Non-Hodgkins Lymphoma

Diagnosis

If your doctor suspects a diagnosis of non-Hodgkin's lymphoma, he or she will ask about the patient’s medical history and perform a physical exam. The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. In addition to checking general signs of health, the doctor may perform blood tests to help diagnose non-Hodgkin's lymphoma.

The doctor may also order tests that produce pictures of the inside of the body. These may include:

  • X-rays: Pictures of areas inside the body created by high-energy radiation.

  • CT (or CAT) scan: A series of detailed pictures of areas inside the body. The pictures are created by a computer linked to an x-ray machine.

  • MRI (magnetic resonance imaging): Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.

  • Lymphangiogram: Pictures of the lymphatic system taken with x-rays after a special dye is injected to outline the lymph nodes and vessels.

A biopsy is needed to make a non-Hodgkin’s lymphoma diagnosis. A surgeon removes a sample of tissue so that a pathologist can examine it under a microscope to check for cancer cells. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well. Sometimes, an operation called a laparotomy may be performed. During this operation, a surgeon cuts into the abdomen and removes samples of tissue to be checked under a microscope for the presence of non-Hodgkin's lymphoma.

Types of Non-Hodgkin's Lymphoma

Over the years, doctors have used a variety of terms to classify the many different types of non-Hodgkin's lymphoma. Most often, the types of non-Hodgkin's lymphoma are grouped by how the cancer cells look under a microscope and how quickly they are likely to grow and spread. Aggressive lymphomas, also known as intermediate and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms. Indolent lymphomas, also referred to as low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms.

Stages of Non-Hodgkin's Lymphoma

If a non-Hodgkin's lymphoma diagnosis is made, the doctor needs to learn the stage, or extent, of the disease. The staging of non-Hodgkin's lymphoma is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Treatment decisions depend on these findings.

The doctor considers the following to determine the stage of non-Hodgkin's lymphoma:

  • The number and location of affected lymph nodes;

  • Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen); and

  • Whether the disease has spread to the bone marrow, spleen, or to organs outside the lymphatic system, such as the liver.

In non-Hodgkin's lymphoma staging, the doctor may use some of the same tests used for the diagnosis of non-Hodgkin's lymphoma. Other non-Hodgkin's lymphoma staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. A pathologist examines the sample under a microscope to check for cancer cells.

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