lymphoma diagnosis | Diagnosis of non-Hodgkin's lymphoma

Diagnosis of non-Hodgkin's lymphoma

The non-Hodgkin's lymphoma (NHL) diagnostic process usually begins with a visit to your family physician. He will ask you about the symptoms you are experiencing and will give you a physical examination. Based on this information, your doctor may direct you to a specialist or prescribe exams to verify the presence of an NHL or other health problems.

The diagnostic process may seem long and discouraging. It's normal to worry, but try not to forget that other medical conditions can cause symptoms similar to those of the NHL. It is important that the care team eliminates any other possible cause of the health problem before making an NHL diagnosis.

The following tests are commonly used to eliminate or diagnose the NHL. Many tests to diagnose cancer are also used to determine the stage, which is how far the disease has progressed. Your doctor may also take other exams to check your health condition and help plan your treatment.

Health History and physical examination
Your health history consists of a review of your symptoms, risk factors and all the medical events and disorders you may have experienced in the past. By noting your health history, your doctor will ask you questions about your personal history:

Symptoms that suggest an NHL
Medications or conditions that could weaken your immune system
Immunosuppressive drugs after organ transplant
HIV/AIDS
Immunodeficiency disorders
Auto-Immune disorders
Recent infections
Treatment of cancer already administered
Exposure to pesticides
Your doctor may also ask if there is a history of NHL in your family.

The physical exam allows your doctor to look for any NHL signs. During the physical exam, your doctor may:

Palpate the lymph nodes of your neck, armpits and groins to see if they are larger than normal (swollen);
Palpate your abdomen to see if your spleen or liver is larger than normal
Listening to your lungs
Check to see if there are any signs of infection.
Learn more about the physical exam.

Biopsy
During a biopsy, the doctor collects tissue or cells from the body in order to have them analyzed in a pathology laboratory. The report from the lab confirms the diagnosis and the type of NHL.

The type of biopsy practiced by the doctor depends on the location of the swollen lymph nodes. It may remove, in part or in whole, a ganglion from the neck, armpit or groin. It can also take a sample from a ganglion in the chest or abdomen. It is possible that it uses CT scan to guide you through a biopsy of the lymph node in these areas.

The NHL may appear in organs or tissues located outside the lymph nodes (Extraganglionnaires seats), including the brain, breast, skin, stomach, liver and intestine. The doctor can biopsy to see if an NHL or other type of cancer affects these organs or tissues. Sometimes the doctor can biopsy these organs or tissues to establish the NHL stage.

Surgical biopsy
There are two types of surgical biopsy.

During the excisional biopsy, the lymph node or the whole mass is removed, as well as a region of tissue around it.

In the incisional biopsy, a tissue sample is taken from a lymph node or other part of the body.

Learn more about the surgical biopsy.

Biopsy by drilling

During the drilling biopsy, a hollow needle is used to collect a sample of a lymph node or other part of the body.

Learn more about the biopsy by drilling.

Bone marrow puncture and biopsy

During a bone marrow puncture and biopsy, the doctor takes cells from the bone marrow for laboratory analysis.

The doctor may use bone marrow puncture and biopsy to diagnose the NHL, but it is primarily used to establish the stage since it can spread to the bone marrow. The report from the laboratory confirms the presence of lymphoma cells in the sample.

Learn more about bone marrow puncture and biopsy.

Lumbar puncture

The lumbar puncture, or spinal Tap, is used to collect a small amount of cerebrospinal fluid (CSF) in the space surrounding the spine that will be examined under a microscope. The CSF sample will indicate whether the NHL is present in the brain and spinal cord (which together form the central nervous system, or CNS). It is used to:

Help diagnose CNS primary lymphoma;

Whether an NHL that originated elsewhere in the body has spread to the CSF or brain.

Learn more about the lumbar puncture.

Cell and tissue Studies

Cytogenetics is the analysis of chromosomes in a cell, including their number, size, shape and layout. Cytogenetic techniques reveal chromosomal anomalies, which helps physicians confirm the diagnosis and establish the type of NHL. The results of cytogenetic studies also help physicians plan the treatment and predict how effective it is.

Important chromosomal anomalies can be detected by observing the cells under a microscope. But most of the changes affecting the DNA require more detailed analysis using other molecular techniques.

Fluorescence in situ hybridization (FISH)

Fluorescence in situ hybridization (FISH) is a molecular genetic test that identifies chromosomal anomalies and other genetic changes in lymphoma cells. Special DNA probes marked with fluorescent dyes are used. FISH is used to diagnose genetic anomalies in different types of NHL, which can help physicians plan treatments.

Polymerase chain reaction (PCR)

Polymerase chain reaction (PCR) is used to produce many copies of a particular gene segment in order to test it in the laboratory. Doctors use the PCR to find changes in genes and some changes in chromosomes that are too small to be seen microscopically. It can help them diagnose a specific type of NHL and determine its prognosis.

