How is lymphoma diagnosed?
You might have a number of tests to investigate your symptoms and confirm a diagnosis of lymphoma, including:
- medical history and physical examination
- blood tests for blood cell counts and other laboratory tests
- biopsy of the lymph nodes, where a small sample of tissue is removed to be examined under a microscope
- biopsy of the skin, if lymphoma of the skin is suspected
- imaging tests, such as chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, ultrasound or positron emission tomography (PET) scan, to examine the area that might contain lymphoma and find out how far the lymphoma has spread.
If you are diagnosed with lymphoma, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you.
Lymphoma (both Hodgkin and non-Hodgkin) is divided into 4 stages, depending on how far the cancer has spread within the lymphatic system or to other parts of the body:
- Stage I:
- Lymphoma is in only 1 lymph node area or lymphoid organ such as the thymus, or
- lymphoma is in only 1 area of a single organ outside the lymphatic system.
- Stage II:
- Lymphoma is in 2 or more lymph node areas either above or below the diaphragm, or
- lymphoma extends locally from 1 lymph node area into a nearby organ.
- Stage III:
- Lymphoma is in lymph node areas both above and below the diaphragm, or
- lymphoma is in lymph nodes areas both above and below the diaphragm, and has also spread to a nearby organ and/or the spleen.
- Stage IV:
- Lymphoma has spread widely through 1 or more organs outside the lymphatic system, and may be in nearby lymph nodes, or
- lymphoma is in organs in 2 distant parts of the body (and not in nearby lymph nodes), or
- lymphoma is in the liver, bone marrow, lungs or cerebrospinal fluid.
Other descriptions might be added to these stages to describe specific characteristics of the disease.
Different staging systems are used for lymphoma of the skin. These systems describe how much of the skin surface is affected, the extent to which the lymphoma has spread to the lymph nodes and other organs, and sometimes the number of lymphoma cells in the blood.
A different staging system is also used for non-Hodgkin lymphoma in children.
Tests to determine the stage of lymphoma can include:
- imaging tests, such as X-ray, CT, MRI or PET scans
- blood tests
- lymph node biopsy
- bone marrow aspiration and biopsy
- tests of heart and lung function.
- American Cancer Society. Hodgkin disease http://www.cancer.org/cancer/hodgkindisease/index.
- National Cancer Institute (2014). Adult Hodgkin lymphoma treatment (PDQ®) http://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq, patient version.
- American Cancer Society. Non-Hodgkin lymphoma http://www.cancer.org/cancer/non-hodgkinlymphoma/index.
- American Cancer Society. Lymphoma of the skin http://www.cancer.org/cancer/lymphomaoftheskin/index.
- American Cancer Society. Non-Hodgkin lymphoma in children http://www.cancer.org/cancer/non-hodgkinlymphomainchildren/index.
- National Cancer Institute (2015). Childhood non-Hodgkin lymphoma treatment (PDQ®) http://www.cancer.gov/types/lymphoma/patient/child-nhl-treatment-pdq, patient version.
- National Cancer Institute (2014). Adult non-Hodgkin lymphoma treatment (PDQ®) http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq, patient version.