The first sign of lymphoma is often a painless swelling in the lymph nodes in the neck, armpit, groin or belly. Sometimes people also have unexplained loss of weight, fevers and drenching sweats at night. They may also feel generally tired and unwell. Another symptom can be itching without an obvious cause.
Doctors and other health professionals who treat lymphoma
Your doctor will examine you and refer you for tests. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and ask you to have some more tests. If you have cancer, one or more specialists will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment should be available at your hospital. This may not be possible in some non-metropolitan areas.
Specialists and other health professionals who care for people with lymphoma include:
- medical oncologists and haematologists, who are responsible for chemotherapy and coordinating the total treatment
- radiation oncologists, who are responsible for radiotherapy
- surgeons, who are responsible for biopsies and other surgical procedures
- nurses, who will help you through all stages of your cancer
- dietitians, who will recommend the best diets to follow while you are in treatment and recovery
- social workers and occupational therapists, who will advise you on support services available and help you to get back to normal activities.
How lymphoma is diagnosed
The common tests for lymphoma are described in this chapter. You may not have all the tests. When the tests are done, your doctor or doctors will tell you what they have learned about your cancer, and suggest the best treatment for you.
Your doctor will begin by examining your body, especially the areas where there are lymph nodes. Your doctor will also discuss your medical history and ask about symptoms.
If you have swollen lymph nodes that your doctor thinks may be cancerous, they will take some tissue from a swollen lymph node. This is called a tissue biopsy. The whole node may be removed or only a part of the node. This tissue will be sent to a pathology laboratory to be examined in detail to see if it has cancer cells in it.
You could have either a general or a local anaesthetic when you have your biopsy. This will depend on where the lymph node is that the doctor wishes to biopsy. If the biopsy shows that you have lymphoma, other tests will be done to find out whether the cancer has spread, and if so, to where. This is called ‘staging' the cancer.
Your doctor may take some blood from your arm using a needle and syringe. This will be sent to a pathology laboratory to be examined. These tests will also tell the doctors how well your other organs such as liver and kidneys are working.
Bone marrow biopsy
Lymphoma cells can spread to bone marrow. In a bone marrow biopsy, a sample from your bone marrow is taken with a needle. The bone marrow is usually taken from the back of your hipbone.
You will have a local anaesthetic and possibly some sedative so you do not feel pain during the biopsy. The sample will be looked at under a microscope to see if the lymphoma has spread to the bone marrow.
Computerised tomography (CT) scan
A CT scan is a special type of x-ray that gives a three-dimensional (3-D) picture of the organs and other structures in your body. It usually takes about 30 to 40 minutes to complete this painless test.
You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Before the scan, you may have an injection of a dye that shows up body tissues more clearly. You will be asked not to eat or drink for a while before you have your scan. Most people are able to go home as soon as their scan is over.
A child with a non-Hodgkin lymphoma will also have an ultrasound scan of their abdomen.
In this test your whole body is checked. You will have an injection of radioactive gallium, a sort of metal. After a few days, when it has had time to circulate around your body, you will return to the hospital to have pictures of your body taken with a special camera (a gamma camera). If gallium is seen outside body areas that normally would take it up, a cancer may be present at that site.
Positron emission tomography (PET) scan
A PET scan builds up clear and detailed pictures of the body. You will have an injection of a glucose solution containing a very small amount of a radioactive substance. The scanner can ‘see' this substance, which shows where the glucose is being used in the body. Cancer cells show up as areas where glucose is being used by actively growing cells.
Sometimes, other tests are needed. These could include:
- Magnetic resonance imaging (MRI), which uses a combination of magnetism and radio waves to build up detailed cross-section pictures (or images) of part of the body.
- Ultrasound scan, where sound waves of a very high frequency are directed at the body. The sound waves are reflected back differently by different types of tissue. These differences are measured and used to build up pictures of structures inside the body.
- Lumbar puncture, where a needle is put into the area around the spinal cord and fluid taken for examination under a microscope.
- Gastroscopy, in which a long, hollow tube with a light attached is inserted down the throat and into the stomach. It projects magnified pictures of the inside of the stomach, and instruments can be inserted through the tube, if needed.
- Colonoscopy, where a long, slim, flexible tube, with a light attached, is inserted through the anus, so the doctor can examine the bowel.
If any of these are required, your doctor should explain to you why you need the test and what is involved.
The tests described on the previous pages will show if cancer cells have spread to other places in the body. Finding out where the cancer is in your body is called ‘staging' the disease. This helps your doctors work out the best treatment for you.
In Stage 1 lymphoma, cancer is found in only one lymph node area or one area/organ outside the lymph nodes.
In Stage 2, cancer is found in two or more lymph node areas on the same side of the diaphragm. Cancer is found in one area/organ outside the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may be involved.
In Stage 3, cancer is found in lymph node areas on both sides of the diaphragm. It may have spread to an area/organ near the lymph node area, or to the spleen, or both.
In Stage 4, cancer has spread in more than one spot, within or outside the lymphatic system (for example, liver, lung, bone marrow or bone).
Staging is very important as it allows your doctors to recommend the best treatment for you. Staging may take from one to three weeks.
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your own situation.
Expert content reviewers:
Assoc. Prof. Jeff Szer, Head, Bone Marrow Transplant Service, Dept of Clinical Haematology & Medical Oncology, Royal Melbourne Hospital