What Happens Before The Test
In most cases there is nothing to be done to prepare for a blood test. For some blood tests fasting may be required prior to the test. Some medications may need to stop or some foods should be avoided. If you need to do anything prior to the test this will be explained to you by your doctor or nurse. If you are unsure about any requirements it is important you check with your medical team.
Bone Marrow Aspiration And Biopsy
Our doctors may use bone marrow aspiration and biopsy to determine if non-Hodgkin lymphoma has spread to the bone marrow, the soft spongy tissue that makes blood cells and is found in the center of bones throughout the body. Cancerous lymphocytes from the lymph nodes may travel to the bone marrow, which is also part of the lymphatic system. Cancer in the bone marrow is a sign the disease has advanced.
During a bone marrow aspiration, your doctor uses a needle to withdraw liquid and tissue from bone marrow in the back of the pelvis. During a bone marrow biopsy, your doctor removes a piece of bone and marrow from this same area. Tissue samples are then evaluated under a microscope for signs of non-Hodgkin lymphoma. Both of these procedures require a local anesthetic and may be conducted either in the doctors office or in the hospital. People can go home the same day as the biopsy.
Other Types Of Blood Tests
Choose from the menu or scroll down to read about different blood tests:
Cytogenetic Analysis
Chromosomes are long strands of DNA, the genetic material of a cell. Healthy human cells have 23 pairs of chromosomes. Some lymphomas and other types of cancer have too few or too many chromosomes, or have abnormal chromosome structures. In cytogenetic analysis, chromosomes from a patients lymphoma cells are examined under a microscope to check for changes in their number or the presence of other abnormalities.
Immunophenotyping
Immunophenotyping is a process used during evaluation of biopsy material to distinguish between different types of cells , by detecting specific molecules found on the cell surface. These cell markers are detected using special antibodies grown and chemically modified in the laboratory so that they will change color when they stick to their corresponding markers.
This color change is studied under a microscope using immunohistochemistry analysis or sorted and counted using a process called flow cytometry. Sometimes, both IHC and flow cytometry are necessary for accurate immunophenotyping.
- Immunohistochemistry : In this test, thin slices of the biopsy sample are placed on slides and treated with sets of antibodies that recognize different markers found in different types of lymphoma cells and normal lymphocytes.
Biomarker and Genetic Testing
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Stages Of Hodgkin Lymphoma
When testing is complete, it should be possible to determine the stage of your lymphoma. “Staging” means scoring the cancer by how far it’s spread.
The main stages of Hodgkin lymphoma are:
- stage 1 the cancer is limited to 1 group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm
- stage 2 2 or more lymph node groups are affected, either above or below the diaphragm
- stage 3 the cancer has spread to lymph node groups above and below the diaphragm
- stage 4 the cancer has spread through the lymphatic system and is now present in organs or bone marrow
Health professionals also add the letters “A” or “B” to your stage, to indicate whether or not you have certain symptoms.
“A” is put after your stage if you have no additional symptoms other than swollen lymph nodes. “B” is put after your stage if you have additional symptoms of weight loss, fever or night sweats.
Page last reviewed: 22 November 2021 Next review due: 22 November 2024
Results And Leukemia Diagnosis
After youve undergone blood tests and/or a bone marrow biopsy to determine whether you have leukemia, your doctor may follow up with you once the results are returned from the laboratory.
Your doctor may explain the findings, including the levels of different kinds of blood cells found in your blood sample, and whether those levels are consistent with leukemia. If a bone marrow biopsy was performed, the doctor may explain whether this sample contained leukemia cells.
If diagnostic tests reveal that you have leukemia, your doctor may also tell you what type of leukemia you have. Leukemias may be acute or chronic. Chronic leukemias tend to progress slowly, while acute leukemias grow quickly. The cancer cells may look and act differently depending on the type of leukemia. These differences are important in determining an informed treatment plan, which is the next step after your leukemia is diagnosed and the type of leukemia is determined. If the preliminary tests werent detailed enough to determine the type of leukemia, you may need to repeat these tests or undergo additional testing.
Your care team may provide information and support, and discuss treatment options with you at each step of the way.
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How Do You Test For Lymphoma
Tests and procedures used to diagnose lymphoma include:
Is white blood cell count elevated with lymphoma?
People with HL can sometimes have abnormal blood counts. For example, if the lymphoma invades the bone marrow a person might have anemia . A high white blood cell count is another possible sign of HL, although it can also be caused by infection.
Low White Blood Cell Count
An overall low white blood cell count, also called leukopenia, may mean a bodys ability to fight infection is impaired. If there are fewer neutrophils in white blood cell counts, this is called neutropenia. When neutrophils are low, normal symptoms of infection may not show up, since those symptoms are specifically caused by the reaction of neutrophils fighting infection. This can lead to infections lasting longer and being harder to treat.
