Lymphoma – Diagnosis and Treatment

Diagnosis

Examining Signs and Symptoms

Doctors usually start by asking the patient about symptoms like fatigue, fever, unexplained weight loss, or night sweats. They also ask about recent infections, family history of cancer or immune problems, and exposure to viruses such as Epstein-Barr or HIV.

Next, the doctor performs a physical exam. The doctor gently feels the neck, underarms, and groin to check for painless swelling or lumps in lymph nodes. Swollen lymph nodes can signal lymphoma but may also result from infections.

Doctors may also check for swelling in the spleen or liver, listen for chest sounds if the patient has a cough or chest pain, and look for changes in skin color or unusual bruising.

A table summarizing what doctors may look for:

Symptom	Area Checked	What It May Mean
Swollen lymph nodes	Neck, underarm, groin	Possible lymphoma or infection
Unexplained weight loss	General	Seen in cancers, including lymphoma
Fever, night sweats	General	Common with lymphoma
Coughing, chest pain	Chest and lungs	Lymphoma near chest lymph nodes
Fatigue, weakness	General	Possible effect of cancer

Sometimes, swelling is painless. That is why reporting any new or long-lasting lumps is important.

Taking a Tissue Sample

If doctors find swollen lymph nodes or other concerning signs, they usually order a biopsy. This test helps diagnose lymphoma by taking a tissue sample.

There are different ways to collect the sample:

• Excisional Biopsy: The doctor removes a whole lymph node or most of it.
• Incisional Biopsy: The doctor removes only part of the lymph node.
• Core Needle Biopsy: The doctor uses a needle to take a small core of tissue.
• Fine Needle Aspiration: The doctor uses a thin needle to remove a small sample (less common for lymphoma).

Lab specialists examine the sample under a microscope to look for cancer cells. They check the cell type and how abnormal it looks.

If lymphoma is present, special tests like immunohistochemistry or flow cytometry help identify if the cells are B lymphocytes (B cells) or T lymphocytes (T cells), and detect features of Hodgkin lymphoma, such as Reed-Sternberg cells.

Doctors may also perform a bone marrow biopsy to see if cancer cells have spread. The results help determine the grade and type of lymphoma, which affects treatment decisions.

Common biopsy options include:

• Excisional or incisional biopsy
• Core needle biopsy
• Bone marrow biopsy

The tissue type and results from special stains help doctors identify the lymphoma type, its grade, and how far it may have spread.

Scanning the Body

Doctors use imaging tests to find out if lymphoma involves other parts of the body. These tests show the size, number, and location of enlarged lymph nodes or affected tissues.

Imaging can also find growths deep inside the chest or belly.

Some types of imaging include:

Imaging Test	What It Shows	Why Doctors Use It
CT Scan	Enlarged nodes, masses	To locate tumors, check spread
MRI	Details in soft tissues	For brain, spine, detailed body imaging
PET-CT	High activity in tissues	Locates areas of lymphoma activity
X-ray	Large nodes in chest	Fast first look at chest area

• CT Scans (Computed Tomography): Show clear images of organs, lymph nodes, spleen, and other areas. CT scans help doctors find masses and plan biopsies.
• MRI Scans (Magnetic Resonance Imaging): Show details of soft tissues and are used for the brain or spinal cord.
• PET-CT Scans (Positron Emission Tomography-CT): Highlight areas of high activity, which may indicate cancer. Doctors often use these scans for staging.
• Chest X-ray: Helps detect enlarged lymph nodes in the chest or lung involvement.

Imaging tests show how far lymphoma has spread, which is called staging. Staging helps guide treatment plans.

Doctors also use scans to check how well treatment is working or to watch for changes over time. They may repeat imaging to see if the lymphoma is shrinking or growing after therapy.

Other Tests Supporting Diagnosis:

• Blood Tests: A complete blood count (CBC) helps check if the cancer affects the blood or bone marrow. Blood tests also show how well the liver or kidneys are working.
• Immune Cell Testing: Flow cytometry and immunohistochemistry help identify the cancer cell type and look for markers.
• Family and Medical History: Doctors review family history and previous infections, such as Epstein-Barr virus or Helicobacter pylori, as these may increase risk.

The approach depends on the patient’s age, symptoms, health, and risk factors. A team of doctors reviews all the information to make a complete diagnosis before starting treatment.

Treatment

Sometimes, lymphoma grows slowly and does not need immediate treatment. The medical team may suggest “watchful waiting.”

During this time, doctors check the patient regularly for changes or symptoms. This approach helps avoid side effects from early treatment when there are no symptoms.

