Investigations for lymphoma diagnosis and management
Investigations for establishing the correct diagnosis and lymphoma type
If lymphoma is suspected but not proven, or if the particular variety of lymphoma is not known with confidence, you are likely to need a biopsy. Sometimes a needle biopsy has already been done, confirming a diagnosis of lymphoma but not the particular category. To ensure we have all the information required for the appropriate management of the lymphoma, you may need what is called an excision biopsy. This involves complete removal of a lymph node or, if there is a large mass of lymph nodes, a piece of the abnormal mass. These procedures are generally done as a day patient or require an overnight stay. If a biopsy is required, you will be referred to an appropriate surgeon with expertise in cancer surgery to undertake the biopsy. If you or your GP have a preference for a surgeon please let us know. Otherwise a suitably experienced surgeon will be contacted by us. The choice of surgeon is influenced by the precise location of the area to be biopsied; for example, if the affected lymph node is in your chest, a specialised chest surgeon will be involved.
Other investigations
Once a diagnosis of lymphoma is confirmed you will need to have additional investigations to inform treatment decisions. The major purposes of these further investigations, and the types of tests involved, are as follows:
- To determine precisely where in the body the lymphoma has spread. This is called "staging". Staging can assist in establishing the treatment required, the prognosis in your particular case and, by defining the extent of disease prior to treatment, assists monitoring of the progress of therapy (for example to ensure the lymphoma has been completed eradicated by the treatment). The staging investigations are likely to include: a whole body x-ray (called a CT scan) including neck, chest, abdomen and pelvis; a nuclear medicine scan called a PET scan (sometimes done at the same time as the CT scan); and a bone marrow biopsy (see additional information regarding bone marrow biopsies). Tests that are abnormal before treatment will be repeated after the treatment is finished to ensure that all signs of the lymphoma have gone.
- To determine the function of your heart, lung, liver and kidney's. Problems with any of these organs may influence the choice or doses of treatment. Investigations are likely to include: an ECG (electrocardiogram) and an echocardiogram (to assess your heart function); blood tests to assess your liver; kidney, lung and bone marrow function tests; and tests for any infections that may influence the treatment.
- To assist you in returning to normal life after treatment, you may also have additional testing of your fitness levels and muscle strength to provide a guide to your recovery.