Non-Hodgkin Lymphoma - Tests and Diagnosis

If you have swollen lymph nodes or another symptom that suggests non-Hodgkin lymphoma, your doctor will try to find out what's causing the problem. Your doctor may ask about your personal and family medical history. Your doctor may also run some tests.

If you have swollen lymph nodes or another symptom that suggests non-Hodgkin lymphoma, your doctor will try to find out what's causing the problem. Your doctor may ask about your personal and family medical history.

You may have some of the following exams and tests:
  • Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms, and groin. Your doctor also checks for a swollen spleen or liver.
  • Blood tests: The lab does a complete blood count to check the number of white blood cells. The lab also checks for other cells and substances, such as lactate dehydrogenase (LDH). Lymphoma may cause a high level of LDH.
  • Chest x-rays: You may have x-rays to check for swollen lymph nodes or other signs of disease in your chest.
  • Biopsy: A biopsy is the only sure way to diagnose lymphoma. There are two major types of biopsies used to diagnose non-Hodgkin lymphoma: 
  •  
    • In an excisional biopsy, your doctor removes an entire lymph node
  •  
    • In an incisional biopsy, your doctor removes only part of a lymph node 
A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose lymphoma. 

Removing an entire lymph node is best. The pathologist uses a microscope to check the tissue for lymphoma cells.


You may want to ask your doctor these questions before having a biopsy:

  • How will the biopsy be done?
  • Where will I have my biopsy?
  • Will I have to do anything to prepare for it?
  • How long will it take? Will I be awake? Will it hurt?
  • Are there any risks? What are the chances of swelling, infection, or bleeding after the biopsy?
  • How long will it take me to recover?
  • How soon will I know the results? Who will explain them to me?
  • If I do have cancer, who will talk to me about next steps? When?

If non-Hodgkin lymphoma cells are found, your doctor needs to determine its stage to plan the best treatment. At this point, the following tests may be performed:
  • Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for lymphoma cells in the sample.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head, neck, chest, abdomen, or pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.
  • MRI: Your doctor may order MRI pictures of your spinal cord, bone marrow, or brain. MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film.
  • Ultrasound: An ultrasound device sends out sound waves that you cannot hear. A small hand-held device is held against your body. The waves bounce off nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show possible tumors.
  • Spinal tap: The doctor uses a long, thin needle to remove fluid from the spinal column. Local anesthesia can help control pain. You must lie flat for a few hours afterward so that you don't get a headache. The lab checks the fluid for lymphoma cells or other problems.
  • PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures.

Source: National Cancer Institute

 


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