Tests for initial diagnosis
The most common means of establishing a firm diagnosis of non-Hodgkin's lymphoma is a biopsy of an enlarged lymph node. A biopsy involves removing some or all of the node so that it can be examined under a microscope and so that other tests can be performed on any abnormal cells in the tissue sample.
A biopsy is generally a minor surgical procedure. It can often be performed with a local anaesthetic. If so, there is usually no need to stay in hospital overnight.
A general anaesthetic might be necessary in young children or particularly nervous patients, or if the enlarged node is very deep below the skin. It might be necessary to have an overnight hospital stay if a general anaesthetic is used. Even so, the biopsy itself is almost always a minor procedure.
Sometimes, cells are taken out of the node using a needle, in a procedure known as a fine needle aspiration, although it is not always adequate for diagnosing non-Hodgkin's lymphoma. This is an even more minor procedure than a surgical biopsy.
Patients will have to give informed consent and will be told what arrangements need to be made for a biopsy, and they will also be given any other instructions before the day of the biopsy, such as whether they need to avoid eating and drinking before the procedure.
Depending on the site of the lymphoma, it might be necessary to take a biopsy of other tissues as well as a lymph node, often a bone marrow biopsy. Again, patients will be told about this and given any other necessary information before the biopsy is done.
A lymphoma can be diagnosed on the basis of the biopsy. The tissue taken in the biopsy will have to be looked at under a microscope by a pathologist, so the diagnosis will not be available immediately, but usually within 1-2 weeks.
If the biopsy is positive for lymphoma, it will also be possible to tell whether it is a non-Hodgkin's lymphoma or a Hodgkin's lymphoma, what type or 'grade' of lymphoma it is, and what classification it is (indolent or aggressive).
However, further tests are still likely to be necessary. These can be divided into two main groups:
The most common blood tests to assess the general health are:
Blood for all of these tests is usually taken in one go. Blood tests are then likely to be repeated at regular intervals, both during treatment and afterwards.