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Diagnosing lymphoma

NHS Choices Medical Reference

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Biopsy

The presence of swollen lymph nodes and other associated symptoms can suggest a diagnosis of lymphoma, but the only way to confirm the diagnosis is by carrying out a biopsy.

A biopsy involves removing some, or sometimes all, of an affected lymph node, which is then studied in a laboratory. Biopsies can be carried out under a local anaesthetic (where the area is numbed), though there may be some cases where the affected lymph node is not easily accessible and a general anaesthetic may be required (where you are put to sleep).

A pathologist (expert in the study of diseased tissue) will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of lymphoma you have, which is an important factor in planning your treatment.

Confirming a diagnosis

There are two main types of lymphocytes (white blood cells found in lymph):

  • B-lymphocytes make antibodies that attack infecting bacteria and viruses
  • T-lymphocytes kill cells that have been infected with a virus and cause the immune response to respond faster to an infection the second time round

In Hodgkin's lymphoma, a cell called the Reed-Sternberg cell (a B-lymphocyte that has become cancerous) is always present.

In non-Hodgkin's lymphoma, both the B-lymphocytes and T-lymphocytes can be affected. 

The treatment and outlook for all subtypes of Hodgkin's lymphoma is similar. However, treatment for non-Hodgkin's lymphoma depends on the subtype that you have.

There are more than 20 types of non-Hodgkin's lymphoma, including:

  • diffuse large B-cell lymphoma
  • follicular lymphoma
  • extranodal marginal zone B-cell (MALT)
  • mantle cell lymphoma
  • Burkitt lymphoma
  • mediastinal large B-cell lymphoma
  • nodal marginal zone B-cell lymphoma
  • small lymphocytic lymphoma
  • lymphoplasmacytic lymphoma (also called Waldenstrom's macroglobulinaemia)
  • peripheral T-cell lymphoma
  • skin (cutaneous) lymphomas
  • anaplastic large-cell lymphoma
  • lymphoblastic lymphoma (mainly T-cell but can be B-cell)

B-cell lymphomas are more common than T-cell lymphomas.

See the Macmillan cancer website for more information on the different kinds of non-Hodgkin's lymphoma.

Further testing

If a biopsy reveals the presence of a lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma.

Further tests may include:

  • Blood tests - samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs, such as your liver and kidney, are working.
  • Bone marrow sample - another biopsy may be carried out to see if the lymphoma has spread to your bone marrow. This involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic.
  • Chest X-ray - can check whether your lymphoma has spread to your chest or lungs.
  • Computerised tomography (CT) scan - takes a series of X-rays that build up a three-dimensional picture of the inside of the body to check the spread of your lymphoma.
  • Magnetic resonance imaging (MRI) scan - uses strong magnetic fields instead of X-rays to build up a detailed picture of areas of your body to check the spread of your lymphoma.
  • Positron emission tomography (PET) scan - a type of scan that shows how the tissues of the body are working by measuring the activity of cells in different parts of the body. It can check the spread of your lymphoma and the impact of treatment.
  • Lumbar puncture - using a thin needle, a sample of spinal fluid is taken and examined to see if it contains any lymphoma cells.

Staging of lymphoma

When the testing is complete, it should be possible to determine the stage of your lymphoma. These stages are explained below.

  • stage 1: the lymphoma is limited to one group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm
  • stage 2:  two lymph node groups are affected, either above or below the diaphragm
  • stage 3: the lymphoma has now spread to lymph node groups above and below the diaphragm
  • stage 4: the lymphoma has spread through the lymphatic system and is now present in organs and/or bone marrow outside of the lymphatic system

Stage 1 or 2 lymphomas can usually be cured. Achieving a cure for a stage 3 or 4 lymphoma is more challenging. Only a remission (when there are no active signs of disease) of symptoms may be achievable.

Sometimes, health professionals use an additional grading system, either 'A' or 'B'.

  • A-type lymphoma  means that you have no additional symptoms other than swollen lymph nodes
  • B-type lymphoma means that you have additional symptoms, such as weight loss, fever or night sweats
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Blood count
A blood count is when a sample of blood is taken, usually from your arm, and then examined in a laboratory to look at the number of cells it has.
Genetic
Genetic is a term that refers to genes- the characteristics inherited from a family member.
Lymph node
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Part of the immune system.
Malignant
Malignant is a term used to describe a life-threatening or worsening condition. In the case of tumours, malignant means cancerous.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Medical Review: May 26, 2010

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