Diagnosis & staging
This is information about Non-Hodgkin Lymphoma. For information about Hodgkin Lymphoma, see Hodgkin Lymphoma.
For information about Skin Lymphomas, including Mycosis fungoides, cutaneous T-cell lymphoma, and Sézary syndrome, see Skin Lymphoma.
The lymphoid system includes:
-
Lymph nodes.
- Lymphatic vessels.
- Lymph fluid.
- Lymph tissue in organs such as the spleen, thymus, and bone marrow.
The lymph nodes are small organs in many places in your body. They are mostly in your chest, neck, armpit, groin and near the blood vessels of your intestines. Lymphatic vessels carry lymph fluid between your lymph nodes and throughout your body.
This cancer may also be called NHL, malignant lymphoma, or lymphoid cancer. Dr. Thomas Hodgkin first described lymphoma in the 1830s.
Most symptoms of Non-Hodgkin lymphoma are also common in other, less serious illnesses. It is always important to have symptoms checked by a health care provider.
Non-Hodgkin lymphoma symptoms can include:
- Painless, enlarged lymph nodes in your neck, groin or armpit.
- Fatigue (extreme tiredness).
- Shortness of breath.
- Itchiness on the trunk (chest and stomach area) of your body.
- Unusual back or abdominal pain.
- Abdominal swelling.
The following are known as "B" symptoms. These symptoms will affect the staging of your disease and what treatment you have:
- A fever that will not go away and has an unknown cause.
- Unexplained night sweats. These can be so severe that you need to change your bed sheets.
- Unexplained weight loss of more than 10% of your body weight in the last 6 months.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose Non-Hodgkin lymphoma include:
-
Physical exam: close attention to lymph nodes, spleen, liver and pain in bones.
-
Blood and urine (pee) tests
-
Chest X-ray
-
CT (computed tomography) scan: scans of your chest, abdomen and/or pelvis to look for signs of cancer in those organs and nearby lymph nodes.
-
Biopsy: a surgeon will remove the lymph node(s) or tissue with cancer. A specialist doctor (pathologist) will look at the cells under a microscope.
-
Other scans of bones or organs, such as the liver and spleen.
-
Endoscopy: a doctor uses an endoscope (a thin tube with a light and camera) to look at your stomach and intestines.
-
Spinal tab (lumbar puncture): a doctor takes a sample of your cerebrospinal fluid.
Non-Hodgkin lymphoma does not always spread in a regular pattern, like Hodgkin lymphoma.
For more information on tests used to diagnose cancer:
BC Cancer Library screening and diagnosis pathfinder.
There are many types of lymphoma with different names. Waldenstrom's Macroglobulinemia, lymphomatoid granulomatosis, lymphomatoid papulosis, and MALT are all types of lymphoma. Most other types have "lymphoma" in the name.
Lymphomas are called B-cell or T-cell lymphoma, depending on the type of lymphocyte that has the cancer.
- B-cell lymphocytes come from the bone marrow. 90% (90 out of 100) of lymphomas are B-cell.
- T-cell lymphocytes come from the thymus, a gland in the central part of the chest. T-cell lymphomas are less common and have a greater chance of recurring (coming back).
Abnormal or cancerous lymphocytes (T-cell or B-cell) may:
- Stay in the lymph nodes.
- Form solid tumours.
- Rarely, like leukemia, circulate in the blood.
Non-Hodgkin lymphomas can show up almost anywhere in the body.
Non-Hodgkin lymphomas are B-cell or T-cell. Each type has a subtype depending on certain features of the cells:
- If the pattern is
follicular (cells clumped in the lymph node) or
diffuse (cells are spread out in the lymph node).
- If the size or types of cells with cancer are large, small or a mix of both.
- How well-differentiated (mature) the cells are.
Non-Hodgkin lymphomas can be:
- Low grade, indolent (slow growing).
- Higher grade, aggressive (fast growing).
- Special.
There are many types of non-Hodgkin lymphoma. The most common are listed below.
- Most common type of non-Hodgkin lymphoma.
- Aggressive.
- Usually diagnosed in people in their mid-60s.
- Second most common type of non-Hodgkin lymphoma.
- B-cell lymphoma.
- Usually diagnosed in people 50 years of age or older.
- B-cell lymphoma.
- Also called extranodal marginal zone B-cell lymphoma.
- Usually diagnosed in people in their 60s.
- Usually slow growing but can be aggressive.
- B-cell lymphoma.
- Usually diagnosed in people in their 60s.
- Has often spread at the time of diagnosis.
- May be slow growing or aggressive.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
-
Stage 1: Cancer is only in one lymph node area.
-
Stage 2: Cancer is in two or more lymph node areas on the same side (above or below) of your diaphragm. The diaphragm is a thin muscle below your lungs and separates your chest from your abdomen.
-
Stage 3: Cancer is in lymph node areas on both sides of your diaphragm.
-
Stage 4: Cancer has spread outside of the lymph system, into other organs or tissues.
-
A: you have no symptoms from the "B" list [see signs and symptoms above].
-
B: you have symptoms from the "B" list.
-
E: Lymphoma is in nearby tissue outside of the lymph nodes (extranodal site).
-
S: Lymphoma has spread to your spleen.
-
X: There are large areas of lymphoma (bulky disease).
For more information about staging, see About Cancer.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Non-Hodgkin lymphoma is either low grade (indolent) or high grade (aggressive).
Low grade (indolent): cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread. However, some low grade types of non-Hodgkin lymphomas can change into high grade types.
High grade (aggressive): cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
