Further tests for non-Hodgkin lymphoma
Sometimes further tests are needed to find out whether the cancer has spread. This is called staging.
Below we describe tests that are commonly used to help stage non-Hodgkin lymphoma. You will probably not need to have all these tests – most people will have blood tests and some imaging tests. Some tests may be repeated during or after treatment to check your health and how well the treatment is working.
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Your doctor will take a blood sample to see how well your kidneys and liver are working, and to check your general health.
Low blood counts before treatment may indicate that the cancer has spread to the bone marrow. You will also have regular blood tests to check the effects of treatment on your total number of red blood cells, white blood cells and platelets.
You may have a biopsy to check whether non-Hodgkin lymphoma has spread to the bone marrow. A bone marrow biopsy is done in two steps:
- Bone marrow aspiration – The doctor inserts a needle into the bone at the back of your hip (pelvic bone) to remove a small sample of fluid (aspirate) from the bone marrow.
- Bone marrow trephine – A second needle is used to take a matchstick-wide sample of both bone and bone marrow tissue.
A bone marrow biopsy takes about 30 minutes. It is usually done as an outpatient procedure and you do not need to stay in hospital overnight. You will lie still while a local anaesthetic is injected into your pelvis (hip) to numb the area. You may also be offered light sedation to help you feel relaxed, or a general anaesthetic.
You may feel some pressure or discomfort during the biopsy. If you feel uncomfortable afterwards, ask a member of your health care team about pain-relieving medicine. You will need to lie flat in bed for another 30 minutes after the biopsy to make sure there is no bleeding.
The bone marrow sample is examined under a microscope to see if any lymphoma cells are present. Results are usually available within a couple of days to a week.
You will usually have at least one of the tests described below:
Before an excision biopsy, you may have an x-ray of the chest area to see if the lymphoma has spread to the lymph nodes in your chest or lungs. An x-ray is painless and takes only a few minutes.
A CT (computerised tomography) scan uses x-ray beams to create a detailed three-dimensional picture of an area inside the body. Your chest, abdomen and pelvis will be scanned to check whether the cancer has spread.
Before the scan, you may be asked to drink a liquid or have a special dye called contrast injected into a vein. This helps ensure that anything unusual can be seen more clearly. The dye may make you feel hot all over and leave a strange taste in your mouth for a few minutes.
The CT scanner is large and round like a doughnut. You will lie on a table that moves in and out of the scanner. The scan is painless, and takes 30–45 minutes. Most people can go home as soon as the scan is over.
|Before having scans, tell the doctor if you have any allergies or have had a reaction during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant.|
This specialised test combines a positron emission tomography (PET) scan with a non-contrast CT scan to produce a three-dimensional colour image.
For the PET scan, you will be injected with a glucose (sugar) solution containing a small amount of radioactive material. Many cancer cells show up brighter on the scan because they take up more glucose solution than normal cells do.
You will be asked to sit quietly for 30–90 minutes while the glucose moves around your body, then the PET scan itself will take about 30 minutes. Clinic staff will tell you how to prepare for the scan, particularly if you are diabetic. You’ll be encouraged to drink plenty of water to help the glucose solution leave your body.
The CT scan is used to help work out the precise location of any abnormalities revealed by the PET scan.
This uses soundwaves to create a picture of the internal organs. This test is most commonly used to help find swollen lymph nodes or other lumps in the body.
A technician called a sonographer will spread gel over your skin and then pass a small device called a transducer over the area. The transducer creates soundwaves. When soundwaves meet something dense, such as an organ or tumour, they produce echoes. A computer turns the echoes into a picture on a computer screen.
An ultrasound is painless and takes only a few minutes.
An MRI (magnetic resonance imaging) scan is not commonly used for people with non-Hodgkin lymphoma, but may be used to check the brain and spinal cord.
The MRI scan uses a combination of a powerful magnet and radio waves to create detailed pictures of areas inside the body. You will lie on a treatment table that slides into a metal cylinder. The test is painless, but some people find lying in the cylinder noisy and confined. An MRI scan takes 30–60 minutes.
Lumbar puncture (spinal tap)
A lumbar puncture allows the doctor to examine the fluid that protects the brain and spinal cord (the central nervous system) for lymphoma cells. This is uncommon, so most people with non-Hodgkin lymphoma will not need to have a lumbar puncture. Sometimes a lumbar puncture may also be used to deliver chemotherapy.
If you do have a lumbar puncture, you will be placed in a curled or sitting position and given a local anaesthetic. A thin needle will be inserted to remove some fluid from the space between the bones in your lower back. You may feel some discomfort. Tell your doctor if you feel any pain, as they may be able to give you some more anaesthetic.
After the procedure, you may have to lie on your back for a short time to help prevent a headache starting. If you do get a headache, check with your doctor whether you can take pain-relieving medicine. A lumbar puncture can also cause nausea, but this will usually ease within a few hours.
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Dr Ian Bilmon, Haematologist, Westmead and Sydney Adventist Hospitals; Dr Anne Capp, Radiation Oncologist, Calvary Mater Newcastle; Rachelle Frith, Clinical Nurse Consultant Haematology, Prince of Wales Hospital; Jason Gardner, Consumer; A/Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Samantha Rennie, Social Worker, Cancer Services, St George Hospital. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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