Low levels of lymphocytes mean the body cannot detect or fight viral infection as easily as usual, as lymphocytes are the cells that react first to viruses. If a test has shown you have low white blood cell counts and you develop a fever, you should seek immediate medical attention, as this may be the first sign of a serious problem.
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How Do Doctors Determine The Stage Of A Lymphoma
After a diagnostic test confirms you have lymphoma, your doctor will explain the extent of your cancer, which is called staging.
Currently, the staging system for the two main types of lymphoma, non-Hodgkin lymphoma and Hodgkin lymphoma, is called the Lugano classification. Stages are given Roman numerals .
Heres what the staging system looks like:
- Stage I: The cancer is only present in one lymph node area or lymphoid organ.
- Stage II: The lymphoma is found in two or more lymph node areas on the same side of the diaphragm .
- Stage III: The cancer is in lymph node areas on both sides of the diaphragm, or its in the lymph nodes above the diaphragm and in the spleen.
- Stage IV: The lymphoma has spread to at least one organ outside the lymph system, such as the liver, bone marrow, bones, or lungs.
Some types of lymphoma, such as small lymphocytic lymphoma , may be staged differently. Talk to your doctor if you have this type of cancer.
Stage I or II lymphomas that affect an organ outside the lymph system have an E added to them. If the lymphoma is considered bulky , its labeled with an X.
You may also be given an additional letter A or B to describe your lymphoma. If your cancer is assigned a B classification, it means you have B symptoms, which include:
- Unexplained fever
What Happens During The Test
If you are not in hospital your doctor or nurse will tell you where you need to go to have your blood test. This may be at your local hospital, a pathology department, a community nurse or your GP. The blood sample will be taken using a small needle. This is inserted into a vein most often in your arm. It takes only a few seconds to obtain the sample, then the small needle is withdrawn. If you have a central venous access device the nurses may be able to use this to obtain the blood sample.
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What Do The Findings Imply
Your health care team must carefully review the findings of CBC tests. Bear in mind that a variety of causes, including noncancerous diseases, might result in abnormal findings. Consult your physician for assistance in deciphering the significance of your test findings.
- Deficiency of white blood cells Certain cancer therapies, most notably chemotherapy, may cause a decrease in your bodys white blood cell count. Cancers of the blood and bone marrow can also cause a decrease in the count. Leukemia, lymphoma, and multiple myeloma are examples of these malignancies.
- Amounts of several types of white blood cells Increased lymphocytes or monocytes can suggest the presence of some kinds of cancer.
Some malignancies and their therapies may cause neutropenia. Neutropenia is a condition in which a persons neutrophil count is abnormally low. This significantly raises the risk of contracting a bacterial illness. Occasionally, your doctor will reduce your chemotherapy dose to reduce your risk of developing neutropenia. Additionally, your doctor may prescribe medicine, such as white blood cell growth factors to boost your bodys neutrophil production, particularly if you have a fever.
If you are receiving cancer treatment for leukemia and lymphoma, your doctor will likely watch your blood cell counts often using a CBC.
What Happens After The Test
If you are an outpatient, you can usually go straight home after the test unless you need to stay at the hospital for an appointment or treatment. Some blood tests results are available within minutes and some take a couple of weeks to come back. Check with your doctors about how you will get the results and how long it will take. Waiting for results can be difficult, speak with your team if you feel anxious about your test results.
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Tumor Marker Blood Tests
Some subtypes of non-Hodgkin lymphoma cause abnormalities in the levels of certain substances in your bloodstream. These substances can be measured with tests like immunophenotyping, immunohistochemistry, and flow cytometry.
Some tumor markers are tied specifically to one type of cancer. Others may be linked to several types, and a few may be related to other conditions. Finding these can be useful for diagnosing both B-cell and T-cell lymphoma, monitoring the severity of NHL, or determining how well your lymphoma treatment is working.
Exams Conducted On Biopsy Samples
The tissue removed during a biopsy undergoes lab tests to help diagnosis and classify the type of lymphoma. Samples are analyzed by a pathologist who examines the cell size and shape and for immunohistochemistry, flow cytometry, cytogenetics, molecular genetic, fluorescent in situ hybridization , and polymerase chain reaction examinations.
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Tests Used To Diagnose Lymphoma
Your doctor might recommend a variety of exams to see if you have lymphoma and how far advanced the cancer is. When choosing a diagnostic test, your physician might consider the type of lymphoma thats suspected, your symptoms, your age, and your medical conditions.
Some common tests include:
- Physical exam: Your doctor will ask about your medical history and check for swollen or enlarged lymph nodes.
- Lymph node biopsy: With this procedure, part or all of a lymph node is removed and sent to the lab for examination.
