Lymphoma – How is it diagnosed?
Lymphoma is a blood cancer involving mature lymphocytes located at haematolymphoid or lymphatic tissue, such as lymph nodes, bone marrow, tonsils, adenoids, spleen, liver, digestive tract, and thymus.
There are two broad categories of lymphoma: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and within the category of NHL, is further subdivided into B- and T-cell lymphomas, and clinically categorised into aggressive or indolent lymphomas.
Symptoms
The clinical phenotype is variable depending on the aggressiveness of the malignancy and body site involved. The clinical manifestations may include drenching night sweats and fever, unexplained weight loss, enlarged lymph nodes, and liver and/or splenic enlargement, bleeding, and symptoms of anaemia. More sinister presentations include obstructive symptoms of the airway or digestive tract, and tumour lysis syndrome characterised by kidney failure.
Prior to investigations the initial clinician will conduct a detailed medical history and clinical examination to stage the patient and investigate appropriately.
Masses
A histological analysis is indicated through an excisional biopsy or tru-cut biopsy of the lymph node or lymphatic tissue involved. Referral to a general surgeon may be indicated to perform this procedure, under general anaesthesia.
An anatomical pathologist in the laboratory will analyse the histological sections and confirm the diagnosis of a lymphoma including the subtyping and classification.
In addition, it’s recommended to have a CT scan or PET-CT scan for staging and a BMAT facilitated by a clinical haematologist.
Lymphoma may also infiltrate the central nervous system and therefore investigations to exclude this is recommended through a spinal tap (lumbar puncture) to assess the cerebrospinal fluid. A small amount of cerebrospinal fluid is extracted from the spinal canal using a special needle. Moderate sedation may be used. However, some patients may require general anaesthesia.
Additional fluid from pleural or peritoneal fluid may be sampled for immunophenotypic analysis.
An FBC with a differential count and PBS is required.
Further molecular tests are recommended for prognostication and diagnosis. For example: conventional cytogenetics, FISH and PCR. A BMAT is done to aid in staging the patient’s disease.
Dr Jasmine Ramiah is a haematopathologist now pursuing super specialisation in clinical haematology at the Inkosi Albert Luthuli Hospital. She has a passion for transplant medicine, and management of haematolymphoid neoplasms.
Header image by Freepik
Check out more Big C Survivor’s Guides
