Lymphoma: Tests


Hodgkin's Lymphoma

Common tests to evaluate Hodgkin's lymphoma include:

  • Physical Examination The doctor checks for swollen lymph nodes in the neck, underarms or groin and for a swollen spleen or liver.
  • Lymph Node Biopsy The doctor removes lymph node tissue to be examined under a microscope for signs of cancer. The entire lymph node may be removed, called an excisional biopsy, or only part of a lymph node, called an incisional biopsy.
  • Chest X-ray A picture is taken of the chest, lungs, heart, large arteries, ribs and diaphragm to reveal any swollen lymph nodes.
  • CT Scan (Computerized Tomography Scan)  A three-dimensional picture of the inside of the body is taken with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.
  • PET (Positron Emission Tomography)/FDG Scan Small amounts of FDG, a radioactive sugar molecule, are injected into the bloodstream. Cancer cells absorb sugar more quickly than normal cells, so they will light up on the PET scan. 
  • Blood Tests A complete blood count measures the number of red blood cells, white blood cells and platelets and is used to check for the number of white blood cells.
  • Bone Marrow Examination The hip area is made numb with a local anesthetic and a long needle is pushed into the skin, then through to the center of the bone to extract the bone marrow.

Non-Hodgkin's Lymphoma

Common tests to evaluate non-Hodgkin's lymphoma include:

  • Blood Tests Blood tests determine whether different types of blood cells, including red blood cells, white blood cells and platelets, are normal in number and appearance when viewed under the microscope.
  • Bone Marrow Examination The hip area is made numb with a local anesthetic and a long needle is pushed into the skin, then through to the center of the bone to extract the bone marrow. The bone marrow is examined to see if non-Hodgkin's lymphoma cells are present outside the lymph nodes.
  • Biopsy The doctor removes a piece of tissue from the area of suspected cancer and examines it under a microscope for signs of cancer.
  • Core Biopsy, or Needle Biopsy A needle is inserted into a lymph node suspected of being cancerous and a small tissue sample is removed. This type of biopsy can be done under local anesthesia and stitches are usually not required. It is more often used to confirm a relapse rather than make an initial diagnosis as these biopsies do not provide sufficient tissue to establish a diagnosis.
  • Surgical Biopsy If a lymph node is readily accessible, many doctors recommend an open biopsy in which an entire swollen lymph node is removed. This procedure usually can be done under local anesthesia, but a general, or whole body, anesthetic is sometimes needed, and a few stitches are often required.
  • Cytogenetic Analysis A lab test that is done to see if there are changes in the chromosome of the non-Hodgkin's lymphoma cells.
  • Immunophenotyping A lab test that is done to find out if the patient’s non-Hodgkin's lymphoma cells are B-cells or T-cells.
  • Cerebrospinal Fluid Examination In a small number of patients, non-Hodgkin's lymphoma can spread to the nervous system. When this occurs, the fluid around the spinal cord and the brain, or cerebrospinal fluid, may be abnormal and contain cancer cells. To determine whether this has occurred, the doctor may recommend a spinal tap or lumbar puncture in which a thin needle is inserted into the lower back under local anesthetic. A small sample of fluid is then removed. The cerebrospinal fluid is examined for chemical content and abnormal cells.

Non-Hodgkin's Lymphoma Imaging Tests

Imaging tests help the doctor find the affected lymph nodes and find out if other parts of the body besides the lymph nodes, such as the lungs or liver, have been affected by non-Hodgkin's lymphoma.

  • X-rays Using radiation, a picture is taken of a certain area inside the body to reveal areas affected by non-Hodgkin's lymphoma.
  • CT or CAT (Computerized Axial Tomography) Scan A CT scan takes x-rays from different angles around the body. A computer then combines these pictures to create a detailed image. People with non-Hodgkin's lymphoma often have CT scans of the neck, chest, abdomen and pelvis. These tests are useful in determining how many lymph nodes are involved, how large they are and whether internal organs are affected.
  • MRI (Magnetic Resonance Imaging) An MRI is similar to a CT scan, but uses magnets and radio frequency waves instead of x-rays. An MRI can provide important information about tissues and organs, particularly the nervous system, that is not available from other imaging techniques. An MRI may be ordered when the physician wants to get clear images of the bones, brain and spinal cord to see whether the cancer has spread to these areas.
  • PET (Positron Emission Tomography) Scan A radioactive sugar tracer substance is injected into the bloodstream. A positron camera is then used to detect the radioactivity and produce cross-sectional images of the body. PET scans are very useful in determining response to treatment. While CAT scans show the size of a lymph node, PET scans show if the lymph node still has the disease.