Once the diagnosis is established as Hodgkin’s disease, the second important part of diagnosis is assessing how advanced the disease is. Depending on where the initial lymph nodes are, you may need some or all of these tests.
Computed tomography (CT) scan of your chest, abdomen, and pelvis. In this test, an X-ray beam takes pictures of the body from many angles. A computer puts these pictures together, making a cross-section of the body. The doctor may enhance the pictures by asking you to drink or by injecting you with a contrast material before the X-rays. A CT scan is needed to show up groups of lymph nodes, an enlarged spleen, or abnormalities in your liver.
Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to take pictures of the inside of the body. MRIs are not as useful as CT scans but may tell whether there is bone marrow involvement with Hodgkin’s disease.
PET scan. This is the latest addition to the Hodgkin’s disease workup. It’s useful because it can give quick information on the presence of lymphoma almost anywhere in the body. For this test, you take a radioactive sugar. The cells of Hodgkin’s disease take up this sugar, which shows up on a scan. A computer can reconstruct the pictures in many different ways. It can also help look at areas seen on the CT scan to tell whether they are lymphoma or not.
Ultrasonography. This test uses sound waves to look for things in the body that do not belong, such as tumors. The sound waves bounce off body parts and send back signals, much like sonar on a submarine, to the computer. The computer makes an image of the body using those signals. This test is very helpful in seeing whether a tumor is a cyst, a fluid-filled sac that is probably not cancer, or a solid tumor, which may be cancerous.
Gallium scan. For this test, you first get have a gallium isotope injected into a vein in your arm. One to 3 days later, you’ll go to the hospital or clinic to have a special camera take pictures of your body. Doctors use this scan to look in your chest and to see whether any active lymphoma has been left behind after treatment. It is being replaced by PET scanning.
With increasing availability of CT, MRI, and PET scans, as well as changes in treatment, ultrasonography, gallium scans, and abdominal surgical procedures are becoming outmoded.
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