Tests for Non-Hodgkin Lymphoma - American Cancer Society

The doctor also might order blood tests to look for signs of infection or other problems. Blood tests aren't used to diagnose lymphoma, though. Search Verenespañol | Downloadthistopic[PDF] EarlyDetection,Diagnosis,andStaging CanNon-HodgkinLymphomaBeFoundEarly? SignsandSymptomsofNon-HodgkinLymphoma TestsforNon-HodgkinLymphoma Non-HodgkinLymphomaStages SurvivalRatesandFactorsThatAffectPrognosis(Outlook)forNon-HodgkinLymphoma QuestionstoAskAboutNon-HodgkinLymphoma Home CancerA-Z Non-HodgkinLymphoma EarlyDetection,Diagnosis,andStaging TestsforNon-HodgkinLymphoma Mostpeoplewithnon-Hodgkinlymphoma(NHL)seetheirdoctorbecausetheyhavefeltalumpthathasn’tgoneaway,theydevelopsomeoftheothersymptomsofNHL,ortheyjustdon’tfeelwellandgoinforacheck-up. Ifyouhavesignsorsymptomsthatsuggestyoumighthavelymphoma,examsandtestswillbedonetofindoutforsureand,ifso,todeterminetheexacttypeoflymphoma. Medicalhistoryandphysicalexam Yourdoctorwillwanttogetacompletemedicalhistory,includinginformationaboutyoursymptoms,possibleriskfactors,andothermedicalconditions.  Next,thedoctorwillexamineyou,payingspecialattentiontothelymphnodesandotherareasofthebodythatmightbeaffected,includingthespleenandliver.Becauseinfectionsarethemostcommoncauseofenlargedlymphnodes,thedoctorwilllookforaninfectionneartheswollenlymphnodes.  Thedoctoralsomightorderbloodteststolookforsignsofinfectionorotherproblems.Bloodtestsaren'tusedtodiagnoselymphoma,though.Ifthedoctorsuspectsthatlymphomamightbecausingyoursymptoms,theymightrecommendabiopsyofaswollenlymphnodeorotheraffectedarea. Biopsy Forabiopsy,asmallpieceofalymphnodeor,moreoften,anentirelymphnodeisremovedfortestinginalab. AbiopsyistheonlywaytoconfirmapersonhasNHL.Butit'snotalwaysdonerightawaybecausemanysymptomsofNHLcanalsobecausedbyotherproblems,likeaninfection,orbyotherkindsofcancer.Forexample,enlargedlymphnodesaremoreoftencausedbyinfectionsthanbylymphoma.Becauseofthis,doctorsoftenprescribeantibioticsandwaitafewweekstoseeifthelymphnodesshrink.Ifthenodesstaythesameorcontinuetogrow,thedoctormightorderabiopsy. Abiopsymightbeneededrightawayifthesize,texture,orlocationofalymphnodeorthepresenceofothersymptomsstronglysuggestslymphoma. Biopsiestodiagnosenon-Hodgkinlymphoma Thereareseveraltypesofbiopsies.Doctorschoosewhichonetousebasedoneachperson’ssituation. Excisionalorincisionalbiopsy:Thisisthepreferredandmostcommontypeofbiopsyiflymphomaissuspected,becauseitalmostalwaysprovidesenoughofasampletodiagnosetheexacttypeofNHL. Inthisprocedure,asurgeoncutsthroughtheskintoremovethelymphnode.  Ifthedoctorremovestheentirelymphnode,itiscalledanexcisionalbiopsy.  Ifasmallpartofalargertumorornodeisremoved,itiscalledanincisionalbiopsy.  