. Your child’smedical history and a physical examination are the most important parts of forming the diagnosis. A patient’s medically relevant history may include information such as diet, everyday activities, past illnesses and past treatments. Additionally, a physical examination includes checking for swollen lymph nodes, which often affect the neck, underarm, groin, spleen and liver.

In addition to a complete medical history and physical examination, the following tests help to establish a diagnosis and or stage the Hodgkin lymphoma:

• blood tests
  • complete blood count test – count of red blood cells, white blood cells, platelets and amount of oxygen-carrying protein (hemoglobin)
  • sedimentation test – drawn blood is checked to see how fast it settles to the bottom of a test tube
  • c-reactive protein –  measures a protein made in the liver
• x-rays of the chest - a diagnostic test which uses invisible electromagnetic energy beams to produce images of your child’s internal tissues, bones and organs onto film
• biopsy - a sample of tissue is removed from a wherever the Hodgkin is located, such as a lymph node, and is examined under a microscope
• computerized tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.
• Positron emission tomography (PET) scan –is a very sensitive technology that uses a radioactive material to measure chemical and functional changes within the body
• bone marrow biopsy/aspiration - a procedure that involves a small amount of bone marrow fluid and tissue to be taken to look for abnormal cancerous cells

How is Hodgkin lymphoma staged?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that are used for Hodgkin lymphoma.

One method of staging Hodgkin lymphoma is the following:

• stage I - usually involves a single lymph node region or structure
• stage II - involves two or more lymph node regions or structures on the same side of the body, specifically either below or above the space between the midsection and chest (diaphragm)
• stage III - involves lymph node regions or structures on both sides of the body, above and below the diaphragm, and is further classified depending on the organs and areas involved
• stage IV - involves disease that has spread to other areas (metastasized) such as the lungs, liver or bones, in addition to the lymphatic system

Stages are also noted by the presence or absence of symptoms of the disease:

• asymptomatic (A)
• symptomatic (B)

For example, if your child’s Hodgkin lymphoma is stage IIIB, it means that it is symptomatic, involves lymph node regions or structures on both sides of the body, and is further classified depending on the organs and areas involved.

We meet with families multiple times to share information as it becomes available.  We describe an overview of the multifaceted treatment of Hodgkin before final information is available.  After all the information is available and has been reviewed, we meet with families to summarize all available data, proposed treatment options.   Additional discussions are often necessary if there is more than one reasonable treatment option, if the patient/family has additional questions, and to ensure the final choice is best tailored to each child and their family.