Keypoints

Introduction

Surgery is rarely a means of curing non-Hodgkin's lymphoma. There are three main reasons why surgery may be performed:

• Obtain a sample of tissue to help in diagnosis or staging (a biopsy)
• Remove an organ that is badly affected by lymphoma, most usually the spleen
• Reduce the volume of lymphoma before other treatments, especially in the case of aggressive non-Hodgkin's lymphoma involving the intestines

Surgery is most-often used in non-Hodgkin's lymphoma to obtain a sample of tissue to help in diagnosis of staging

Biopsy

Biopsy is not a treatment as such. It is a means of obtaining a sample of tissue to help doctors to diagnose non-Hodgkin's lymphoma. The tissue can be examined under the microscope, and various laboratory tests can also be performed on it. This can help in deciding if the patient has non-Hodgkin's lymphoma and, if so, what type of lymphoma it is. Biopsies can also be used to assess how well the non-Hodgkin's lymphoma is responding to treatment.

Most biopsies can be carried out with a local anaesthetic. However, children, particularly nervous patients and those having a biopsy of a lymph node that is not easily accessible may need to have a general anaesthetic.

There are several types of biopsy:

• Lymph node biopsy, in which tissue is taken from an enlarged lymph node; in an incision biopsy, the whole node is removed. Usually this is done with a local anaesthetic
• Fine-needle aspiration biopsy, in which a small sample of a lymph node is taken with a needle and syringe. This is sometimes done to monitor the response to treatment. This is done with a local anaesthetic
• Bone marrow biopsy, in which bone marrow is taken from the pelvic bone to see if the non-Hodgkin's lymphoma is involving the bone marrow. Usually this is done with a local anaesthetic

Gastrointestinal surgery and splenectomy

If the spleen is heavily involved by non-Hodgkin's lymphoma it may be removed, which is known as a splenectomy. This is carried out under a general anaesthetic. People who have had a splenectomy are more likely to contract certain bacterial infections, and should, in general, receive vaccinations to prevent them.

Non-Hodgkin's lymphoma of the stomach is sometimes removed by surgery. It is not entirely clear whether this is necessary or not, and chemotherapy with or without radiotherapy or monoclonal antibody therapy may be used instead.

Coping with surgery

Most biopsies are performed with local anaesthetic, and the patient does not usually need to stay in hospital. Patients having an operation, such as a removal of the spleen, or 'splenectomy', that involves a general anaesthetic may be admitted to hospital the day before and will usually stay in hospital for a few days afterwards.