Iftheenlargednodeisjustundertheskin,thisisafairlysimpleoperationthatcanoftenbedonewithlocalanesthesia(numbingmedicine).Butifthenodeisinsidethechestorabdomen,youwillbesedated(givendrugstomakeyoudrowsyandrelaxed)orgivengeneralanesthesia(drugstoputyouintoadeepsleep). Needlebiopsy:Needlebiopsiesarelessinvasivethanexcisionalorincisionalbiopsies,butthedrawbackisthattheymightnotremoveenoughofasampletodiagnoselymphoma(ortodeterminewhichtypeitis).Mostdoctorsdonotuseneedlebiopsiestodiagnoselymphoma.Butifthedoctorsuspectsthatyourlymphnodeisenlargedbecauseofaninfectionorbythespreadofcancerfromanotherorgan(suchasthebreast,lungs,orthyroid),aneedlebiopsymaybethefirsttypeofbiopsydone.Anexcisionalbiopsymightstillbeneededevenafteraneedlebiopsyhasbeendone,todiagnoseandclassifylymphoma. Thereare2maintypesofneedlebiopsies: Inafineneedleaspiration(FNA)biopsy,thedoctorusesaverythin,hollowneedleattachedtoasyringetowithdraw(aspirate)asmallamountoftissuefromanenlargedlymphnodeoratumormass.  Foracoreneedlebiopsy,thedoctorusesalargerneedletoremoveaslightlylargerpieceoftissue. Tobiopsyanenlargednodejustundertheskin,thedoctorcanaimtheneedlewhilefeelingthenode.Ifthenodeortumorisdeepinsidethebody,thedoctorcanguidetheneedleusingacomputedtomography(CT)scanorultrasound(seedescriptionsofimagingtestslaterinthissection). Iflymphomahasalreadybeendiagnosed,needlebiopsiesaresometimesusedtocheckabnormalareasinotherpartsofthebodythatmightbefromthelymphomaspreadingorcomingbackaftertreatment. Othertypesofbiopsies Theseproceduresarenotnormallydonetodiagnoselymphoma,buttheymightbeusedtohelpdeterminethestage(extent)ofalymphomathathasalreadybeendiagnosed.  Bonemarrowaspirationandbiopsy:Theseproceduresareoftendoneafterlymphomahasbeendiagnosedtohelpdetermineifithasreachedthebonemarrow.The2testsareoftendoneatthesametime.Thesamplesareusuallytakenfromthebackofthepelvic(hip)bone,althoughinsomecasestheymaybetakenfromotherbones. Forabonemarrowaspiration,youlieonatable(eitheronyoursideoronyourbelly).Aftercleaningtheskinoverthehip,thedoctornumbstheareaandthesurfaceofthebonewithlocalanesthetic,whichcancauseabriefstingingorburningsensation.Athin,hollowneedleistheninsertedintotheboneandasyringeisusedtosuckoutasmallamountofliquidbonemarrow.Evenwiththeanesthetic,mostpeoplestillhavesomebriefpainwhenthemarrowisremoved. Abonemarrowbiopsyisusuallydonejustaftertheaspiration.Asmallpieceofboneandmarrowisremovedwithaslightlylargerneedlethatispushedintothebone.Thebiopsycanalsocausesomebriefpain. Lumbarpuncture(spinaltap):Thistestlooksforlymphomacellsinthecerebrospinalfluid(CSF),whichistheliquidthatbathesthebrainandspinalcord.Mostpeoplewithlymphomawillnotneedthistest.Butdoctorsmayorderitforcertaintypesoflymphomaorifapersonhassymptomsthatsuggestthelymphomamayhavereachedthebrain. Forthistest,youmaylieonyoursideorsitup.Thedoctorfirstnumbsanareainthelowerpartofyourbackoverthespine.Asmall,hollowneedleisthenplacedbetweenthebonesofthespinetowithdrawsomeofthefluid.  Pleuralorperitonealfluidsampling:Lymphomathathasspreadtothechestorabdomencancausefluidtobuildup.Pleuralfluid(insidethechest)orperitonealfluid(insidetheabdomen)canberemovedbyplacingahollowneedlethroughtheskinintothechestorabdomen. Whenthisprocedureisusedtoremovefluidfromtheareaaroundthelung,it’scalledathoracentesis.  