Immunophenotyping

Immunophenotyping is the study of proteins expressed by cells. It is used to establish the type of NHL.

Immunophenotyping is based on a very specific antigen-antibody reaction to identify proteins in tissues or cells. Monoclonal antibodies labelled with a fluorescent substance or a specific enzyme that bind only to specific antigens (proteins) are used. The fluorescent marker and the marker enzyme allow doctors to observe lymphoma cells.

The following 2 methods are most commonly used in immunophenotyping.

In immunohistochemistry, the microscope is used to observe fluorescent markers. It also allows doctors to examine the cells and what surrounds them.

Flow cytometry allows physicians to sort and classify cells using fluorescent markers present on their surface. Doctors can observe many antibodies all at once. The cells are exposed to a laser which makes them emit a measured and analyzed light by computer. Flow cytometry allows data to be collected quickly in thousands of cells present in a single sample.

Flow Cytometry helps physicians define the unique characteristics of lymphoma cells. These characteristics can help physicians establish a prognosis and measure response to treatment based on the minimal residual disease (MRM). MRM refers to the presence of lymphoma cells in the bone marrow that cannot be found using standard laboratory tests.

Learn more about cell and tissue studies.

Complete Blood formula

The Complete Blood formula (FSC) is used to evaluate the quantity and quality of white blood cells, red blood cells and platelets. It is used to:

Help exclude an infection

Assess the quality of functioning of blood-producing organs, such as bone marrow and spleen;

Whether lymphoma cells have spread to the blood

Obtain reference values that can be compared with the results of the next CSF performed during and after treatment.

Learn more about the complete blood formula (FSC).

Blood Biochemical Analyses

In a blood biochemical analysis, the rate of chemical substances in the blood is measured. It allows to evaluate the quality of the functioning of certain organs and also to detect anomalies. Blood biochemical analyses help establish the NHL stage and include the following.

Higher than normal levels of LDH (LDH) may mean that the NHL has spread to the liver. The level of LDH is often higher in people with an aggressive NHL type, that is, rapidly evolving.

Higher than normal levels of alanine aminotransferase (ALT) and aspartate transaminase (AST) may mean that the NHL has spread to the liver.

Higher than normal alkaline phosphatase levels may mean that the NHL has spread to the bone or liver.

Learn more about biochemical blood tests.

Other blood tests

You may be tested for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) if you receive a diagnosis of a certain type of NHL or if some treatments may be given to you. An infection with these viruses may affect your treatment.

Chest X-Ray

In an X-ray, low-dose radiation is used to produce images of body structures on film. Pulmonary radiography is used to determine if the chest lymph nodes are swollen and if the NHL has spread to the lungs.

Learn more about the X-ray.

CT Scan (CT)

In a CT, specific X-ray equipment is used to produce 3-dimensional images and cuts of organs, tissues, bones and blood vessels of the body. A computer assembles the pictures in detailed images.

TDM is used to:

evaluate swollen lymph nodes;

Examine organs in the thorax, abdomen, pelvis and other areas of the body;

Monitor the response to treatment as part of the follow-up.

Learn more about TDM.

Magnetic resonance imaging (MRI)

In MRI, powerful magnetic forces and radio-electric waves are used to produce cutting images of organs, tissues, bones and blood vessels of the body. A computer assembles images into 3-dimensional snapshots.

MRI is used to check whether the NHL has spread to the brain or spinal cord. Doctors also use MRI to exclude or diagnose CNS primary lymphoma.

Learn more about MRI.

Ultrasound

During an ultrasound, high frequency sound waves are used to produce images of the body structures. It allows:

To check if the spleen or liver is swollen or to look for signs of NHL in these organs;

To check whether the testicles are affected by the NHL;

Doctors to take tissue during a biopsy.

Learn more about ultrasound.

Bone scan

In a bone scan, radioactive material is used that attaches to the bones (radiopharmaceuticals) and a computer to create an image of the bones. Bone scan is used to determine if the NHL has spread to the bone when a person experiences bone pain or the blood level of alkaline phosphatase is higher than normal.

Learn more about bone scan.

Positron emission tomography (PET)

In a positron emission tomography (PET), radioactive material called radiopharmaceutical is used to detect changes in the metabolic activity of the body tissues. A computer analyzes the distribution patterns of radioactivity and produces 3-dimensional and coloured images of the region examined.

Doctors are always trying to figure out how best to use pet to help diagnose and stadifier the NHL. You can use pet to:

Identify areas affected by the NHL;

Help monitor the response to treatment and find relapse.

Pet is not available in all treatment centers. Learn more about pet.

Questions to ask your healthcare team

Learn more about the diagnosis. To make the right decisions for you, ask questions about the diagnosis to your healthcare team.