Hodgkin's Disease

As with many forms of cancer, diagnosis of Hodgkin's disease has two important components. First is the identification of Hodgkin's lymphoma as the cause of the patient's disease. Second is the staging of the disease; that is, an attempt to identify the degree of spread of the lymphoma.

Diagnosis of Hodgkin's lymphoma requires removal of a sample of a suspicious lymph node (biopsy) and careful examination of the tissue under a microscope. In Hodgkin's lymphoma, certain characteristic cells, which are called Reed-Sternberg cells, must be present in order to confirm the diagnosis. These cells usually contain two or more nuclei. The nucleus is the oval, centrally located structure within a cell that houses the genetic material of the cell. Reed-Sternberg cells also have other unique characteristics, which cause them to appear under the microscope as "owl's eyes" or yin-yang cells. In addition to the identification of these Reed-Sternberg cells, other cells in the affected tissue sample are examined. The characteristics of these other cells help to classify the specific subtype of Hodgkin's lymphoma present.

Once Hodgkin's disease has been diagnosed, staging is the next important step. This involves computed tomography scans (CT scans) of the abdomen, chest, and pelvis, to identify areas of lymph node involvement. In rare cases, a patient must undergo abdominal surgery so that lymph nodes in the abdominal area can be biopsied (staging laparotomy). Some patients have their spleens removed during this surgery, both to help with staging and to remove a focus of the disease. Bone marrow biopsy is also required unless there is obvious evidence of vital organ involvement. Some physicians also order lymphangiograms (a radiograph of the lymphatic vessels).

Staging is important because it helps to determine what kind of treatment a patient should receive. It is important to understand the stage of the disease so that the treatment chosen is sufficiently strong to provide the patient with a cure. All available treatments, however, have potentially serious side effects. The goal of staging, then, is to allow the patient to have the type of treatment necessary to achieve a remission, but to minimize the severity of short and long-term side effects from which the patient may suffer.