- Blood tests: A simple blood test might help your physician determine if you have lymphoma.
- Bone marrow biopsy: During this procedure, a needle is inserted into your hip bone to remove a sample of bone marrow. The sample is then analyzed to see if it contains lymphoma cells.
- X-rays: X-rays are sometimes used to let doctors see the structures in your body.
- Imaging tests: Your physician might recommend computed tomography , magnetic resonance imaging , or positron emission tomography scans to look for lymphoma in your body.
- Spinal tap: This test is sometimes performed to look for lymphoma cells in the cerebrospinal fluid. You doctor will insert a small needle between the bones of your spine to withdraw some fluid.
- Ultrasound: An ultrasound test might be done to determine the size of your spleen. An enlarged spleen can be a sign of lymphoma. This test uses sound waves to create images on a computer monitor.
Does Diagnosis Differ By Type Of Lymphoma
The process of diagnosing lymphoma is typically different for each person. The tests youll need depend on the type of lymphoma the doctor is testing you for.
The main way to diagnose both non-Hodgkins and Hodgkins lymphoma involves a lymph node biopsy. This includes diffuse large B-cell lymphoma, the most common form of non-Hodgkins lymphoma.
Some subtypes of lymphoma require specialized tests:
- Central nervous system lymphoma. Diagnosis usually involves a lumbar puncture or spinal tap. This test checks for lymphoma calls in the cerebrospinal fluid.
- Primary gastric lymphoma . To diagnose PGL, an upper endoscopy is used to collect biopsy samples from your upper digestive tract. Its often combined with an endoscopic ultrasound, which takes pictures of organs and lymph nodes deep inside the body.
- Skin lymphoma. Also called cutaneous lymphoma, skin lymphoma diagnosis requires a skin biopsy.
- Bone marrow lymphoma. If lymphoma starts or spreads in the bone marrow, youll need a bone marrow biopsy.
You might also need additional tests to determine the stage of your lymphoma.
- your preferences
Options include:
The earlier you see a doctor about non-Hodgkins lymphoma diagnosis, the more effective treatment is likely to be.
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Treatment Of Early Favorable Classic Hodgkin Lymphoma
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of early favorable classic Hodgkin lymphoma in adults may include the following:
- A clinical trial of targeted therapy with a monoclonal antibody or immunotherapy with immune checkpoint inhibitortherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Further Tests For Lymphoma
Liver Function Test
Additionally, your doctor may want to evaluate the function of your liver and kidneys. A liver function test for albumin concentration may aid in the diagnosis of advanced lymphoma. Albumin levels, a protein generated by the liver, may drop as a result of the disease.
Lactic dehydrogenase
LDH, an enzyme typically found in most of your tissues, may be included in your blood panel. Certain types of lymphoma cause an increase in LDH production. However, because elevated levels might develop due to other illnesses, another testing will be required to diagnose.
C-reactive protein
The body produces C-reactive protein during the inflammatory reaction. Increased levels in the blood may indicate the presence of cancer, particularly lymphoma, but other sources of inflammation might also cause them.
Biopsy of lymph nodes
The gold standard for diagnosing lymphoma is a lymph node biopsy. Often, it is the only test capable of establishing an official diagnosis. A professional obtains a sample of a lymph node during the operation. A microscope is used to analyze the sample for indications of lymphoma.
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Can You Have Lymphoma For Years And Not Know
Low-Grade Lymphoma
These grow so slowly that patients can live for many years mostly without symptoms, although some may experience pain from an enlarged lymph gland. After five to 10 years, low-grade disorders begin to progress rapidly to become aggressive or high-grade and produce more severe symptoms.
Getting The Results Of Your Blood Tests
Most blood tests take only a short amount of time to perform. In some cases, you can even get your results within a few minutes. However, you should always discuss your blood tests with your doctor, who is trained to interpret your results in light of all the other medical information available and your medical history.
Its important that you dont jump to conclusions or make treatment changes based on a blood test without consulting your doctor first.
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When Should You Get Tested For Leukemia
If your first alert to leukemia comes from routine blood testing, youre not alone. This happens because early symptoms of leukemia can be vague and easy to miss. Its a good idea to speak with a doctor if you have unexplained:
hydrated and not hungry. Your doctor will let you know in advance if there are any special instructions.
Getting blood drawn for these tests is a simple, routine procedure. The medical professional drawing the blood will place a tight band around your arm and look for the best vein.
After cleaning the skin, theyll insert a small needle into your vein. Blood will flow into small vials, and they will remove the band. Then they will place a cotton ball or bandage on the injection site. It shouldnt take more than a few minutes.
If blood tests make you feel sick or you have a fear of needles, make sure to let the physician giving the test know. Theyll be able to help you stay calm. The blood samples will go to a lab, so it may take several days before you get the results.