Diagnosis of non Hodgkin Lymphoma
The diagnostic process of the no (NHL) Hodgkin lymphoma usually begins with a visit to your family doctor. He will ask about symptoms you are experiencing and will do a physical exam. Based on this information, it is possible that your doctor directs you to a specialist or you prescribe examinations to verify the presence of NHL or other health problems.
The diagnostic process may seem long and discouraging. It's normal to worry, but try not to forget that other medical conditions may cause symptoms similar to those of the NHL. It is important that the care team eliminates any other possible cause of the health problem before making a diagnosis of NHL.
Commonly is used in the tests that follow to eliminate or diagnose the NHL. Well tests for the diagnosis of cancer are also used to determine the stage, i.e. how far the disease has progressed. Your doctor may also order other tests to check your general State of health and to help plan your treatment.
Health history and physical examination
Your health history is a record of your symptoms, your risk factors and of all the events and medical conditions you may have experience in the past. Noting your health history, your doctor will ask you questions about your personal background:
symptoms that suggest a NHL
medications or conditions that could weaken your immune system
After an organ transplant immunosuppressant drugs
HIV/AIDS
immunodeficiency disorders
Autoimmune disorders
recent infections
already administered cancer treatment
exposure to pesticides
Your doctor may also ask if there is a history of NHL in your family.
Physical exam allows your doctor to look for any signs of NHL. During the physical examination, your doctor may:
palpate the lymph nodes in your neck, your underarms and your elders to find out if they are larger than normal (swollen);
palpate your abdomen to see if your liver or your spleen is larger than normal;
listen to your lungs;
check for signs of infection.
Learn more about the physical examination.
Biopsy
During a biopsy, the doctor removes tissue or cells of the body in order to analyze in a pathology lab. The report from the laboratory confirms the diagnosis and the type of NHL.
The type of biopsy performed by the doctor depends on the location of the swollen lymph nodes. It can remove, in whole or in part, a lymph node in the neck, armpit or groin. It can also take a sample of a ganglion in the chest or abdomen. It is possible that he would resort to CT (CT) for guidance during a biopsy of the lymph node practiced in these regions.
The NHL may appear in organs or tissues outside the lymph nodes (extraganglionnaires seats), including the brain, breast, skin, stomach, liver, and intestine. The doctor can do biopsies for know if NHL or another type of cancer affects those organs or tissues. Sometimes the doctor do a biopsy of these organs or tissues to stage of the NHL.
Surgical biopsy
There are 2 types of surgical biopsy.
On excisionnelle biopsy, we remove the lymph node or the mass as a whole, as well as a region of tissue all around.
During the incisional biopsy, we take a sample of tissue from a lymph node or to another part of the body.
Learn more about the surgical biopsy.
Biopsy by drilling
During biopsy by drilling, use a needle dug to collect a sample of a lymph node or to another part of the body.
Learn more about biopsy by drilling.
Puncture and biopsy of bone marrow
In a drain and a bone marrow biopsy, the doctor removes cells from bone marrow for analysis in the laboratory.
The doctor may use to puncture and biopsy of bone marrow to diagnose the NHL, but it is mainly used to determine the stage since it can spread to the bone marrow. The report from the laboratory confirms the presence of lymphoma in the sample cells or not.
Learn more about the puncture and biopsy of the bone marrow.
Lumbar puncture
The lumbar puncture, or rachicentese, is used to collect a small amount of cerebrospinal fluid (CSF) in the space surrounding the spinal column that will be examined under the microscope. The sample of CSF will indicate if the NHL is present in the brain and spinal cord (which form together the central nervous system, or CNS). It is used for:
help diagnose a primitive CNS Lymphoma;
see if an NHL that originated elsewhere in the body has spread to the CSF or brain.
Learn more about the lumbar puncture.
Studies of cells and tissues
Cytogenetics is the analysis of the chromosomes of a cell, including their number, their size, their shape and their disposal. Cytogenetic techniques show chromosomal anomalies, which helps doctors to confirm the diagnosis and determine the type of NHL. The results of cytogenetic studies also help doctors plan treatment and predict its degree of effectiveness.
We can detect significant chromosomal abnormalities by looking at the cells under a microscope. But most of the changes affecting the DNA require more careful analysis using other molecular techniques.
Hybridization in situ fluorescence (FISH)
Hybridization in situ fluorescence (FISH) is a molecular genetic test which can identify chromosomal abnormalities and other genetic changes in lymphoma cells. We use special DNA probes marked with fluorescent dyes. The FISH is used to diagnose genetic anomalies in different types of NHL, which can help doctors plan treatments.
Amplification by polymerase (ACP) chain
Is used for amplification by polymerase (ACP) chain to produce many copies of a particular gene segment in order to test it in the lab. Doctors use the ACP to find changes in genes and some changes in the chromosomes that are too small to be seen with a microscope. It can help to diagnose a specific type of NHL and establish the prognosis.
