The signs and symptoms of lymphoma and other blood cancers can be vague and may be the same as many other less serious conditions. It is very important for the doctor to have an accurate diagnosis to:
- Predict how the disease will progress
- Determine the most effective treatment
Usually when a person shows signs or symptoms of lymphoma, they are referred to a specialist called a hematologist or oncologist. This will be the physician that will determine the diagnosis, as well as plan any treatments, if required.
- Physical exam and medical history: When healthcare providers are investigating a patient for lymphoma, they will almost always begin with a thorough physical exam and medical history. They will be interested to know details about any symptoms you are experiencing and will do a complete head-to-toe assessment.
- Bloodwork: To do these tests, blood will usually taken from a vein in your arm. The cells are then looked at under a microscope. This will determine if there are lymphoma cells in the blood, ensure that the disease is not affecting normal production of other blood cells, and look for other indicators of lymphoma such as "tumor markers."
- Lymph Node Biopsy: Since there are many types of lymphoma, and they require different treatments, an accurate diagnosis is essential. To confirm a suspected diagnosis of lymphoma, a tissue biopsy is often taken.
In some cases, the physician will choose a biopsy called fine needle aspirate cytology in which tissue is removed from the tumor site using a special needle inserted through the skin. However,this procedure is almost always insufficient to make a proper diagnosis. In most cases, a surgical biopsy in which the entire lymph node is removed for examination is required.
If a diagnosis of lymphoma is confirmed by the lymph node biopsy, the next step will be “staging” or determining the extent of the disease. Some tests that may be done to stage lymphoma are:
- Chest X-Ray: Standard X-rays may help the doctor to visualize lymph node enlargement and determine if there are organs other than lymph nodes involved. During an X-ray, a special film is placed on one side of your body, and X-rays will be projected through your body to create an image of your internal structures on the film. You may be asked to lie still on a table, or sit upright for this procedure. It is completely painless and only takes a few moments to complete.
- CT Scan (Computerized Tomography) or MRI (Magnetic Resonance Imaging):CT Scans and MRI use computers to capture detailed pictures of organs, bones and almost all body structures. For both procedures, you will be asked to lie still on a special movable table. The technologist will then slide you into a cylindrical opening in the machine. This procedure is also painless, but if you have a fear of enclosed spaces, you may ask your physician for a medication to help you relax. Images are taken of the neck, chest, abdomen and pelvis, areas where lymph nodes are located, to determine any areas of disease.
- PET Scan (Positron Emission Tomography): While CT scans and MRI can give very detailed pictures of tumors or enlarged lymph nodes, they cannot tell us if the mass is cancerous or something harmless. A PET scan can help to identify cancers by taking an image of the cellular activity within the tumor.
During a PET scan, the patient will typically receive a very small amount of radioactive sugar (glucose) into their vein. The high activity of cancer cells will cause them to trap more of the radioactive material, making them appear different than normal tissue when images are taken.
Bone Marrow Tests (Aspiration and Biopsy): Many patients diagnosed with lymphoma will also have bone marrow tests to make sure the disease has not spread to their marrow. These are tests that give doctors the opportunity to look at the cells in the marrow. The tests are usually done together at the same time, and may be done in the doctor’s office or clinic.
During this procedure, you will get a medication to numb the area where the sample will be taken, usually the hipbone, but possibly the breastbone. Then, using a special needle, a very small piece of bone with marrow (the biopsy) is removed, as well as a sample of just the marrow (the aspiration). These samples are then looked at under the microscope to determine if an abnormality is present.
Questions To Ask Your Doctor:
Tests and procedures can be frightening if you are unsure of what to expect. You may want to write down some questions to ask to help you prepare. Some examples of questions you may want to ask your healthcare provider are:
- Where will this test be done?
- What is the procedure for this test?
- Do I need to bring someone with me?
- Will I need to fast?
- Will I be able to return to work after the test?
- How long will it take to get the results back?
- How will I get the results?
- Should I expect any side effects from this test?
- Will this test be covered by my health plan?
Do not feel embarrassed to take notes, or to ask the doctor to repeat the answers or explain them in a different way. Your healthcare team will want you to be well informed before proceeding
Taking Care Of Yourself:
Being tested, or having your child tested, for cancer can be a very frightening and stressful experience. Fear of the unknown, anxiety about the future, in addition to any physical symptoms you may be experiencing, can be overwhelming.
It is important for you to remember to care for yourself, and allow others to care for you as well, during this difficult time. Think of things that you find enjoyable and relaxing, and take a few moments each day to do them. You may be surprised to discover that when your mind is relaxed, even your body feels better.
Lichtman, M. and Beutler, E.(2006). Initial Approach to the Patient: History and Physical Examination. In Lichtman, M., Beutler,E., Kipps,T. et al(eds.)Williams Hematology- 7th edition. (pp. 3-11). New York, New York: The McGraw-Hill Companies, Inc.
Ryan, D.(2006). Examination of the Blood. In Lichtman, M., Beutler,E., Kipps,T. et al(eds.)Williams Hematology- 7th edition. (pp. 11-21). New York, New York: The McGraw-Hill Companies, Inc.
Ryan, D. and Felgar, R. (2006). Examination of the Marrow. In Lichtman, M., Beutler,E., Kipps,T. et al(eds.)Williams Hematology- 7th edition. (pp. 1461- 1483). New York, New York: The McGraw-Hill Companies, Inc.