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 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), although there may be some cases where the affected lymph node is not easily accessible and a general anaesthetic may be required (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 usually present.
Further testing
If a biopsy reveals the presence of Hodgkin’s lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose at what stage your lymphoma might be.
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 – this 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 3-D 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 or more 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 or bone marrow outside of the lymphatic system.
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.
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Diagnosing Hodgkin"s lymphoma