Whenitisusedtocollectfluidfrominsidetheabdomen,it’sknownasaparacentesis.  Thedoctorusesalocalanesthetictonumbtheskinbeforeinsertingtheneedle.Thefluidisthentakenoutandcheckedinthelabforlymphomacells.  Labtestsonbiopsysamples Allbiopsysamplesandfluidsarelookedatinthelabbyapathologist(adoctorspeciallytrainedtorecognizecancercells).Thesizeandshapeofthecellsandhowtheyarearrangedmayshownotonlyifthepersonhasalymphoma,butalsowhattypeoflymphomaitis.Butusuallyothertypesoflabtestsareneededaswell.  Flowcytometryandimmunohistochemistry:Forbothflowcytometryandimmunohistochemistry,thebiopsysamplesaretreatedwithantibodiesthatsticktocertainproteinsoncells.Thecellsarethenlookedatinthelab(immunohistochemistry)orwithaspecialmachine(forflowcytometry),toseeiftheantibodiesattachedtothem. Thesetestscanhelpdeterminewhetheralymphnodeisswollenbecauseoflymphoma,someothercancer,oranon-cancerousdisease.Thetestscanalsobeusedforimmunophenotyping–determiningwhichtypeoflymphomaapersonhas,basedoncertainproteinsinoronthecells.Differenttypesoflymphocyteshavedifferentproteinsontheirsurface,whichcorrespondtothetypeoflymphocyteandhowmatureitis. Chromosometests:Normalhumancellshave23pairsofchromosomes(strandsofDNA),eachofwhichisacertainsizeandlooksacertainwayinthelab.Butinsometypesoflymphoma,thecellshavechangesintheirchromosomes,suchashavingtoomany,toofew,orabnormalchromosomes.Thesechangescanoftenhelpidentifythetypeoflymphoma. Cytogenetics:Inthislabtest,thecellsarecheckedforanyabnormalitiesinthechromosomes. Fluorescentinsituhybridization(FISH):ThistestlooksmorecloselyatlymphomacellDNAusingspecialfluorescentdyesthatonlyattachtospecificgenesorpartsofchromosomes.FISHcanfindmostchromosomechangesthatcanbeseeninstandardcytogenetictests,aswellassomegenechangestoosmalltobeseenwithcytogenetictesting.FISHisveryaccurateandcanusuallyprovideresultswithinacoupleofdays. Polymerasechainreaction(PCR):PCRisaverysensitiveDNAtestthatcanfindgenechangesandcertainchromosomechangestoosmalltobeseenwithamicroscope,evenifveryfewlymphomacellsarepresentinasample. Formoreinformation,seeTestingBiopsyandCytologySpecimensforCancer. Imagingtests Imagingtestsusex-rays,soundwaves,magneticfields,orradioactiveparticlestoproducepicturesoftheinsideofthebody.Thesetestsmightbedoneforanumberofreasons,including: Tolookforpossiblecausesofcertainsymptoms(suchasenlargedlymphnodesinthechestinsomeonehavingchestpainortroublebreathing) Tohelpdeterminethestage(extent)ofthelymphoma Tohelpshowiftreatmentisworking Tolookforpossiblesignsoflymphomacomingbackaftertreatment Chestx-ray Thechestmightbex-rayedtolookforenlargedlymphnodesinthisarea. Computedtomography(CT)scan ACTscancombinesmanyx-raystomakedetailed,cross-sectionalimagesofyourbody.Thisscancanhelptellifanylymphnodesororgansinyourbodyareenlarged.CTscansareusefulforlookingforlymphomaintheabdomen,pelvis,chest,head,andneck. CT-guidedneedlebiopsy:ACTcanalsobeusedtoguideabiopsyneedleintoasuspiciousarea.Forthisprocedure,youlieontheCTscanningtablewhilethedoctormovesabiopsyneedlethroughtheskinandtowardthearea.CTscansarerepeateduntiltheneedleisintherightplace.Abiopsysampleisthenremovedtobelookedatinthelab. Magneticresonanceimaging(MRI)scan