Diagnosing Hodgkin’s lymphoma
Even if all the mentioned clinical signs and symptoms are present, the diagnosis of Hodgkin’s lymphoma remains unsure unless a confirmatory test is done. Some conditions may still resemble Hodgkin’s lymphoma such as:
♦ Viral infections like cytomegalovirus and Epstein-Barr virus, both of which can cause enlarged lymph nodes and spleen.
♦ Tuberculosis: It can also cause enlarged painless lymph nodes with enlarged spleen in some cases. Tuberculosis can also cause night sweating and fever.
♦ Non–Hodgkin’s lymphoma: Although they may have similar names, but the outcome and clinical presentation of each condition varies greatly. Non-Hodgkin’s tends to occur at an older age and has a greater percentage of affecting the spleen as well as other sites of lymphoid tissue outside the lymph nodes.
♦ Other cancers: Other solid cancers can send metastases to their neighboring or even distant lymph nodes and cause a similar clinical presentation to Hodgkin’s lymphoma. A notable similar cancer is small cell lung cancer which is considered occult, which means that it usually presents by lymph node involvement and paraneoplastic syndrome.
To differentiate Hodgkin’s lymphoma from these conditions, a battery of laboratory investigations and imaging modalities are available. Not only do they confirm the diagnosis, but also help predict the outcome of the condition. Lab studies include:
- Complete blood count: Although the blood picture isn’t conclusive for diagnosing lymphoma, but some cases with anemia and decreased white blood count could mean an advanced stage with bone marrow involvement.
- Liver function tests: Again, they detect the extent of the disease and liver involvement.
- Lactate dehydrogenase: Lactate dehydrogenase is an enzyme found inside many cells and is essential for energy production. It is not specific for cancer cells, but an excess in its level could indicate an increased cellular destruction and points towards a large tumor load.
General lab studies can’t confirm the diagnosis of lymphoma since no specific marker is secreted by cancerous lymphocytes, but it can help assess the severity of the condition and give a rough estimation of cancer load.