Non-Hodgkin’s Lymphoma

What Is Non-Hodgkins Lymphoma?

Non-Hodgkins lymphoma is a type of cancer in the lymphatic system. Non-Hodgkins lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually causing tumors to grow.  Because lymph tissue is found throughout the body, adult non-Hodgkins lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues.

Non-Hodgkin's Lymphoma

Prognosis

People have survived every stage of non-Hodgkins lymphoma.

Types of Non-Hodgkins Lymphomas

There are many types of non-Hodgkins lymphomas. Some types spread more quickly than others. The type is determined by how the cancer cells look under a microscope. This determination is called the histology. The histologies for adult non-Hodgkins lymphoma are divided into 2 groups:

  • Indolent lymphomas, which are slower growing and have fewer symptoms
  • Aggressive lymphomas, which grow more quickly

Aggressive lymphomas are also seen more frequently in patients who are HIV-positive (AIDS-related lymphoma).

Diagnosis of Non-Hodgkins Lymphoma

How is Non-Hodgkins lymphoma identified?

Tests that examine the body and lymph system are used to help detect (find) and diagnose adult non-Hodgkins lymphoma.

The following tests and procedures may be used:

Physical exam and history

Physical Exam and History

Physical exam and history is an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Please provide your medical records to us before your appointment. At the visit itself, the nurses and doctors will ask additional questions and carry out a detailed physical exam.

Bone marrow aspiration and biopsy

Bone Marrow Aspiration and Biopsy

Bone marrow aspiration and biopsy involves the removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. This type of biopsy is performed either from the sternum (breastbone) or the iliac crest hipbone (the bone area on either side of the pelvis on the lower back area). The skin is cleansed and a local anesthetic is given to numb the area. A long, rigid needle is inserted into the marrow, and cells are aspirated for study; this step is occasionally uncomfortable. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer. A core biopsy (removing a small bone ‘chip’ from the marrow) may follow the aspiration.

Lumbar puncture

Lumbar Puncture (Spinal Tap)

A lumbar puncture (also called a spinal tap) can be used to analyze the fluid in the spinal cord. This test is helpful for spinal tumor assessment and also for measuring whether certain cancers have spread to the brain. In this procedure, a special needle is inserted into the lower back spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF), the fluid in the brain and spinal cord, can be removed and sent for testing to determine if there is an infection or other problems.

Lymph node biopsy

Lymph Node Biopsy

A lymph node biopsy is the removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. During an excisional biopsy, an entire lymph node will be taken out whereas only a part of a lymph node will be removed during an incisional biopsy.

Laparoscopy

Laparotomy

Laparotomy

A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.

Tests conducted if Non-Hodgkins lymphoma is found

If cancer is found, the following tests may be done to study the cancer cells:

Immunohistochemistry study

Immunocytochemistry Study

An immunocytochemistry study is a laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer cells to test for certain antigens. This type of study is used to tell the difference between different types of cancer.

Cytogenetic analysis

Cytogenetic Analysis

In this laboratory test, cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the structure or number of chromosomes in the lymphocytes.

Immunophenotyping

Immunophenotyping

Immunophenotyping is a test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes. The process identifies cells based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing the cancer cells to normal cells of the immune system.

Tests and procedures that may be used in the staging process for Non-Hodgkins lymphoma

The following tests and procedures may be used in the staging process for non-Hodgkins lymphoma:

Complete blood count (CBC)

Complete Blood Count (CBC)

A complete blood count (CBC) measures the size, number, and maturity of the different blood cells in a specific volume of blood. This is one of the most common tests performed.

  • Red blood cells are important for carrying oxygen and fighting anemia and fatigue. The hemoglobin portion of the CBC measures the oxygen carrying capacity of the red blood cells while the hematocrit measures the percentage of red blood cells in the blood.
  • White blood cells fight infection. Increased numbers of white blood cells, therefore, may indicate the presence of an infection. Decreased levels may indicate certain rheumatic diseases or reaction to medication.
  • Platelets prevent the body from bleeding and bruising easily. It is usually performed to check for a blood infection.

Blood chemistry studies

Blood Chemistry Study

A blood chemistry study is a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

CT scan (CAT scan)

PET scan (positron emission tomography scan)

What Is Positron Emission Tomography (PET) Scan?

Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine imaging. A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning.

PET is a powerful diagnostic test that is having a major impact on the diagnosis and treatment of disease. A PET scan (positron emission tomography scan) monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). PET can detect extremely small cancerous tumors, subtle changes of the brain and heart, and give doctors important early information about heart disease and many neurological disorders, like Alzheimer’s.

Most common medical tests, like CT and MRI scans, only show details about the structure of your body. PET scans give doctors images of function throughout the entire body, uncovering abnormalities that might otherwise go undetected. This allows doctors to treat these diseases earlier and more accurately. A PET scan puts time on your side. The earlier the diagnosis, the better the chance for treatment.

For example, a PET scan is the most accurate, non-invasive way to tell whether or not a tumor is benign or malignant, sparing patients expensive, often painful diagnostic surgeries and suggesting treatment options earlier in the course of the disease. Although cancer spreads silently in the body, PET can inspect all organs of the body for cancer in a single examination.

Today, most PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic activity within the body. The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.

About nuclear medicine

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose or treat a variety of diseases, including many types of cancers, heart disease, and certain other abnormalities within the body. Depending on the type of nuclear medicine exam you are undergoing, the radiotracer is either injected into a vein, swallowed or inhaled as a gas and eventually accumulates in the organ or area of your body being examined, where it gives off energy in the form of gamma rays. This energy is detected by a device called a gamma camera, a PET scanner and/or probe.

MRI (magnetic resonance imaging)

Symptoms used in staging

Additional Symptoms Used in Staging

Non-Hodgkins lymphoma stages are also noted by the presence or absence of certain symptoms of the disease:

  • A lymphoma that affects organs or tissues other than the lymph nodes has an “E”, for extranodal, added to its stage.
  • If it affects the spleen, an “S” is added.
  • If the patient has fever, night sweats, or unexplained weight loss, the letter “B” is added.
  • If none of these is present, an “A” is added.
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