Stephen Forman, M.D., Chair, Hematology & Hematopoietic Cell Transplantation, Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation
Lymphoma is a large group of cancers with overlapping features – and since every patient’s disease looks different, getting an accurate diagnosis can be the most challenging part of treatment. The differences between lymphoma tumors is subtle and, since lymphoma involves immune system cells, it may be difficult to distinguish it from a normal infection.
For these reasons treatment at City of Hope begins with leading-edge diagnostics, performed by world-renowned hematopathologists who are well versed about the entire spectrum of this disease. This powerful combination of experience, next generation technology and talent is why City of Hope is known for transforming lymphoma patients with advanced or misdiagnosed disease – and dire diagnoses – into survivors.
How lymphoma is diagnosed
Lymphoma is diagnosed using biopsy, which involves removing a small sliver of tissue or an entire lymph node, and examining it under a microscope. A biopsy may be performed using a needle, or with surgery, and the tissue is tested to determine:
- The type of abnormal cell involved in the lymphoma
- The size of the cell involved (small or large cell)
- The type of cell affected (B or T cell)
- Whether it is fast- or slow-growing
- Abnormalities inside the cell driving the lymphoma
- What markers are on the lymphoma cell surface
We perform several tests on the tissue to arrive at the most accurate diagnosis. Once a diagnosis is determined, other tests may be performed to figure out where lymphoma is in the body and the stage of disease.
If cancer is suspected, we may perform other tests to better visualize the cancer and determine if it has spread, including:
- Imaging tests: CT, PET and MRI scanning
- Bone marrow aspiration: taking a small sample of marrow cells from inside the bone
- Bone marrow biopsy: removing a small sample of bone along with the marrow
These tests also serve as a baseline used later to assess your response to treatment.
What are the stages of Lymphoma?
When lymphoma is found early, it tends to be confined to one or more lymph nodes. More advanced disease occurs when cancer cells have spread beyond the lymph system into organs like the liver, skin, brain, bone or other tissues. Lymphoma stages include:
- Stage 1, when one lymph node area (for example, the side of neck or under arm) is involved
- Stage 2, when two or more lymph node areas are involved but on same side of the diaphragm – either all below or above
- Stage 3, when more than one lymph node area on both sides of the diaphragm is involved
- Stage 4, widespread disease that has gone beyond the lymphatic system, most commonly to the bone marrow or liver, but also the skin, brain, bone and other tissues
Within each stage, the disease is categorized as either symptomatic or asymptomatic – either causing symptoms or not.