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Lymphoma

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Testing

The goals with testing are to diagnose and stage lymphoma, to distinguish it from other conditions, and to identify and monitor any associated complications. There are few blood tests that clearly indicate lymphoma.

Laboratory tests

The gold standard diagnostic test for both Hodgkin lymphoma and non-Hodgkin lymphoma is the examination of involved lymph nodes or lymphoid tissue by a pathologist. The sample is usually collected from an affected lymph node or tissue using a biopsy or fine needle aspiration procedure and is examined under the microscope. (To learn more about biopsies for non-Hodgkin lymphoma, visit the College of American Pathologist web site, mybiopsy.org, Lymph Node: Non-Hodgkin Lymphoma.)

Other laboratory tests that may be useful include:

  • Complete Blood Count (CBC) – may be ordered to rule out non-lymphoma conditions (such as leukemia) and/or to see if anemia is present. A CBC can determine if the platelet count and/or white blood cell count are low, which may indicate that lymphoma is present in the bone marrow.
  • Bone marrow biopsy and examination – used to evaluate the cells present in the bone marrow. The presence of abnormal lymphoid cells and/or lymphoid aggregates may be seen with lymphoma.
  • Blood smear – used to evaluate the quality of red and white blood cells and platelets as well as abnormal cells (lymphocytes), if present. 
  • Immunophenotyping can identify the cells involved by testing for the presence or absence of certain markers on the membrane of the cells or inside the cells. These commonly used markers are called clusters of differentiation (CD) and are listed numerically. By developing a list of the CDs present on the cells, it is possible to classify the cells. This test can be done by several different methods, including flow cytometry and immunohistochemistry.
  • Cytogenetics – an evaluation of the chromosomes in the nucleus of cancer cells to determine if pieces of the chromosomes have moved (translocation). This is rarely used for lymphomas. 
  • Molecular genetic analysis – evaluating the cancer cell's DNA for genetic changes, particularly to determine whether all of the cells belong to a single clone. (See B-cell Immunoglobulin Gene Rearrangement and T-cell Receptor Gene Rearrangement.)
  • If it is thought that lymphoma has spread (metastasized) to other areas of the body, analysis of cerebrospinal fluid or other body fluids may be performed. 
  • Beta-2 microglobulin – this test may be used to help predict the prognosis.

Non-laboratory tests
Primarily used to help stage and monitor lymphoma. They include:

  • Physical examination
  • Computed tomography (CT) scans
  • Positron emission tomography (PET) scan
  • Chest X-ray
  • Exploratory surgery (occasionally necessary)
  • Magnetic Resonance Imaging (MRI)

For more on these imaging studies, visit RadiologyInfo.org.

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