Because the symptoms of Hodgkin's lymphoma are similar to those of other disorders, such as influenza, the disease can be difficult to diagnose. Some distinctive characteristics help diagnose Hodgkin's lymphoma, and these include:

• Orderly spread to lymph nodes. The pattern of spread is orderly, progressing from one group of lymph nodes to the next.
• Only rare 'skipping' of lymph nodes. The disease rarely skips over an area of lymph nodes as it spreads.

These tests and procedures help diagnose Hodgkin's lymphoma.

• Biopsy. Taking a tissue sample (biopsy) of an enlarged lymph node is the most common way to make a definite diagnosis. Once a sample is removed, the tissue is examined for malignant cells.
• Physical exam. Your doctor checks for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.
• X-rays. These pictures can reveal swollen lymph nodes in the body.
• Computerized tomography (CT) scan. This is a series of pictures of the inside of your body, usually the chest, abdomen and pelvis. You usually swallow a dye or it's injected into your veins so that your organs and tissues will show up more clearly.
• Magnetic resonance imaging (MRI). A device that uses a magnet, radio waves and computer provides your doctor with a series of detailed pictures of the inside of your body.
• Positron emission tomography (PET) scan. A small amount of radioactive glucose (sugar) is injected into your vein. Glucose becomes more concentrated around cancerous cells, so when a scanner takes pictures of your body it can reveal where the cancer is located.
• Bone marrow aspiration and biopsy. A small amount of bone marrow, blood and bone are removed through a needle and are examined for signs of cancer.
• Blood tests. A sample of your blood is examined in a lab to see if anything in your blood indicates the possibility of cancer.

Staging Hodgkin's lymphoma

Once the diagnosis is confirmed, doctors "stage" the disease. Staging is how doctors determine the extent of the disease, which will affect your treatment options.

• Stage I. The cancer is limited to one lymph node region or a single organ.
• Stage II. In this stage, the cancer is in two different lymph nodes or the cancer is in a portion of tissue or an organ and nearby lymph nodes. But the cancer is still limited to a section of the body either above or below the diaphragm.
• Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, it's considered stage III. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.
• Stage IV. This is the most advanced stage of Hodgkin's lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV Hodgkin's lymphoma affects not only the lymph nodes but also other parts of your body, such as the liver, lungs or bones.

Additional definitions of the cancer

Additionally, your doctor may use the letters A, B, E and S to help define the extent of your cancer and the treatment needed:

• The letter A means that you don't have any significant symptoms as a result of the cancer.
• The letter B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.
• The letter E stands for extranodal, which means that the cancer has spread beyond your lymph nodes.
• The letter S designates a cancer that has spread into your spleen.

The letters B, E and S indicate potentially more serious disease.

The most important factor in Hodgkin's lymphoma treatment is the stage of the disease. The number and regions of lymph nodes affected and whether only one or both sides of your diaphragm are involved also are important considerations. Other factors affecting decisions about treating this disease include:

• Your age
• Your symptoms
• Whether you're pregnant
• Your overall health status

The goal of treatment is to destroy as many malignant cells as possible and bring the disease into remission. As many as 95 percent of people with stage I or stage II Hodgkin's lymphoma survive for five years or more with proper treatment. The five-year survival rate for those with widespread Hodgkin's lymphoma is about 60 to 70 percent, according to the American Cancer Society. But those numbers are based on people treated before 1990, so the outcome may be even more promising for people with more recent diagnosis and treatment.

Chemotherapy

When the disease progresses and involves more lymph nodes or other organs, chemotherapy is the preferred treatment. Chemotherapy uses specific drugs in combination to kill tumor cells. The drugs travel through your bloodstream and can reach nearly all areas of your body.

A major concern with chemotherapy is the possibility of long-term side effects and complications, such as heart damage, lung damage, liver damage, fertility problems and secondary cancers, such as leukemia.

Although severe effects aren't common, an ongoing effort is being made to find equally effective regimens with less toxicity. Drug regimens have been developed for Hodgkin's lymphoma that substantially diminish the likelihood of long-range, life-threatening complications, including acute leukemia, in people who have received multiple courses of chemotherapy and radiation therapy.

Radiation

When the disease is confined to a limited area, radiation therapy may be the treatment of choice. With radiation therapy, high-energy X-rays are used to kill cancer cells. It's typical to radiate the affected lymph nodes and the next area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease. Radiation therapy may be used alone, but it is commonly used with chemotherapy. If you relapse after radiation therapy, chemotherapy becomes necessary.

Some forms of radiation therapy may increase your risk of heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as breast or lung cancer. Radiation can also damage nearby healthy tissue. Most children with Hodgkin's lymphoma are treated with chemotherapy, but they may also receive low-dose radiation therapy.

Bone marrow or stem cell transplant

If the disease returns after treatment, you may need a bone marrow or stem cell transplant. For this procedure, your own bone marrow or stem cells (autologous) are removed and treated to kill cancerous cells. Then the marrow or stem cells are frozen and stored for safekeeping. Next you receive high-dose chemotherapy to destroy cancerous cells in your body. Finally your frozen marrow or stem cells are thawed and injected into your body through your veins.

Alternative Medicine

There are no alternative medicine treatments that can cure Hodgkin's lymphoma. But some alternative and complementary therapies can reduce symptoms or relieve side effects from treatment. These therapies may also help people with cancer reduce stress and anxiety and improve overall quality of life. Many cancer treatment centers offer complementary and alternative therapies alongside conventional treatment. They include:

• Relaxation techniques learned in biofeedback, meditation and yoga that may improve quality of life for people with cancer.
• Acupuncture to treat nausea caused by chemotherapy.
• Massage to help decrease stress, anxiety, depression, pain and fatigue.
• Aromatherapy to help reduce stress, pain, nausea and depression.