LikeCTscans,MRIscansshowdetailedimagesofsofttissuesinthebody.ButMRIscansuseradiowavesandstrongmagnetsinsteadofx-rays.ThistestisnotusedasoftenasCTscansforlymphoma,butifyourdoctorisconcernedaboutspreadtothespinalcordorbrain,MRIisveryusefulforlookingattheseareas. Ultrasound Ultrasoundusessoundwavesandtheirechoestocreatepicturesofinternalorgansormasses.Inthemostcommontypeofultrasound,asmall,microphone-likeinstrumentcalledatransducerisplacedontheskin(whichisfirstlubricatedwithagel).Itgivesoffsoundwavesandpicksuptheechoesastheybounceofftheorgans.Theechoesareconvertedbyacomputerintoanimageonacomputerscreen.  Ultrasoundcanbeusedtolookatlymphnodesnearthesurfaceofthebodyortolookinsideyourabdomenforenlargedlymphnodesororganssuchastheliverandspleen.Itcanalsodetectkidneysthathavebecomeswollenbecausetheoutflowofurinehasbeenblockedbyenlargedlymphnodes. Positronemissiontomography(PET)scan ForaPETscan,youareinjectedwithaslightlyradioactiveformofsugar,whichcollectsmainlyincancercells.Aspecialcameraisthenusedtocreateapictureofareasofradioactivityinthebody.ThepictureisnotdetailedlikeaCTorMRIscan,butitcanprovidehelpfulinformationaboutyourwholebody. Ifyouhavelymphoma,aPETscanmightbedoneto: Seeifanenlargedlymphnodecontainslymphoma.  Findsmallareasthatmightbelymphoma,evenifthearealooksnormalonaCTscan. Checkifalymphomaisrespondingtotreatment.SomedoctorswillrepeatthePETscanafter1or2coursesofchemotherapy.Ifthechemotherapyisworking,thelymphnodeswillnolongerabsorbtheradioactivesugar. Helpdecidewhetheranenlargedlymphnodestillcontainslymphomaorisjustscartissueaftertreatment. PET/CTscan:SomemachinescandobothaPETscanandaCTscanatthesametime.ThisletsthedoctorcompareareasofhigherradioactivityonthePETscanwiththemoredetailedappearanceofthatareaontheCTscan.PET/CTscanscanoftenhelppinpointtheareasoflymphomabetterthanaCTscanalone. Bonescan Thistestisusuallydoneifapersonishavingbonepainorhaslabresultsthatsuggestthelymphomamayhavereachedthebones. Forbonescans,aradioactivesubstancecalledtechnetiumisinjectedintoavein.Ittravelstodamagedareasofbone,andaspecialcameracanthendetecttheradioactivity.Lymphomaoftencausesbonedamage,whichmaybeseenonabonescan.Butbonescanscan’tshowthedifferencebetweencancersandnon-cancerousproblems,suchasarthritisandfractures,sofurthertestsmightbeneeded.  Othertests Bloodtests Bloodtestsarenotusedtodiagnoselymphoma,buttheycansometimeshelpdeterminehowadvancedthelymphomais.  Acompletebloodcount(CBC)measuresthelevelsofdifferentcellsintheblood.Forapersonalreadyknowntohavelymphoma,lowbloodcellcountsmightmeanthatthelymphomaisgrowinginthebonemarrowandaffectingnewbloodcellformation.  Bloodchemistrytestsareoftendonetolookathowwellthekidneyandliverfunctionareworking.  Iflymphomahasbeendiagnosed,thelactatedehydrogenase(LDH)levelmaybechecked.LDHlevelsareoftenincreasedinpatientswithlymphomas.  