Because many symptoms associated with the most common blood cancer lymphoma are similar to other diseases, diagnosis is difficult. Lymphoma occurs when white blood cells called lymphocytes reproduce and grow excessively. Mostly it attacks the lymphatic system which is very important to the body’s immune system. The most common first symptom of the disease is painless swelling of the lymph nodes.
Another common symptom seems like a common cold that will not go away. Night sweats, chills or fevers, unexpected weight loss, loss of appetite, lack of energy or tiredness, itching or rash, coughing, difficulties in breathing, enlarged tonsils, or headaches are also lymphoma symptoms.
Physicians need to conduct a series of medical exams in order to make a diagnosis.
Complete Physical Examination for Lymphoma Diagnosis
Physicians usually start diagnostic procedures with a complete physical exam and a comprehensive medical history that includes family history. The physical examination will be particularly focused on a search for swollen lymph nodes and for other changes in the spleen or liver. The physician usually looks for infections that may first explain the swellings. A biopsy will be ordered if the doctor suspects lymphoma.
Biopsy to Diagnose Lymphoma
The biopsy of tissue removed from the body is subject to a series of exams that result not only in the confirmation of the disease but also in the determination of its type, size, texture, and location. Results will help set appropriate treatment.
Types of Diagnosis Biopsies
Different types of biopsies can be conducted. The most common is the surgical excisional or incisional of the suspected lymphoma during which a part or all of the node is removed for analysis. Fine needle aspiration, or core needle biopsy, is another procedure conducted via needle without surgery.
Additional Types of Biopsies
The physician might also order further biopsies to understand stage, extent and type of the disease. A bone marrow aspiration and biopsy will determine if the lymphoma has reached the bone marrow. A lumbar puncture or spinal tap is used to search for lymphoma cells in the cerebrospinal fluid of the brain and spinal cord. The pleural fluid sampling looks for signs of lymphoma in the chest. Peritoneal fluid can indicate lymphoma in the abdomen.
Exams Conducted on Biopsy Samples
The tissue removed during a biopsy undergoes lab tests to help diagnosis and classify the type of lymphoma. Samples are analyzed by a pathologist who examines the cell size and shape; and for immunohistochemistry, flow cytometry, cytogenetics, molecular genetic, fluorescent in situ hybridization (FISH), and polymerase chain reaction (PCR) examinations.
Blood Tests to Complement Lymphoma Diagnosis
Blood tests for diagnosis reveal the types and amounts of cells and chemicals present in the blood. Blood also helps determine the stage of the disease. The most common test is a complete blood count to count red and white blood cells. Platelets may indicate if the disease has affected the bone marrow. A blood chemistry test verifies kidney and liver function. Further tests may be used to examine if the patient is infected with viruses like hepatitis B, hepatitis C, or human immunodeficiency virus (HIV).
Imaging Tests Used in Lymphoma Diagnosis
Imaging tests examine the abnormal areas that may be affected by the disease.
The most common tests are chest x-ray to search for swollen nodes in the chest, computed tomography (CT) scan that provides detailed images of the full body including soft tissues, CT-guided needle biopsy used to drive the biopsy needle into suspicious areas, and magnetic resonance imaging (MRI) scan to verify if the disease has spread to the brain or spinal cord. Ultrasound examines damage to the internal organs and existence of masses, positron emission tomography (PET) scan and gallium scan both determine the body parts with cancerous cells using radioactivity, and bone scan shows the damage caused by lymphoma in the bones.
In addition, heart and lung function may also be tested to determine the accurate type of treatment.
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