How Does Diagnosing Lymphoma Work?

Diagnosing lymphoma is one of the more difficult diagnoses to make in cancer medicine, and contrary to perception, diagnosing lymphoma is not made by one's primary physician or even one's oncologist. Instead, diagnosing lymphoma will be made by a qualified pathologist.

Diagnosing Lymphoma: Here Is How It Works

Let's say that for the last few months you haven't quite felt like yourself. Perhaps you're experiencing some of the symptoms listed below:

  • Swollen and painless lymph nodes in the neck or groin
  • A general feeling of fatigue
  • Appetite loss
  • Occasional, drenching night sweats
  • Unexplained fevers and flu-like symptoms
  • Unexplained weight loss

After you report these symptoms to your primary care physician, you will likely undergo a physical examination during which your doctor will pay close attention to the nodal areas as well as your spleen and liver.

However, the most important part of diagnosing lymphoma will come after your doctor recommends you undergo an incisional or excisional biopsy. In this procedure, one of your suspect lymph nodes is removed for examination by a pathologist.

That pathologist, whom you will likely never meet or even be aware of, will examine your biopsy under a microscope, then subject it to a number of laboratory tests in order to determine A) whether the lymphocytes are in fact cancerous, and B) the subtype of the lymphoma. The pathologist generates a report of your biopsy, which includes the diagnosis, which is sent to your doctor.

This is one of the most important steps in the course of every patient's cancer journey, because a misdiagnosis can lead to unnecessary or useless treatment, and can even be fatal. Estimates as to how many cancer misdiagnoses are made every year vary, but at least one source suggests that as many as 50,000 are made each year (for all cancers, not just lymphomas).

If the diagnosis is lymphoma...

If lymphoma is confirmed by the pathologist, your doctor will probably order several tests for you to undergo in what is known as a Work-Up, and this process helps to determine your overall health as well as the clinical staging of your lymphoma. Tests include:

  • Complete blood count (CBC)
  • Comprehensive metabolic panel
  • Serum lactate dehydrogenase (LDH)
  • Hepatitis B test
  • Chest/abdominal/pelvic CT
  • PET/CT (optional)
  • MUGA scan (optional)

Whether or not some of these tests are given will depend on the lymphoma diagnosis. Ultimately all patients need to realize how important diagnosing lymphoma is, who is making the diagnosis, the chances that the diagnosis is wrong, and that getting a second opinion on one's biopsy from another pathologist is one of the most crucially important steps in the entire process.

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