Non-Hodgkin's Lymphoma Detection & Diagnosis

As with most other cancers, early detection is the main key to the successful treatment of non-Hodgkin lymphoma (NHL). However, because there are currently no recommended screening tests, it’s more important than ever to pay attention to possible signs and symptoms associated with the disease. 

Signs & Symptoms of Non-Hodgkin Lymphoma

While there are various signs and symptoms that could suggest NHL, the most common is enlarged lymph nodes. In most cases, these lumps are painless and can be found in areas such as on the side of the neck, in the armpit, or in the groin. 

Other symptoms, such as fever, chills, night sweats, weight loss, feeling tired, and swelling in the abdomen are less common and are often attributed to something other than lymphoma. Still, it’s a good idea to have them checked by a doctor, especially if they don’t go away or get worse.

Diagnosing Non-Hodgkin Lymphoma

If you have swollen lymph nodes or another symptom that suggests non-Hodgkin’s lymphoma, your doctor will try to find out what’s causing the problem. Your doctor will first ask about your personal and family medical history. He or she will also perform a physical examination, focusing specifically on your lymph nodes, liver, and spleen. If there are signs of an infection, you may be prescribed an antibiotic to see if that relieves the swelling. If not, and your doctor suspects lymphoma, other tests will be recommended. 

Tests that may be used to diagnose NHL can include:

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. In this case, to check the tissue for lymphoma cells. Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose lymphoma. Removing an entire lymph node is best. A biopsy is the only sure way to diagnose lymphoma.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the: 
• Number of red blood cells, white blood cells, and platelets
• Amount of hemoglobin (the protein that carries oxygen) in the red blood cells
• Portion of the sample made up of red blood cells
• Computed tomography (CT or CAT) scan. A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, pelvis, and lymph nodes, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Magnetic resonance imaging (MRI). A test that uses magnetic fields, not x-rays, to produce detailed images of the body. It can be used to measure the size of the tumor. A special dye called contrast medium is given intravenously before the scan to create a clearer picture. A radiologist interprets the scan.
• PET scan (positron emission tomography scan): A procedure to find malignant (cancerous) tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Bone marrow aspiration and biopsy: The removal of bone marrow and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow and bone under a microscope to look for signs of cancer.

If cancer is found, the following tests may be done to study the cancer cells:

• Immunohistochemistry (IHC): A special staining process that looks at proteins on the surface of or inside the cancer cell.
• Cytogenetics: Studies of any changes in chromosomes that could indicate cancer. 
• Immunophenotyping: A technique that uses antibodies to identify cancer cells based on the types of antigens or markers on the surface of the cells. 
• Fluorescence in situ hybridization (FISH): Uses fluorescent probes under a special microscope to look at and count genes or chromosomes in cells and tissues. 

After diagnostic tests are done, your doctor will take time to go over the results with you. If the diagnosis is NHL, these results will also help your doctor determine your specific subtype of NHL as well as the stage. 

If you’ve recently been diagnosed with non-Hodgkin’s lymphoma, visit our guide for newly diagnosed lymphoma patients.