Non-Hodgkin's Lymphoma: Diagnosis

Symptoms

Lymphoma is not difficult to diagnose once a patient and doctor begin to look for signs of cancer. However, Lymphoma–especially non-Hodgkin lymphoma–can be something of a silent killer. Symptoms are frequently minor or nonexistent in the early stages. Furthermore, lymphoma symptoms mimic symptoms of common sickness that are familiar and not necessarily threatening to most patients.

Non-Hodgkin's lymphoma symptoms are not specific to the disease. For this reason, it is very important that you tell your doctor during regular checkups about any symptoms that you might be experiencing. They include:

Unexplained weight loss

Sudden and unexpected weight loss of 10% or more of total body weight could be a cause for concern.

Swollen lymph nodes

Lymphoma may cause swelling of lymph nodes in the neck, chest, abdomen and on the skin. Lymph nodes in the neck frequently swell in cases of sinus infection or can be symptomatic of the flu. But if they persist for a long time or occur apart from other sickness they might be cause for concern. Lymph node swelling in the armpits or abdomen might be cause for more immediate concern. Lymphoma may also cause swelling in the chest area which may interfere with breathing. Lymphomas of the skin often appear as itchy red or purple lumps. Swollen lymph nodes are usually tender and painful to some degree. However, in the case of non-Hodgkin lymphoma, lymph nodes might swell and become firm without any evident pain.

Recurring Fevers

Obviously, fever can be a sign of just about anything. When fever recurs for no apparent reason, especially in conjunction with other symptoms, it could be a sign of lymphoma.

Night sweats

These will usually occur in conjunction with a fever.

Fatigue / Lack of energy

Again, this can be related to many things but in combination with other symptoms might be significant

Rashes

Itchy skin (pruritis) and rashes can be a sign of lymphoma

Diagnosis

Molecular diagnosis of Burkitt's lymphoma

Once a physician has determined that symptoms are not related to minor infections or other causes, tests will be performed to determine if a patient has lymphoma. Diagnostic tests for lymphoma may include one or more of the following:

Blood tests

Blood test results cannot confirm lymphoma but they can signal that something is wrong. A high lymphocyte count or a high lactate dehydrogenase (LDH) count might be cause for further investigation. More on the myriad blood count tests can be found here.

Imaging

X-rays, CT scanning, MRI's, PET scans, etc, may be used to look inside of the body to look for unusual growths.

Biopsy

A biopsy is the only way to truly confirm or deny the presence of a lymphoma. Because a biopsy involves taking a tissue sample from a lymph node or other infected area, and is therefore a surgical procedure, it is usually preceded by other tests such as those mentioned above. Pathologists examine the biopsy in several different ways to determine not only the presence of a lymphoma, but to also determine if it is malignant and to identify the type of lymphoma.

Bone marrow sample

non-Hodgkin lymphoma frequently spreads to the bone marrow and therefore a bone marrow biopsy is a common diagnostic procedure.

Classification and Staging

Following a positive diagnosis, the medical team will classify and stage the lymphoma. Staging is outlined below. For more on lymphoma classification (determining the type of lymphoma) please see this page

Lymphoma Staging

Once non-Hodgkin's lymphoma is identified, more tests must be done to find out if the cancer has spread throughout the body. This testing is called "staging". Your doctor needs to know the stage of your disease to devise an appropriate treatment plan.

Lymphoma staging may involve one or more of the following steps:

Clinical review

Prior test results will be reviewed in light of a diagnosis to help to determine staging.

Additional blood work

Blood tests may be done to determine kidney and liver function

Lumbar Puncture

This is also known as a "spinal tap," which involves the withdrawal and examination of spinal fluid. This is usually done in cases where a physician believes that the disease might have spread to the nervous system.

Imaging

Chest x-rays and CT scans are common methods for observing the extent to which lymphoma has spread

Laparotomy

This procedure, which involves examining vital organs through a surgical hole in the abdomen, is largely obsolete, having been replaced by non-invasive methods such as CT scanning.

Lymphoma Stages

The "Ann Arbor System" is the most widely used system for describing stages of non-Hodgkin's lymphoma (except in the case of Cutaneous T-Cell Lymphoma - Mycosis Fungoids - Sezary Syndrome which has a separate staging system). As detailed by The American Cancer Society:

Stage I: If either of the following is present it means the disease is stage I

The lymphoma is in a lymph node or nodes in only 1 region, such as the neck, groin, underarm, and so on.
The cancer is found only in 1 area of a single organ outside of the lymph system (IE).

Stage II: If either of the following is present it means the disease is stage II:

The lymphoma is in 2 or more groups of lymph nodes on the same side of (above or below) the diaphragm (the muscle that aids breathing and separates the chest and abdomen). For example, this might include nodes in the underarm and neck area but not the combination of underarm and groin nodes.
The lymphoma extends locally from a single group of lymph node(s) into a nearby organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm.

Stage III: If either of the following is present it means the disease is stage III:

The lymphoma is found in lymph node areas on both sides of (above and below) the diaphragm.
The cancer may also have extended into an area or organ next to the lymph nodes (IIIE), into the spleen (IIIS), or both (IIIE,S).

Stage IV: If either of the following is present it means the disease is stage IV:

The lymphoma has spread outside of the lymph system into an organ that is not right next to an involved node.
The lymphoma has spread to the bone marrow, liver, brain or spinal cord, or the pleura (thin lining of the lungs).

Along with the Roman numeral, each stage is also assigned an A or B.

The letter A

is added if the person doesn't have any symptoms of lymphoma.

The letter B

is added (stage IIIB, for example) if any of the following symptoms are present:
unexplained weight loss (more than 10% of weight)
soaking night sweats
unexplained fever > 100°

Online Treatment Resources

• Patients who are looking for more advanced treatment or who have lymphoma that does not respond to standard treatment may want to consider a clinical study. Click here to find clinical trials in your area.
• Radiommunotherapy treatment regimens such as Zevalin® which is now FDA approved for treatment of some types of NHL, are coming into the mainstream. Click here to learn more

Dive Deeper

• Gallium Scans - detailed information
• MRI Scans - detailed information
• PET Scan for Lymphoma
• Lymphoma Classification - what kind of lymphoma is it?
• Non-Hodgkin's Lymphoma: Treatment - dealing with the disease
• A glossary of lymphoma-related terms
• Non-Hodgkin's Lymphoma: Resources
• Adult Non-Hodgkin's Lymphoma: Aggressive NHL's
• Adult Non-Hodgkin's Lymphoma: Indolent NHL's
• Non-Hodgkin's Lymphoma: Description in depth
• How is non-Hodgkin's Lymphoma Diagnosed? from the American Cancer Society
• View sample images of various lymphomas at the American Society of Hematology Image Bank
• "Bone marrow biopsy" at MedlinePlus