Non-Hodgkin's Lymphoma

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Questions to Ask Your Doctor about Non-Hodgkin’s Lymphoma
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Diagnosis

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Most people with lymphoma (e.g., up to 75% of HD patients) experience no classic symptoms. Often, lymphomas are diagnosed because of abnormalities found on chest x-rays or other imaging studies that are performed for nonspecific complaints.

If lymphoma is suspected, the physician obtains a full medical history to uncover any relevant symptoms or risk factors. A complete physical examination will supply other clues about possible infection, health problems, or signs of lymphoma. The physician pays particular attention to the size, location, tenderness, and consistency (firmness) of swollen lymph nodes, and will examine other lymphatic sites for possible disease.

Once the physician suspects that a patient has Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL), a biopsy of the enlarged lymph node is performed. In a biopsy, a small amount of tissue is removed and examined under a microscope. A pathologist (disease diagnosis specialist) evaluates the tissue sample and looks for Reed-Sternberg (R-S) cells, which confirm a diagnosis of Hodgkin's disease.

Types of Biopsy
Several types of biopsy are available, including the following:

• Fine needle aspiration (FNA) biopsy uses a very thin, hollow needle that is attached to a syringe. If the enlarged lymph node is palpable (can be felt) and near the skin's surface, the needle is inserted into the swollen lump. It is then pushed back and forth to free some cells, which are aspirated (drawn up) into the syringe and are smeared on a glass slide for analysis.

  If the suspicious nodes or tissues are deep within the body (e.g., abdominal nodes, thymus), the needle may be guided while it is viewed on a CT (computed tomography) scan.

  FNA can distinguish noncancerous conditions, like infections, from NHLs or other cancers. FNA also is useful for staging, or determining the extent, of disease, and for monitoring recurrence, or return of cancer. But, because of small sample sizes and lack of information about lymph node structure, FNA often is inadequate for the initial diagnosis of HD or NHL. In such cases, larger tissue samples are obtained by surgical biopsy.

  
  
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• Large needle/Core biopsy uses a large-bore needle to obtain a small tissue sample for analysis. Core biopsy has limited role in the diagnosis of lymphoma and is reserved for those patients who are unable to tolerate an invasive surgical procedure. Both FNA and core biopsy procedures may be guided by CT, ultrasound, or other imaging techniques.

• Surgical biopsy refers to both incisional (cutting into) and excisional (cutting away) procedures. If a tumor mass is large and only a tiny piece of it is removed for examination, the procedure is called an incisional biopsy. Incisional biopsy has, in large part, been replaced by needle biopsy; needle biopsy is less time-consuming and less prone to infection and it produces less scarring.

  If the tumor mass is small and it is completely removed by biopsy, the procedure is called an excisional biopsy. Excisional biopsy usually is performed if a physician suspects that a lump is not cancerous (benign). Local anesthesia is used if the node is located near the skin's surface and the child or adult is cooperative; however, deeper nodes (e.g., in the chest or abdomen) require general anesthesia.

Biopsy samples usually are sent to a laboratory for a number of additional tests, such as immunocytochemistry, flow cytometry, and cytogenetic studies. These tests, which also are used in diagnosing leukemia, rely on changes in cell-specific antibodies, the immune system chemicals that are directed against foreign substances, and genetic material to help identify specific types of lymphoma.

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