How is the disease diagnosed?
Diagnosis of non-Hodgkin's lymphoma begins with a medical history and physical exam. Lymphoma is diagnosed by biopsies, or the examining of tissue samples. Blood samples are taken so that immune studies can be done on white blood cells. Some lymphomas cause higher levels of white cells in the blood, but others do not.
Bone marrow biopsies and lymph node biopsies are usually used to make a diagnosis. Lymphomas are classified into different subtypes based on their characteristics. This classification of lymphomas continues to evolve as knowledge of the disease advances.
Lymphomas need to be staged, which is a rough measure of the amount of cancer in the body. Tests used in staging include:
blood tumor marker tests
bone marrow biopsy, usually on both sides of the pelvis
a complete blood count, or CBC
CT scans of the chest, abdomen, and pelvis
kidney function tests
LDH and isoenzymes blood test, which measures tissue damage
liver function tests
Lymphoma stages are classified as I, II, III, and IV. This classification scheme is like the one for Hodgkin's lymphoma, another type of blood cancer.
Stage I is limited to one lymph node area in the body.
Stage II involves two lymph node areas that are next to each other.
Stage III involves lymph node areas on both sides of the diaphragm, the muscle that separates the chest from the abdomen.
Stage IV involves widespread disease that affects other organs, such as the liver, spleen, bone marrow, bone, lung, central nervous system, and skin.
Staging does not predict treatment outcomes like it does in Hodgkin's lymphoma. In non-Hodgkin's lymphoma, a better predictor is the type of tissue involved. Special laboratory testing called immune analysis can help predict the outcome of lymphoma. This analysis looks at cell proteins and gene abnormalities. It is not always helpful in figuring out which treatment to use, though.