Your child will have a number of tests to investigate their symptoms and confirm a diagnosis of non-Hodgkin lymphoma, including:
- medical history and physical examination
- blood tests
- medical imaging, which may include:
- chest X-ray
- computed tomography (CT) scan
- magnetic resonance imaging (MRI)
- positron emission tomography (PET) scan
- biopsy – where a small sample of a tumour or lymph node is removed to be examined under a microscope
- mediastinoscopy – where a thin tube is inserted through an incision (cut) in the chest to look for tumours in the space between the lungs (the mediastinum)
- lumbar puncture (spinal tap) – where a sample of cerebrospinal fluid is taken to be examined under a microscope
- paracentesis or thoracentesis – where a thin, hollow needle is used to collect fluid that has built up in the belly cavity (paracentesis) or chest cavity (thoracentesis) to be examined under a microscope
- bone marrow aspiration and biopsy – where a sample of bone marrow is taken with a small piece of bone to be examined under a microscope.
These tests are explained in more detail in How is cancer diagnosed?.
If your child is diagnosed with non-Hodgkin lymphoma, some of the diagnostic tests will also help to stage the tumour. Staging determines where the tumour is, how big it is, which nearby organs are involved and whether the cancer has spread to other parts of the body. This is important to determine the outlook (prognosis) for your child, and to decide on the best options for treatment.
There are different ways to assess the stage and extent of disease. One of the most common ways to describe stages for non-Hodgkin lymphoma is as follows:
- Stage I – the lymphoma is either a single tumour (not in the lymph nodes), or is in the lymph nodes in a single part of the body. The lymphoma is not in the chest or belly
- Stage II – the lymphoma is not in the chest, and is 1 of the following:
- a single tumour, and in nearby lymph nodes in 1 part of the body
- more than 1 tumour and/or involves more than 1 set of lymph nodes on the same side of the body (either both above or both below the diaphragm, which separates the chest and the abdomen)
- in the digestive tract (e.g. the intestine or stomach) and can be removed during surgery; lymph nodes may or may not also have lymphoma cells
- Stage III – one of the following applies:
- the lymphoma started in the chest
- the lymphoma started in the belly but has spread too far to be completely removed with surgery
- the lymphoma is next to the spine (and may also be in other places)
- the lymphoma is more than 1 tumour or is found in more than 1 set of lymph nodes on both sides of the diaphragm (both above and below)
- Stage IV – the lymphoma is in the brain, spinal cord or bone marrow when it is first diagnosed. If more than 25% of the bone marrow is made up of cancer cells, Stage IV non-Hodgkin lymphoma may be reclassified as acute lymphocytic leukaemia.