Diagnosis and Tests for Lymphoma

  • Lymphoma
    Lymphoma is the name for a group of blood cancers that develop in the lymphatic system. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).     
Submitted by PatientsEngage on 2 January 2016

Diagnosis of Hodgkin's Lymphoma
The doctor will take your case history, carry out physical examination and recommend laboratory tests and imaging studies.
Physical examination focuses on the location and size of all palpable lymph nodes, abnormal lung sounds, and enlargement of liver, spleen, or both. 
Laboratory studies
The doctor may recommend the following: 

  • Complete blood picture: may be normal in early stages but in advanced stages there may be either decrease in the red blood cell count (RBC) or platelet cells or white blood cell count or may be decrease in all three cells.
  • Serum chemistry studies: This may show elevated calcium levels, LDH levels (an enzyme whose levels are abnormally increased in some cancers), abnormal liver function tests.
  • Serum beta2-microglobulin level: May be elevated.
  • HIV test
  • Bone marrow biopsy is recommended, although bone marrow involvement is uncommon. Positive bone marrow will greatly influence the treatment decision. 
  • Imaging studies include chest x-ray, computed tomography (CT), positron emission tomography (PET)

Classification and staging of Hodgkin’s lymphoma
The diagnostic tumour cells are Hodgkin-Reed-Sternberg (H-RS) cells. The classification is based on the number and appearance of H-RS cells into 4 subtypes:

  • Nodular Sclerosis 
  • Mixed Cellularity 
  • Lymphocyte-Depleted 
  • Lymphocyte-rich  

Staging: Ann Arbor staging classification is currently used along with pathology to guide the treatment choice for both Hodgkin’s and non-Hodgkin’s lymphoma.

 Ann Arbor Staging Classification.

Stage I: Involvement of a single lymph node region or lymph node structure (eg, spleen, thymus or Waldeyer’s ring)
Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm
Stage III: Involvement of lymph node regions on both sides of the diaphragm
Stage IV: Disseminated (multifocal) involvement of one or more extralymphatic organs, with or without associated lymph node involvement; or isolated extra lymphatic organ involvement with distant (non regional) nodal involvement   

    

 

Diagnosis of Non-Hodgkin's Lymphoma

Examination in patients shows swollen spleen and liver and enlargement of lymph nodes

Laboratory investigations
The doctor may suggest the following tests.

  • Complete blood picture: May be normal in early-stage disease; in more advanced stages, may demonstrate decreased RBC count (anaemia), decreased WBC count (leucopenia), decreased platelet count (thrombocytopenia).
  • Serum chemistry studies: May show elevated calcium levels, abnormal liver function tests
  • Serum beta2-microglobulin level: May be elevated

Imaging

The following imaging studies should be obtained in a patient suspected of having NHL:

  • Chest radiography
  • CT scanning of the neck, chest, abdomen, and pelvis
  • PET scanning
  • Bone scanning: Only in patients with bone pain, elevated alkaline phosphatase, or both
  • MRI of brain/spinal cord: For suspected primary brain lesions or tumors, lymphomatous meningitis.
  • Biopsy: The diagnosis of NHL depends on pathologic confirmation following appropriate tissue biopsy. The following are procedures in cases of suspected NHL:
    • Bone marrow aspiration and biopsy
    • Excisional lymph node biopsy 
    • Lumbar Puncture (A procedure in which a needle is inserted into the lower part of spine to collect cerebrospinal fluid) 

Staging: Ann Arbor Staging Classification

Stage I: Involvement of a single lymph node region or lymph node structure (eg, spleen, thymus or Waldeyer’s ring)
Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm
Stage III: Involvement of lymph node regions on both sides of the diaphragm
Stage IV: Disseminated (multifocal) involvement of one or more extralymphatic organs, with or without associated lymph node involvement; or isolated extra lymphatic organ involvement with distant (non regional) nodal involvement

Diagnosis of Burkitt's Lymphoma

The doctor may suggest some of the following:

  • Computed tomography (CT) imaging of the chest, abdomen, and pelvis
  • Chest X-ray, PET or gallium scan (looks for inflammation and uses a material called gallium)
  • Bone marrow biopsy, examination of spinal fluid
  • Blood tests to measure kidney and function 
  • Testing for HIV
  • Biopsy (if Burkitt’s lymphoma is suspected, all or part of an enlarged lymph node or other suspicious disease site will be biopsied) 

Staging:  Ann Arbor Staging

Stage I: The lymphoma is only in one group of lymph nodes in one particular area of the body.
Stage II: More than one group of lymph nodes is affected, but all the affected nodes are contained within either the upper half or lower half of the body.
Stage III: Lymphoma is present in lymph nodes in both the upper and lower parts of the body (above and below the diaphragm). The spleen is considered as a lymph node in this staging system.
Stage IV: The lymphoma has spread beyond lymph nodes to other organs, i.e to sites such as the nervous system, bone marrow, liver or lungs.

 

Community
Cancer
Condition
Lymphoma

Stories

  • Signs and Symptoms of Lymphoma
    There are roughly over 60 types of lymphomas which are commonly grouped as Hodgkin and non-Hodgkin. Symptoms can be general and can be seen almost anywhere in the body not just the area where the cancer is around. Signs and Symptoms of Hodgkin's Lymphoma Approximately one-third of the patients may have disease-related symptoms, including B symptoms and pruritis (itching of the skin). Less commonly, patients may report pain in involved regions after ingestion of alcohol.  B symptoms are…
  • Management of Lymphoma
    Ensure that patients understand their diagnosis, treatment options, and prognosis and complications of therapy, which, in rare occasions, may result in a fatal event.  Discuss potential complications of treatments with your doctor. Hodgkin's lymphoma Renal failure as a result of tumor lysis syndrome from therapy is a potential risk in all patients, especially those with a high tumor burden. Aggressive management of this potentially life-threatening complication should be clearly addressed…
  • Prevention of Lymphoma
    Prevention of Hodgkin's Lymphoma The exact cause of Hodgkin’s lymphoma is not yet known. The only way to prevent it is by lowering one's risk factors such as obesity, HIV etc. Prevention of non-Hodgkin's Lymphoma The exact cause of Hodgkin’s lymphoma is not yet known. The only way to prevent it is by lowering one's risk factors such as obesity, HIV, HTLV-1 infection etc. Prevention of Burkitt's Lymphoma Some risk factors associated with the Sporadic form can be lowered, most particularly…
  • Lymphoma
    Lymphoma is a cancer of the lymphatic system. The lymphatic system is a part of the circulatory system, which defends the body against infections. The lymphatic system is made up of organs, such as spleen and tonsils, lymph vessels and lymph nodes and they circulate lymph, a fluid, which contains lymphocytes that fight bacteria. In Lymphoma, there is an abnormal growth of the lymphocytes that then begin to accumulate in the lymph nodes of the body or in the spleen. In some cases, it can…
  • Lymphoma World Awareness Day
    Lymphoma is the name for a group of blood cancers that develop in the lymphatic system. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).    

Latest Stories

Booklet