Regular monitoring might include:

• Physical exams
• Blood tests
• Imaging scans

Chemotherapy Medicines

Chemotherapy uses strong medicines to destroy cancer cells. Doctors usually give these drugs through a vein, but some come as pills.

Doctors often combine two or more chemotherapy drugs to make treatment more effective.

List of possible side effects:

• Tiredness
• Increased risk of infection
• Hair loss
• Nausea

Doctors may combine chemotherapy with other treatments, depending on the lymphoma type.

Immunotherapy

Immunotherapy helps the body’s immune system find and attack cancer cells. These treatments can be given as injections or infusions.

Doctors may use immunotherapy for different types of lymphoma, sometimes with other therapies.

Potential side effects:

• Fever or chills
• Skin rashes
• Fatigue

Targeted Treatments

Targeted therapy uses medicines that block specific parts or functions of cancer cells. These drugs focus on certain proteins or genetic signals in lymphoma cells.

Doctors may test lymphoma cells to see if targeted therapy will work. Targeted treatments may cause fewer side effects than chemotherapy.

How targeted therapy works:

Step	Details
Find targets	Test lymphoma cells for key molecules
Attack	Drugs interfere with those molecules
Result	Lymphoma cells are slowed down or destroyed

Radiation Treatment

Radiation therapy uses powerful energy, such as X-rays or protons, to destroy lymphoma cells. A specialized machine directs the energy to the right spot.

Radiation helps shrink cancer or eliminate remaining cancer cells after other therapies. Side effects may include tiredness or skin changes at the treatment site.

Typical uses include:

• Treating lymphoma in a single area
• Reducing symptoms

CAR-T Cell Treatment

CAR-T cell therapy trains the patient’s own T cells to recognize and kill lymphoma cells. Doctors take blood, send T cells to a lab, and modify them to fight cancer.

The modified cells go back into the patient’s body to search for and destroy lymphoma cells. Doctors may use this option if other treatments do not work or if the lymphoma returns.

Main steps:

• Remove T cells from blood
• Modify them in a laboratory
• Return them to the patient

Options for Alternative Therapies

No alternative medicine can cure lymphoma, but some integrative methods may help with symptoms. People often use activities like acupuncture, art therapy, massage, meditation, and music therapy for stress relief.

Other helpful practices include physical activity, relaxation exercises, and yoga. Always ask your doctor before trying these approaches.

Coping and Support

Finding support after a lymphoma diagnosis helps well-being. People can reduce stress by talking to family or friends, joining support groups, or learning about their condition.

Supportive care, including help with side effects and emotional needs, can make daily life easier. Genetic counseling may help those with a family history of lymphoma understand their risks.

Getting Ready for Your Visit

Steps You Can Take Before the Appointment

Prepare in advance to make the most of your time with your medical team.

Here are some helpful actions:

• Ask About Any Pre-visit Instructions: When you set up your appointment, ask if you need to fast or avoid certain foods or medicines.

• Record All Symptoms: Write down every symptom, even those that may not seem related. Note when they started and how often they happen.

• Note Important Personal Information: Think about any recent changes in your life, stress, or health events.

• List All Medications and Supplements: Make a complete list of everything you take, including prescribed medicine, vitamins, and herbal remedies.

• Bring Someone With You: Invite a friend or family member to join you if possible. They can help you remember details or ask questions.

• Jot Down Your Questions: Write your questions before the visit. Put the most important ones at the top in case time is short.

Sample Questions to Ask the Healthcare Team:

Topic	Example Question
Diagnosis	Do I have lymphoma? What kind? What stage is it?
Next Steps	Will I need additional tests?
Treatment	What options are available? How long will treatment last?
Effects	What are the possible side effects?
Daily Life	Can I keep working? How will this affect my routines?
Family and Costs	Should I see a specialist? Will insurance cover this?

Ask more questions during the visit if you think of them.

What Your Healthcare Provider May Discuss

The healthcare professional will likely ask for information to fully understand your situation. Be prepared for questions such as:

• About Symptoms:
  • When did your symptoms begin?
  • Are they constant or do they come and go?
  • How serious are your symptoms?
• Improvement or Worsening:
  • Does anything help your symptoms?
  • Does anything make them worse?
• Family and Personal Background:
  • Has anyone in your family had cancer or immune issues?
  • Have you or a close family member been exposed to harmful substances?

You can list your symptoms or family history in advance to make answering easier. Keeping a symptom diary can also help you provide clear details.

Your healthcare provider will use this information to decide what tests or steps to take next. This conversation helps plan your care and understand your health.