Forsometypesoflymphomaorifcertaintreatmentsmightbeused,yourdoctormayalsoadviseyoutohaveteststoseeifyou’vebeeninfectedwithcertainviruses,suchashepatitisBvirus(HBV),hepatitisCvirus(HCV),orhumanimmunodeficiencyvirus(HIV).Infectionswiththesevirusesmayaffectyourtreatment. Testsofheartandlungfunction Thesetestsarenotusedtodiagnoselymphoma,buttheymightbedoneifyouaregoingtogetcertainchemotherapydrugscommonlyusedtotreatlymphomathatcouldaffecttheheartorthelungs.  Yourheartfunctionmaybecheckedwithanechocardiogram(anultrasoundoftheheart)oraMUGAscan. Yourlungfunctionmaybecheckedwithpulmonaryfunctiontests,inwhichyoubreatheintoatubeconnectedtoamachine. Writtenby References TheAmericanCancerSocietymedicalandeditorialcontentteam Ourteamismadeupofdoctorsand oncologycertifiednurseswithdeepknowledgeofcancercareaswellasjournalists,editors,andtranslatorswithextensiveexperienceinmedicalwriting. FreedmanAS,JacobsonCA,MauchP,AsterJC.Chapter103:Non-Hodgkin’slymphoma.In:DeVitaVT,LawrenceTS,RosenbergSA,eds.DeVita,Hellman,andRosenberg’sCancer:PrinciplesandPracticeofOncology.10thed.Philadelphia,Pa:LippincottWilliams&Wilkins;2015. NationalCancerInstitute.PhysicianDataQuery(PDQ).AdultNon-HodgkinLymphomaTreatment.2018.Accessedathttps://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdqonMay1,2018. NationalComprehensiveCancerNetwork(NCCN).PracticeGuidelinesinOncology:B-cell Lymphomas.Version3.2018.Accessedat https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf onApril30,2018. RoschewskiMJ,WilsonWH.Chapter106:Non-HodgkinLymphoma.In:NiederhuberJE,ArmitageJO,DoroshowJH,KastanMB,TepperJE,eds.Abeloff’sClinicalOncology.5thed.Philadelphia,Pa:Elsevier;2014. References FreedmanAS,JacobsonCA,MauchP,AsterJC.Chapter103:Non-Hodgkin’slymphoma.In:DeVitaVT,LawrenceTS,RosenbergSA,eds.DeVita,Hellman,andRosenberg’sCancer:PrinciplesandPracticeofOncology.10thed.Philadelphia,Pa:LippincottWilliams&Wilkins;2015. NationalCancerInstitute.PhysicianDataQuery(PDQ).AdultNon-HodgkinLymphomaTreatment.2018.Accessedathttps://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdqonMay1,2018. NationalComprehensiveCancerNetwork(NCCN).PracticeGuidelinesinOncology:B-cell Lymphomas.Version3.2018.Accessedat https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf onApril30,2018. RoschewskiMJ,WilsonWH.Chapter106:Non-HodgkinLymphoma.In:NiederhuberJE,ArmitageJO,DoroshowJH,KastanMB,TepperJE,eds.Abeloff’sClinicalOncology.5thed.Philadelphia,Pa:Elsevier;2014. LastRevised:August1,2018 AmericanCancerSocietymedicalinformationiscopyrighted material.Forreprintrequests,pleaseseeourContentUsagePolicy. EarlyDetection,Diagnosis,andStaging CanNon-HodgkinLymphomaBeFoundEarly? SignsandSymptomsofNon-HodgkinLymphoma TestsforNon-HodgkinLymphoma Non-HodgkinLymphomaStages SurvivalRatesandFactorsThatAffectPrognosis(Outlook)forNon-HodgkinLymphoma QuestionstoAskAboutNon-HodgkinLymphoma MoreInNon-HodgkinLymphoma AboutNon-HodgkinLymphoma Causes,RiskFactors,andPrevention EarlyDetection,Diagnosis,andStaging Treatment AfterTreatment BackToTop Close * Close Imageof Previous Next Close Close SelectAHopeLodge