Staging

Staging




Once the physician has diagnosed lymphoma, he or she will want to perform studies to establish the patient's stage—that is, to find out how far the patient's cancer has spread. Staging helps the physician to select appropriate treatment options and helps him/her to arrive at a prognosis, or estimate of disease outlook and survival. Clinical information is reviewed, including findings from the physical examination, blood tests, and imaging studies. The imaging studies most often employed are chest X-ray and computed tomographic (CT) scan of the chest, abdomen, and pelvis.



One of the hallmarks of HD is that it tends to spread from one lymph node set to the next, without "skipping" an area unless the disease has progressed very far. HD rarely invades single, nonlymphatic organs or sites, and it does not tend to spread to nearby organs. Because of these characteristics, HD is "staged" according to sites of involvement in relation to the diaphragm, the major muscle of the abdomen that is used for breathing.



If the patient has Hodgkin's Disease (HD), the physician may order additional tests such as a gallium scan and lymphangiography. In addition, a bone marrow biopsy may be obtained.



Tests

Gallium scanning—Gallium scanning is a nuclear medicine procedure. Radioactive gallium is injected into the patient's vein, and it is taken up by malignant lymphoma cells. A specialized camera then is used to produce a picture of the pooled gallium, which will identify the size and sites of cancerous areas. Gallium scanning is particularly useful when HD is located in the patient's chest; however, this procedure is used more often to help predict recurrence in patients with radiologic abnormalities that remain after therapy.