Which initial investigations should be conducted in a patient suspected of having Hodgkin Lymphoma?

Initial investigations for a patient suspected of having Hodgkin lymphoma should include:

• An urgent full blood count (FBC) to assess for haematological abnormalities such as anaemia or thrombocytopenia, which may suggest malignancy ⁴.
• Assessment of symptoms including unexplained lymphadenopathy, fever, night sweats, weight loss, pruritus, and alcohol-induced lymph node pain to guide urgency of referral ²,³.
• Referral for specialist assessment via a suspected cancer pathway (2-week wait) in adults presenting with unexplained lymphadenopathy and associated symptoms, or very urgent referral (within 48 hours) for children and young people ²,³.
• Imaging such as chest X-ray may be considered to exclude other diagnoses like tuberculosis or sarcoidosis if supraclavicular or persistent cervical lymphadenopathy is present, especially in people aged 40 years and over ⁴.
• Definitive diagnosis requires tissue biopsy, preferably an excision biopsy of the lymph node, to confirm Hodgkin lymphoma histologically ¹.