Diagnosis of Non-Hodgkin’s lymphoma

Diagnostic tests that are run by the doctor/Staging. The critical test is the lymph node (or other mass) biopsy. Here, the surgeon takes a small piece of tissue from the lump and it is analysed histologically (i.e. down the microscope) and for various other diagnostic parameters – vide infra.

 

Once the diagnosis has firmly been established, then the doctor will move to staging: here, a search is conducted to see where else the NHL may be present. A CT scan is performed throughout the whole body to see if any other lymph node groups are affected or if any extra-nodal disease is present. PET scanning powerfully images non-Hodgkins lymphoma (figure below shows brain lymphoma deposit on PET scan). As the bone marrow is often affected in the higher stages of the disease, so it is always sampled in the work-up of this disease. In some high grade NHL, it may be appropriate to sample the CSF (the cerebrospinal fluid, usually by lumbar puncture) to see if any abnormal cells are present in this fluid, which surrounds the brain and spinal cord, and which is ‘accessed’ relatively poorly by intravenous chemotherapy.

 

A large number of blood tests also form part of routine staging. By the above methods, a staging of the patient is achieved (according to a system that was originally evolved at a conference at Ann Arbor so called the Ann Arbor system): Stage 1: NHL affecting one group of lymph nodes only (e.g. node swelling/involvement only affecting the lymph node chain down the left side of the neck). Stage 2: Two or more lymph node groups affected on one side of the diaphragm (e.g. neck and armpit groups of nodes). Stage 3: Lymph nodes (and in this nomenclature the spleen is counted as a lymph node organ) affected on both sides of the diaphragm (e.g. neck nodal and groin nodal involvement). Stage 4: Lymph nodes involved and other organs (e.g. bone marrow, CSF or liver). The overall outlook for the patient presenting with NHL is worse the higher the stage at presentation.

 

A special category is recognised where there is only one extranodal site of lymphoma and no lymph node involvement per se: this is referred to as stage 1E. There is one small addendum: After these staging groupings, the doctor will often place a suffix A or B. If the patient has a suffix B after his staging then he has been observed to exhibit sweating (sufficient to wake him from sleep), more than 10% body weight loss or persistent fever at the time of presentation and this suffix B denotes a slightly worse outlook stage for stage. \Stage suffix A patients do not exhibit any of these clinical features at presentation.