Symptoms

There are some symptoms for Non-Hodgkin's but they are not specific. Often a lymph node swells, especially in the upper body area. Other times one feels that they have a lack of energy. More serious symptoms can include weight loss, fever, night sweats, or unexplained itching. 

What Will Happen

When the patient sees a doctor, tests will be performed to determine what is possibly awry.  The steps in the process are: testing, making a diagnosis of lymphoma, determining what type of lymphoma is present (classification), and staging - determining the spread of the disease.

Testing and Making the Diagnosis

• A physical exam including examining the lymph nodes
• Collecting a medical history and history of symptoms
• A complete blood work-up including checks for abnormal  blood cell count, blood chemistry, and sedimentation rate
• A chest x-ray to view lymph nodes and to see if other organs are involved
• A computerized tomography (CT or CAT) scan or magnetic resonance imaging (MRI) scan of the chest, pelvis, and abdomen to determine the possible spread of the disease
• A Positron Emission Tomography (PET) Scan
• A gallium scan to check for radioactive intake of gallium in the lymph system indicating swelling and ultimately disease
• A bone marrow aspiration and biopsy to determine if the bone marrow has been affected by lymphoma; in this procedure the hip is numbed and a needle is inserted into the bone; liquid bone marrow and a bone chip are extracted and examined under a microscope

Certain medical centers may perform additional tests, including

• Exploratory surgery to determine the extent of the disease. In some cases bulky or life threatening tumors may be removed.
• A lymphangiogram, a procedure during which a radio-opaque liquid is injected into the lymph system through the feet; the fluid travels throughout the lymph system and remains visible by x-rays for up to six months

With modern imaging techniques, these two procedures should not be necessary.

Once a biopsy sample is taken, it is tissue typed into one of several types of Non-Hodgkin's Lymphoma.  A page is devoted to Lymphoma Classification and Typing.

The medical team will also stage the spread of the lymphoma. There are four stages which depend on how far the cancer has spread through the body:

Stages of Non-Hodgkin's Lymphoma

Once non-Hodgkin's lymphoma is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. Your doctor needs to know the stage of your disease to plan treatment. Your doctor may determine the stage of your disease by examining you and doing the testing mentioned above. This type of staging is called clinical staging. In some cases, your doctor may need to do an operation called a laparotomy to determine the stage of your cancer. During this operation, your doctor makes a small surgical incision into your abdomen and carefully looks at the organs to see if they contain cancer. The doctor will remove (biopsy) small pieces of tissue during the operation and look at them under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done when it is needed to help your doctor plan treatment.

The following stages are used for non-Hodgkin's lymphoma (except Cutaneous T-Cell Lymphoma - Mycosis Fungoids - Sezary Syndrome which has a separate staging system):

• Stage I - Cancer is found in only one lymph node area or in only one area or organ outside the lymph nodes.
• Stage II - Either of the following means that the disease is stage II
1. Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps you breathe).
2. Cancer is found in only one area or organ outside the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.

In contiguous stage II lymphoma, the positive lymph node areas are next to one another; in non-contiguous stage II, the positive lymph nodes are not next to each other but are still on the same side of the diaphragm.

• Stage III - Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.
• Stage IV - Either of the following means that the disease is stage IV
1. Cancer has spread in more than one spot to an organ or organs outside the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs.
2. Cancer has spread to only one organ outside the lymph system, but lymph nodes far away from that organ are involved.
• Recurrent - Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

Once the doctor knows the type and stage of the disease he can plan treatment, often in consultation with other oncologists (cancer specialist doctors).

Further Reading / In-Depth

• Non-Hodgkin's Lymphomas, Peter M. Mauch (Editor), James O. Armitage (Editor), et al., 2004.
  • Section II: Diagnosis, Staging, and Initial Evaluation
    • Chapter 7: Procedures for the Primary Diagnosis and Follow-Up of Patients with Lymphoma
    • Chapter 8: Initial Evaluation: Staging and Prognostic Factors
    • Chapter 9: Diagnostic Radiotherapy
    • Chapter 10: Nuclear Medicine
      
• Lymphoma: Methods and Protocols, Illidge & Johnson, 2005, more for professionals but cutting edge.
   
• Non-Hodgkin's Lymphomas - Making Sense of Diagnosis, Treatment, and Options by Lorraine Johnson, 1999
  • Chapter 1: Symptoms and Diagnosis
  • Chapter 5: Tests and Procedures
     
• For Patients & loved ones:  Living With Lymphoma, 
  Elizabeth Adler, Oct. 2005
  • Chapter 2: Symptoms and Diagnosis
    

Multimedia Resources (new)

• Obtaining an Accurate Diagnosis - video
• Diagnosing Lymphoma - Article by Dr. Amy Chadburn

Below are links to more information on Non-Hodgkin's Lymphoma. Take the information you find to discuss with your medical team. A glossary is available if terms are unfamiliar.

For more information on Adult Non-Hodgkin's Lymphoma, please see the following pages: :

• Lymphoma Classification and Types
• Adult Non-Hodgkin's Lymphoma: Treatment
• Adult Non-Hodgkin's Lymphoma: Resources
• Adult Non-Hodgkin's Lymphoma: Aggressive NHLs
• Adult Non-Hodgkin's Lymphoma: Indolent NHLs
• Adult Non-Hodgkin's Lymphoma: Introduction

Other pages you may want to visit:

• Lymphoma Information Network
• Childhood Non-Hodgkin's Information Pages

This page is a work in progress - if you have more complete information, references, or other information please contact the author. The author is not in the medical field and does not warrant the correctness of the material on this page or the sites linked - please take online information and consult with your own medical team to make informed decisions.

Copyright © 1996-2005 Lymphoma Information Network - All Rights Reserved
http://www.LymphomaInfo.Net/
Updated: December 27, 2005