Diagnosing Lymphoma

Since there are so many subtypes of lymphoma and the diagnosis for each of them differs just slightly here and there, we'll use the diagnosis of the most common subtype, diffuse large b-cell lymphoma (DLBCL) as a model for this entry on how lymphoma is diagnosed.

Symptoms

The start of any diagnosis generally begins with the patient experiencing symptoms. In the case of DLBCL, these symptoms might include:

• Unexplained weight loss
• Swollen, rubbery and painless lymph nodes
• Unexplained fevers
• Night Sweats
• Fatigue

These are known as generalized, non-specific symptoms. Taken separately, or even together, they don't necessarily point towards DLBCL.

Essential Work-Up

When the doctor examines the patient, he or she looks for certain indications that lead to or away from lymphoma. The symptoms listed above are part of that.

Blood
They also tend to draw blood and order several tests, including a CBC or complete blood count, platelet count, a comprehensive metabolic panel, and check the levels of LDH and uric acid in the blood.

Scans
A doctor may order:

• Chest/abdominal/pelvic or neck/head CT scan (depending on where the lymphoma is suspected to have spread, if anywhere).
• MUGA scan/echocardiagram
• PET-CT scan

Biopsy

This is the most invasive aspect of diagnosis. The only kind of biopsy that is considered to be of diagnostic quality in lymphoma is an excisional biopsy, in which a full, single lymph node suspected of being cancerous is completely removed. Fine Needle Aspirations (FNA) and core needle biopsies are no longer considered suitable for an accurate diagnosis.

This procedure is done as an out-patient but does require general anesthesia.

HIV tests, lumbar punctures, and bone marrow biopsies are used only in certain cases when the doctor believes they can be useful in specifying the lymphoma subtype.

Pathology and Diagnosis

From this point, diagnosis becomes the job chiefly of the pathologist. This is a doctor who you will never meet. He or she examines your biopsy under a microscope and performs certain lab tests to tease out the subtype and some of the molecular characteristics. He or she then passes that information along to your doctor.

Your doctor takes the blood work, the pathology, the exam and the scans and makes a complete diagnosis based on all of these tests. Since there are many small steps involved in building an accurate diagnosis, it is recommended that every lymphoma patient get a second opinion on their diagnosis.