How We Diagnose and Stage Lymphoma
While establishing a diagnosis of lymphoma, City of Hope doctors also need to determine its stage, meaning how advanced the disease is when first diagnosed. Staging reveals whether the cancer cells have spread within the lymphatic system, and to other parts of the body as well. Knowing the stage of a patient’s lymphoma helps in our treatment planning.

Several tests and procedures may be needed, including:
  • History and physical exam
  • Blood cell counts (white blood cell, hemoglobin, platelet count)
  • Microscopic exam of lymph nodes and/or bone marrow biopsy samples
  • Blood chemistry tests

Because lymphomas are a diverse group of malignancies, a biopsy is needed to confirm a specific diagnosis and type of lymphoma. In this test, a tissue sample is taken and examined under a microscope. Other tests such as immunophenotyping to determine whether it is a B cell or T cell lymphoma, cytogenetics (chromosome abnormalities) and molecular tests are performed.

Biopsies may include:
  • Lymph node biopsy - This involves the removal of all or part of a lymph node. A pathologist then examines the tissue under a microscope to determine if lymphoma is present and what kind.
  • Bone marrow biopsy - In this test, a small amount of liquid and piece of bone are obtained by inserting a needle into the hipbone. Then, a pathologist examines the samples for signs of involvement by the lymphoma.

Imaging Tests
Imaging tests used in staging lymphoma include:

  • Chest X-ray
  • Ultrasound
    High-energy sound waves (ultrasound) are bounced off internal tissues or organs to create an image called a sonogram
  • CT or CAT (Computerized Axial Tomography) Scan
    This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly
  • PET (Positron Emission Tomography) scan
    This scan measures the metabolism of a tumor relative to normal tissue and can help determine where in the body there is active tumor
  • MRI (Magnetic Resonance Imaging)
    This procedure creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves, and computer imaging
In general, scans are performed at diagnosis to determine the extent of disease, repeated during therapy to assess response to treatment at the end to document remission, and to follow our patient to determine if the lymphoma has remained in remission or has returned (relapse).
  • Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).
  • Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
  • Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.
  • Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.
  • Recurrent: The disease returns after treatment.

In addition to these stage numbers, the stage may be described as A or B:
  • A: You have not had weight loss, drenching night sweats, or fevers.
  • B: You have had weight loss, drenching night sweats, or fevers.