If you have symptoms that suggest lymphoma, your doctor will probably run a variety of tests to make a diagnosis and additional tests on blood or biopsied tissue to determine the exact type and the stage of your cancer. An earlier diagnosis can lead to prompt treatment, which often results in a better prognosis. Some common tests include:
Physical exam: Your doctor will ask about your medical history and check for swollen or enlarged lymph nodes.Lymph node biopsy: With this procedure, part or all of a lymph node is removed and sent to the lab for examination.Blood tests: A simple blood test might help your physician determine if you have lymphoma.Bone marrow biopsy: During this procedure, a needle is inserted into your hip bone to remove a sample of bone marrow. The sample is then analyzed to see if it contains lymphoma cells.X-rays: X-rays are sometimes used to let doctors see the structures in your body.Imaging tests: Your physician might recommend computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) scans to look for lymphoma in your body.Spinal tap: This test is sometimes performed to look for lymphoma cells in the cerebrospinal fluid. You doctor will insert a small needle between the bones of your spine to withdraw some fluid.Ultrasound: An ultrasound test might be done to determine the size of your spleen. An enlarged spleen can be a sign of lymphoma. This test uses sound waves to create images on a computer monitor. (1, 2)
Currently, the staging system for the two main types of lymphoma, non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma, is called the Lugano classification. Stages are given Roman numerals (I–IV). Here’s what the staging system looks like:
Stage I: The cancer is only present in one lymph node area or lymphoid organ. Stage II: The lymphoma is found in two or more lymph node areas on the same side of the diaphragm (the muscle band that separates the chest and abdomen). Stage III: The cancer is in lymph node areas on both sides of the diaphragm, or it’s in the lymph nodes above the diaphragm and in the spleen. Stage IV: The lymphoma has spread to at least one organ outside the lymph system, such as the liver, bone marrow, bones, or lungs. (3, 4)
Some types of lymphoma, such as small lymphocytic lymphoma (SLL), may be staged differently. Talk to your doctor if you have this type of cancer. Stage I or II lymphomas that affect an organ outside the lymph system have an “E” added to them. If the lymphoma is considered “bulky” (larger than 10 centimeters in size), it’s labeled with an “X.” (5) You may also be given an additional letter — “A” or “B” — to describe your lymphoma. If your cancer is assigned a “B” classification, it means you have B symptoms, which include:
Unexplained feverDrenching night sweatsLoss of more than 10 percent of your body weight over a six-month period
Lymphomas with B symptoms are usually more advanced and require more intensive treatment. (4) Here are some good questions to ask your doctor:
What type of lymphoma do I have?What is the stage of my cancer? What does this mean?Is my lymphoma slow growing or more aggressive?What are my treatment options?What therapy do you recommend most and why?What are the side effects of treatment? How will they affect my daily life?Will my insurance cover any needed treatment?What advice would you give a loved one or friend with my same diagnosis?Where can I find more information about my type of lymphoma?
It’s a good idea to write your questions down, so you don’t forget what you want to ask at your appointment. You might also want to bring a friend or family member with you. (2) Studies have shown pathologists who aren’t skilled in identifying lymphoma samples may misdiagnose the disease. (2) You may want to get a second opinion if you think your results are inaccurate. Seeking another medical opinion is also a good idea if you’re uncomfortable with your doctor or recommended treatment plan. Most doctors understand a patient’s desire for a second opinion, and many even encourage this practice. Also, insurance companies usually cover the cost of a second opinion. (6) The following strategies can help you cope:
Seek help. Talk to family members or close friends about your worries and ask them to help you out when needed. Learn about your cancer. Being informed about lymphoma can empower you to make better treatment decisions. The American Cancer Society and the Leukemia & Lymphoma Society offer online resources to educate patients about the disease. Stay healthy. Daily exercise, a healthy diet, and lots of rest are important habits to incorporate into your day-to-day routine if you have cancer. You might also want to try some relaxation strategies like yoga or meditation to reduce stress.Join a support group. Many organizations offer ways to connect with others who have your same illness. The Leukemia & Lymphoma Society provides information on how to locate a support group near you. (7)
Many types of lymphoma require therapies that target a specific form of the disease. Additionally, doctors will sometimes recommend that certain people with slow-growing lymphoma “watch and wait” to see if their cancer progresses. The earlier you get diagnosed and treated, the better your outlook.
