Diagnosing Lymphoma

In determining a diagnosis of lymphoma, your physician will review your medical history and perform a physical exam. The purpose of the physical exam is to detect any enlarged lymph nodes or an enlarged liver or spleen.

Blood tests may be ordered to check the function of your liver and kidneys. If lymphoma is suspected a biopsy removing a small amount of tissue from the area of concern will be removed. This tissue will be examined by a pathologist to determine if it is lymphoma.

 

Classification of Lymphomas
Lymphomas are graded as low, intermediate and high depending on the kind of lymphoma cells present and how they affect lymph nodes and chromosomes. Some lymphomas grow faster and require specific treatment. Classifying them is complex because many kinds of lymphocyte cells can be involved.

  • Low-Grade Lymphoma
    These grow so slowly that patients can live for many years mostly without symptoms, although some may experience pain from an enlarged lymph gland. After five to ten years, low-grade disorders begin to progress rapidly and become aggressive or high-grade, producing more severe symptoms.
  • Intermediate-Grade Lymphoma
    This type progresses fairly rapidly without treatment. With treatment, remission can be induced in 50 to 75% of cases. Initial treatment has been so successful that people who stay in remission for three years after diagnosis are often considered cured. Stage I disorders are treated with radiotherapy.
  • High-Grade Lymphoma
    Without treatment, these can progress rapidly regardless of stage. They are treated aggressively. With treatment, between 50 to 75% of patients enter remission. Those who stay in remission one year can look forward to a life free from recurrence. Treatment consists of intensive combination chemotherapy, which is sometimes supplemented with radiation therapy. Drug regimens used are determined by a number of factors, the most important being tissue study.

 

Types of Lymphomas
Based on the course of disease and the kind of lymphocytes affected, lymphomas are divided into two types:

  • Hodgkin Disease
  • Non-Hodgkin Lymphoma

 

Treatment
Radiotherapy is the preferred treatment for patients with stage I or II lymphomas because it successfully induces long-term remissions and even cures in many cases. For treatment of stage III or IV low-grade disorders, one school of thought is to start intensive therapy right after diagnosis - whether a patient has symptoms or not - to achieve and maintain complete remission. Treatment usually consists of high-dose radiotherapy, chemotherapy or a combination of both. Intensive treatment involves risk, but recent studies suggest that such treatment may induce high rates of remission.

Bone marrow transplant is currently being studied as a treatment option for low-grade lymphoma.

 

Staging

Staging is a system of categorizing an individual's disease into one of four groups or "stages," which give a general idea of how far the disease has spread and how it should be treated. This is done after a series of tests are conducted to determine which parts of your body are affected by lymphoma.

  • Stage I:
    The disease is present in only one group of lymph nodes, or, more rarely, in a single organ that does not belong to the lymph system.
  • Stage II:
    Cancer is found in two or more groups of lymph nodes on the same side as the diaphragm. (The diaphragm is a thin muscle below the lungs that helps in breathing and separates your chest from the abdomen). In addition, an organ not in the lymph system may be involved close to the involved lymph nodes.
  • Stage III:
    The disease is present in lymph node groups on both sides of the diaphragm, occasionally with the involvement of other nearby organs. If the spleen is involved then the disease becomes stage III as well.
  • Stage IV:
    Once the liver, the bone marrow or the lung substance becomes involved, the disease is in stage IV. The same is true if other organs are involved far away from involved nodes.

Once the type and stage of lymphoma are determine you and your physician will discuss your treatment options and determine the best course of care for you.