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Lymphoma is a type of blood cancer where lymphocytes (a type of white blood cells) develop abnormally and grow uncontrollably, outnumbering healthy cells. There are two main types of lymphoma: Hodgkin lymphoma (HL, also called Hodgkin disease) and non-Hodgkin lymphoma (NHL, also called non-Hodgkin’s lymphoma).
Hodgkin and non-Hodgkin lymphoma are cancers that start in the lymphatic system, which includes the bone marrow, lymph nodes, spleen, thymus, and a network of vessels that circulate fluids and help fight infection. Lymphoma is related to other blood cancers, including leukemia, myeloma, and myeloproliferative neoplasms (MPNs).
Read on to learn more about how lymphoma is diagnosed, including common early symptoms that may lead to diagnosis and how to get tested for lymphoma.
A person might begin the process of lymphoma diagnosis because they experience symptoms that match symptoms of Hodgkin or non-Hodgkin lymphoma. These symptoms include:
Fever, night sweats, and unexplained weight loss are considered “B symptoms.” The presence of B symptoms can indicate the presence of lymphoma, guiding doctors to determine the stage of the disease and assess the prognosis.
Sometimes people don’t show any obvious symptoms of lymphoma. The cancer might only be discovered when routine blood work or other tests show abnormal results.
Most cases of NHL happen in people in their 60s or older. Hodgkin lymphoma is more common in young adults but can also occur in older adults. Overall, both HL and NHL are more common in men than in women. Both NHL and HL are also more common among non-Hispanic white people.
Learn more about causes and risk factors for lymphoma.
Many of the tests for HL and NHL are the same. Some tests are used to confirm a diagnosis, while others help identify the lymphoma type and stage. The time to diagnose depends on the number and types of tests needed.
There are two main types of HL and many types of NHL. The subtypes of NHL are divided into two categories based on the type of lymphocyte — white blood cell — that has become cancerous. The two main types of lymphocytes are B cells (also called B lymphocytes) and T cells (also called T lymphocytes). Most cases of NHL are B-cell lymphomas, but there are also T-cell lymphomas.
Detecting lymphoma usually starts with a physical exam to check for swollen lymph nodes. If the lymph nodes are swollen, your doctor will probably ask you more questions and do more tests to see if lymphoma is the underlying cause.
One MyLymphomaTeam member shared that they were on the “wait and see program” with a history of swollen lymph nodes: “I have had swollen lymph nodes in my groin for about 15 months, my right armpit for about four months, and in my neck, which the hematologist-oncologist discovered almost six weeks ago.”
If your symptoms suggest lymphoma, your doctor will likely take a detailed medical history and ask about your lymphoma symptoms and any disease risk factors you may have. They may also do a physical exam to check the lymph nodes in your neck, armpits, and groin. Swollen lymph nodes are a common symptom of both HL and NHL. Your doctor may also do tests to check for enlargement of your spleen and liver.
If your health care provider finds swollen lymph nodes during a physical exam, they may order a lymph node biopsy. This procedure involves removing part or all of an enlarged lymph node. Depending on where the lymph node is located, you may receive a local anesthetic (medication to numb the area) or general anesthesia (medication to put you in a sleep-like state). A lymph node biopsy can help identify the type and subtype of lymphoma you have, which helps your care team create a treatment plan.
In HL, the biopsy may show Reed-Sternberg (RS) cells and Hodgkin cells. Reed-Sternberg cells are large, abnormal B cells with a double nucleus (the part of the cell that contains genetic material). Hodgkin cells are smaller than RS cells but larger than normal lymphocytes.
In NHL, the biopsy sample will help determine whether B cells or T cells have become cancerous, which is important for diagnosing B-cell or T-cell lymphoma.
There are three main types of lymph node biopsies used to diagnose HL and NHL.
In an excisional biopsy, a surgeon removes the entire lymph node.
In an incisional biopsy, a surgeon removes a large part of a lymph node. A larger tissue sample provides a more accurate diagnosis. Local anesthetic is used for biopsies of lymph nodes near the surface of the skin. General anesthesia is used for biopsies of lymph nodes deeper in the chest or stomach.
A core needle biopsy uses a needle to remove a small sample of tissue from a lymph node. This method is usually used for lymph nodes in areas that are difficult to reach using excisional or incisional biopsy. However, the tissue sample may be too small for a full diagnosis.
A fine needle aspiration (FNA) biopsy uses a very small needle to collect cells from a lymph node. While the sample of cells is too small to confirm an HL or NHL diagnosis, FNA biopsy is often used to test for cancer relapse.
Immunophenotyping looks for certain cell markers in blood and lymph node samples. The presence of certain cell markers or proteins can help diagnose the subtype of NHL. This technique can help doctors determine whether the cancer cells are B cells or T cells and can also reveal other important features of the cancer.
