Non-Hodgkin Lymphoma is sometimes difficult to detect because the standard symptoms may seem "normal." Because it is often common to have swollen lymph nodes, the doctor will look for infection first. If the doctor thinks that Non-Hodgkin Lymphoma might be causing the symptoms, a biopsy or other tests may be recommended.

Biopsy - The doctor will remove a piece (sample) of the lymph node and examine it under a microscope. This is the only way to know for sure if the swelling is caused by cancer.

Different types of biopsies and surgeries:

Excisional or Incisional Biopsy
- This is the most common type of biopsy for a swollen lymph node. In an excisional biopsy, the skin is cut through and an entire lymph node is removed. If only a small section of a large tumor or node is removed, it is called an incisional biopsy.

If the node is near the skin surface, this is a fairly simple operation that can sometimes be done with local anesthesia. But if the node is inside the chest or abdomen, the patient is then given general anesthesia.

Fine Needle Aspiration Biopsy (FSA) - A very thin needle is used to remove a small amount of fluid and tiny bits of tissue from the tumor.

Core Needle Biopsy - A larger needle is used to remove a slightly larger piece of tissue.

In many cases a needle biopsy cannot get enough of a sample to make a definite diagnosis. Most doctors will use needle biopsies in patients already known to have Non-Hodgkin to see if a swollen lymph node or organ in a different place also contains lymphoma.

Bone Marrow Aspiration and Biopsy - Although, these tests are not used to diagnose Non-Hodgkin Disease, they are used after a diagnosis to determine if the disease is in the bone marrow. A long thin needle is used to remove small bits of bone marrow. A piece of bone might also be removed with a thicker needle. The area is numbed first. But even with the numbing, many people feel some pain. The whole process takes only a few minutes.

Lumbar Puncture (Spinal Tap) - This test looks for lymphoma cells in the cerebrospinal fluid (CSF), which is the liquid that bathes the brain and spinal cord. An area in the lower part of the back over the spine is numbed and a small, hollow needle is then placed between the bones of the spine to withdraw some of the fluid. (Note: Most patients will not need this test but a doctor may order it for certain types of lymphoma or if a person has symptoms that suggest the lymphoma may have reached the brain.)

Pleural or Peritoneal Fluid Sampling - A spread of lymphoma to the chest or abdomen can cause fluid to build up. Pleural fluid (inside the chest) or peritoneal fluid (inside the abdomen) can be removed by placing a hollow needle through the skin into the chest or abdomen. The doctor uses a local anesthetic to numb the skin before inserting the needle. The fluid is then withdrawn and looked at under the microscope to check for lymphoma cells.

Scans and X-Rays:

Bone Scan - A radioactive substance is also used for bone scans. After it is injected, it travels to damaged areas of the bone. Then, a camera locates the areas. Hodgkin can sometimes causes bone damage, which may be picked up on a bone scan. (Note: This test is not often done unless a person is having bone pain or has lab test results that suggest the Hodgkin disease may have reached the bones.)

Chest X-Ray - Swelling of lymph nodes in the chest which can often be seen on a plain chest x-ray.

Computed Tomography (CT) Scan - A CT scanner rotates around the patient while taking multiple images. Then, a computer combines these pictures into an accurate rendering of a "slice" of the body.

Gallium Scan - A small dose of radioactive gallium is injected into a vein, which travels to the lymph tissue in the body. After a few days, a special camera is used to locate the gallium which may indicate Hodgkin.

Magnetic Resonance Imaging (MRI) - Although this test is only rarely used in Hodgkin disease, if a concern exists about the spread of the disease to the spinal cord or brain, then a MRI is very useful. MRI scans use radio waves and strong magnets instead of x-rays to take pictures.

Positron Emission Tomography (PET) - During a PET scan, a patient will have a form of sugar that contains a small amount of radioactivity injected into the blood, which will then collect in the cancer cells. A special camera can then pick up the radioactivity and show the areas of cancer in the body.

Ultrasound - A small, microphone-like instrument called a transducer is placed on the skin (which is first lubricated with a gel) which emits sound waves and picks up the echoes as they bounce off the organs. The echoes are converted by a computer into a black and white image that is displayed on a computer screen. Ultrasound can be used to look at lymph nodes near the surface of the body or to look inside the abdomen for enlarged lymph nodes. It can also detect kidneys that have become swollen because the outflow of urine has been blocked by enlarged lymph nodes.

Once the results from the test or procedure are returned you will be able to make thoughtful decisions. Please see Newly Diagnosed for information on being patient active, treatment decisions, partnering with your healthcare team and finding support.

Receiving a cancer diagnosis is difficult. Please see Caregivers and/or Online Community for more information on how the Cancer Support Community can offer support.

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