Investigations

Investigative procedures include:

• lymph node biopsy
  • pathological diagnosis should be made from a sufficiently large specimen or excisional lymph node biopsy rather than a needle core or fine needle biopsy (1)
• blood evaluation
  • FBC, ESR
  • renal function, liver function, bone profile, lactate dehydrogenase
  • HIV serology
• chest radiography
• staging with contrast - enhanced CT Neck to Pelvis is required although PET/CT is preferable if clinically feasible
• lymphography - rarely used

Consideration should be given to fertility preservation and semen cryopreservation and should be offered routinely before therapy with combination chemotherapy. There is increasing evidence for the effectiveness of oocyte preservation as a fertility sparing strategy and referral to a fertility specialist should be considered, if treatment delays are acceptable (1).

Splenectomy has been used in the past as a diagnostic and therapeutic procedure. Althought the spleen is involved in 30% of cases of Hodgkin's disease there is no prognostic advantage for patients who undergo splenectomy

Reference:

• (1) Guidelines for the First Line Management of Classical Hodgkin Lymphoma (2014). British Committee for Standards in Haematology (BCSH)
• (2) Eichenauer DA, Engert A, Dreyling M; ESMO Guidelines Working Group. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2011;22 Suppl 6:vi55-8