Immunophenotyping
The immunophenotyping is the study of proteins expressed by cells. It is used to establish the type of NHL.
The immunophenotyping is based on an Antigen-antibody reaction very specific to identify proteins in tissues or cells. It has marked monoclonal antibodies of a fluorescent substance or a specific enzyme that binds only to specific antigens (proteins). The fluorescent marker and the marker enzyme allow doctors to observe the lymphoma cells.
The 2 methods that follow are the most used in immunophenotyping.
In IMMUNOHISTOCHEMISTRY, is used under the microscope to observe the fluorescent markers. It also allows doctors to examine cells and what surrounds them.
Flow cytometry allows physicians to sort and classify cells using fluorescent markers on their surface. Doctors can observe many antibodies all at once. The cells are exposed to a laser that makes them emit light measured and analyzed by computer. Flow cytometry allows to quickly collect data in thousands of cells present in a single sample.
Flow cytometry helps physicians identify the unique characteristics of the lymphoma cells. These features can help physicians to establish a prognosis and to measure the response to treatment based on minimal residual disease (MRM). Done MRM refers to the presence of lymphoma cells in the bone marrow can't find using standard laboratory tests.
Learn more about the study of cells and tissues.
Complete blood count
The complete blood count (FSC) allows to evaluate the quantity and quality of white blood cells, red blood cells and platelets. It is used for:
help to exclude an infection;
assess the quality of functioning of the organs that produce blood, like bone marrow and the spleen;
find out if the lymphoma cells spread to the blood;
get reference values to which we can compare the results of next FSC made during and after the treatment.
Learn more about the blood count complete (FSC).
Blood chemistry
During a blood chemistry, measure the rate of chemical substances in the blood. It allows to evaluate the quality of some bodies and also to detect abnormalities. Blood biochemical tests help determine the stage of the NHL and include the following.
A higher than normal rate of lacticodeshydrogenase (LDH) may mean that the NHL has spread to the liver. The rate of LDH is often higher among people with a type of aggressive NHL, which is rapidly changing.
Higher than normal rates of alanine aminotransferase (ALT) and aspartate transaminase (AST) can mean that the NHL has spread to the liver.
Alkaline phosphatase rate higher than normal may mean that the NHL has spread to the bones or liver.
Learn more about the blood chemistry.
Other blood tests
It is possible that get you pass a screening test for HIV, the virus of hepatitis B (HBV) and hepatitis C (HCV) virus if you are diagnosed with a certain type of NHL or if some treatments may be administered to you. Infection by these viruses may affect your treatment.
Chest x-ray
During an x-ray, uses low dose radiation to produce images of the structures of the body on film. Is used to the x-ray to see if the lymph nodes in the chest are swollen and if the NHL has spread to the lungs.
Learn more about radiography.
CT (CT)
During a CT, it uses special x-ray equipment to produce 3-dimensional images and in cuts of organs, tissue, bones and blood vessels of the body. A computer assembles the clichés in detailed images.
The TDM is used for:
assess the lymph nodes swollen;
look at the organs in the chest, abdomen, pelvis and other parts of the body;
monitor the response to treatment in the follow-up.
Learn more about CT.
Magnetic resonance (MRI) imaging
In MRI, is used to powerful magnetic forces and waves radio-electric to produce images in fits of organs, tissue, bones and blood vessels of the body. A computer assemble shots 3-dimensional images.
Is used in MRI to verify if the NHL has spread to the brain or spinal cord. Doctors also use MRI to rule out or diagnose a primitive Lymphoma of the CNS.
Learn more about the MRI.
Ultrasound
During an ultrasound, is used in high-frequency sound waves to produce images of body structures. It allows:
to check if the spleen or liver is swollen or to look for signs of NHL in these bodies;
to check if the testicles are achieved by the NHL;
doctors to collect tissue for a biopsy.
Learn more about the ultrasound.
Bone scan
During a bone scan using radioactive materials that settle on the bones (radiopharmaceuticals) and a computer to create an image of the os. Is the bone scan used to find out if the NHL has spread to the bones when a person is experiencing bone pain or blood levels of alkaline phosphatase is higher than normal.
Learn more about the bone scan.
(Pet) positron emission tomography
During a (pet) positron emission tomography, a radioactive material called radiopharmaceutical is used to detect changes in metabolic activity of tissue in the body. A computer analyzes patterns of distribution of radioactivity and produces images in 3 dimensions and color of the region examined.
Doctors are still trying to find how we can best use the toe to help diagnosis and stage the NHL. Can be used for:
identify areas affected by the NHL;
help to monitor the response to treatment and to find recurrences.
The pet is not available in all treatment centres. Learn more about the pet.
Questions to ask your healthcare team
Learn more about the diagnosis. In order to make the right decisions for you, ask questions about the diagnosis to your healthcare team.
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