Lymphoma Diagnosis and Staging

July 13, 2024

This page was reviewed under our medical and editorial policy by Alex Herrera, M.D., professor, division of lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope^® Cancer Center Duarte

Lymphoma is diagnosed using a variety of medical tests. If a cancer diagnosis is made, details about its stage will be shared with the patient. Staging helps doctors know where the lymphoma is found in the body and if it has spread to other areas.

This guide is designed to help patients learn more about lymphoma diagnosis and staging.

How Is Lymphoma Diagnosed?

Several tests may be used during the diagnostic process. While each test plays an important role in the diagnosis and staging of lymphoma, it is important to note that a biopsy is the only way to definitively diagnose this type of cancer.

The tools listed below help to diagnose lymphoma.

Physical exam: This may include a comprehensive review of a patient’s medical history and a physical examination to look for symptoms, such as enlarged lymph nodes.

Biopsy: In this procedure, a tissue sample from a lymph node will be removed and then examined under a microscope to look for the presence of lymphoma cancer cells. An excisional biopsy, in which the entire lymph node close to the skin is surgically removed, is most often used to diagnose lymphoma. Sometimes, only part of the lymph node is removed (incisional biopsy). After diagnosis, other types of biopsies may be done on the bone marrow or other fluids to check for the presence of lymphoma cells. Laboratory tests will be performed on the samples to help classify the disease further.

The following tools help to further classify and stage lymphoma:

Blood tests are a method of measuring blood counts and organ function. This type of test is used as a staging tool.

Imaging tests, including magnetic resonance imaging (MRI) as well as computed tomography (CT) scans and positron emission tomography (PET) scans, are also used to determine if the cancer has spread and to check how it is responding to treatment.

Lymphoma Screening

There is no national screening program for lymphoma. However, if a patient has a family history of lymphoma, this is considered a risk factor for developing the disease. Patients with an increased lifetime risk of developing lymphoma may be more closely monitored. Anyone who has symptoms of lymphoma, including a painless, enlarged lymph node that does not go away, should let his or her medical team know.

Lymphoma Stages

Lymphoma staging determines if and where the cancer has spread. Staging helps doctors customize treatment plans for each patient, and it may help predict their prognosis.

Because there are several types of lymphoma, the staging system used may vary depending on the cancer type. However, the most common system assigns a stage to the cancer from Stage 1 to 4. Stages 1 and 2 are considered early stages, and Stages 3 and 4 are considered advanced. Lymphoma usually starts in the lymph nodes, so lymphoma staging is based on this.

Stage 1: The cancer is present in only one area of lymph nodes within the body.

Stage 2: The cancer is present in at least two lymph node areas, both on the same side of the diaphragm, a muscle under the lungs. A Stage 2 diagnosis may also mean the cancer has spread from one lymph node area into one nearby organ.

Stage 3: The cancer is present in multiple lymph node areas, both above and below the diaphragm.

Stage 4: The cancer has spread outside of the lymph nodes to at least one other organ, most often the lungs, liver or bone marrow.

Additional classifications may be added to each stage, depending on whether or not the patient has certain symptoms and if their cancer is recurrent, meaning it has come back after remission.

Read more to learn about lymphoma diagnosis and stages by type:

• Hodgkin lymphoma diagnosis and staging
• Non-Hodgkin lymphoma diagnosis and staging
• Cutaneous (skin) lymphoma diagnosis and staging
• Childhood lymphoma and leukemia diagnosis and staging