Chromosome tests are used to check the DNA (genetic material) of cancer cells for specific genetic mutations. This helps doctors identify the subtype of lymphoma. These additional tests are often not needed for HL.
Immunophenotyping and chromosome tests can be very important for evaluating prognosis and choosing the best treatment options for certain types of non-Hodgkin lymphoma.
A lumbar puncture, also called a spinal tap, is a test that can be used in cases of NHL to check if cancer cells have spread to the cerebrospinal fluid (CSF). This test is usually only done if symptoms suggest that lymphoma may have spread to the brain.
Recent advances in molecular techniques, such as next-generation sequencing (NGS), have improved the process of diagnosing lymphomas. NGS provides more information that doctors can use to diagnose lymphomas, determine the prognosis, and choose the best course for treatment.
For example, NGS has detected genetic mutations in lymphomas that can be targeted with specific treatments. Using NGS on liquid biopsies (blood samples) is also a minimally invasive way to diagnose lymphomas and monitor how well treatment is working.
After receiving a diagnosis of HL or NHL, you may undergo additional tests to confirm the subtype or stage of your lymphoma. HL and NHL can each be classified into four stages (stage 1 through stage 4). In both illnesses, stage 1 is the most localized, meaning the cancer is only in one area of the body, and stage 4 is the most advanced, where the cancer has spread to many parts of the body.
Lymphoma can start almost anywhere there are lymphocytes, including the lymph nodes, bone marrow, spleen, and other organs. One MyLymphomaTeam member shared, “Two years ago, I was diagnosed with marginal zone lymphoma. I was told that I have cancer in my bone marrow … My oncologist put me on ‘watch and wait,’ as I have no symptoms.”
After being diagnosed with HL or NHL, you may need a bone marrow aspiration and bone marrow biopsy to see if lymphoma cells have spread to the bone marrow. These two tests are often done together. Bone marrow aspiration uses a smaller needle and removes liquid bone marrow, while a bone marrow biopsy uses a larger needle to remove a piece of solid bone marrow.
Bone marrow samples are usually taken from the hip bone. You will receive a local anesthetic to numb the area. Your doctor may offer a mild sedative to help you relax. You may experience some pain at the site of the biopsy for a few days after the procedure.
Imaging tests can be used to stage HL or NHL. They can also be used to identify the cause of certain symptoms, check how well the treatment is working, or see if the cancer has returned. One MyLymphomaTeam member with stage 3 lymphoma shared that they get “labs every six months and scans once a year,” and that all their “labs are normal.”
A chest X-ray can help identify swollen lymph nodes in the chest for both HL and NHL.
A computed tomography (CT) scan can help identify cancer in the stomach, chest, head, or pelvis. CT scans are useful for lymphoma diagnosis, as they can show swollen lymph nodes or enlarged organs. CT scans can also guide biopsies to make sure the right tissue is sampled.
A positron emission tomography (PET) scan may be used to determine if a swollen lymph node may be affected by lymphoma or to check for small areas of cancer. PET scans are also used to see how well chemotherapy is working or monitor lymph nodes after treatment.
Lymphoma can show up in blood work. Blood tests are often used to check how advanced the lymphoma is. They can also help doctors in diagnosing both types of lymphoma.
A complete blood count (CBC) test measures the number of red blood cells, white blood cells, and platelets in a blood sample. Low blood cell counts could be a sign that lymphoma has spread to the bone marrow. This could suggest a more advanced stage of lymphoma. CBC tests are used for both HL and NHL.
An ESR test measures how quickly red blood cells settle in a test tube. If the red blood cells settle faster than normal, it may mean there’s inflammation in the body. This test is usually used for diagnosing HL.
If you have HL or NHL, you may need additional blood tests to check how well your liver and kidneys are working. Blood tests may also be used to check for conditions like HIV or hepatitis B or C. These viruses may affect your lymphoma treatment plan.
MyLymphomaTeam is the social network for people with lymphoma and their loved ones. On MyLymphomaTeam, more than 20,000 members come together to ask questions, give advice, and share their stories with others who understand life with lymphoma.
Have you recently been diagnosed with Hodgkin lymphoma or non-Hodgkin lymphoma? What tests have been most helpful in your diagnosis and treatment journey? Share your experiences in the comments below, or start a conversation by posting on your Activities page.
Leonora Valdez Rojas, M.D.
received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute.
Learn more about her here.
Alison Channon
has nearly a decade of experience writing about chronic health conditions, mental health, and women's health.
Learn more about her here.
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A smile for today, I got a cosmetic Lumpectomy for a lump under my armpit. It turned out to be Hodgkin's. It had manifested as Night Sweats, skin rash, fever, chronic cough, and fatigue. Hey I got… read more
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