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Diagnosis of Non-Hodgkin’s lymphoma

Scanning of patient to detect the extent of cancer.
Scanning of patient to detect the extent of cancer.
Diagnostic tests are run by the doctor. 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 immunopathological parameters (see below).

 

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.

 

As the bone marrow is often affected in the higher stages of the disease, 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)

 

(See staging section.)


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