Lymphoma Diagnosis
What are the symptoms of lymphoma?
Low grade lymphomas are mostly present as an anatomic disturbance. The anatomic disturbance caused by lymphoma is a growth of a nodule of some sort. The higher grade lymphomas: the high grade Non-Hodgkin's lymphomas, the Burkett's lymphomas, the fuse large b-cells lymphomas, the Hodgkin's lymphomas, are more aggressive types of lymphoma. When I say a more aggressive lymphoma, I means these lymphomas grow quicker and not only do they grow quicker but as they grow, they outgrow their blood supply and they die quicker, so there's growth and death going on at the same time in these lymphomas. So when you have growth and death going at the same time in a lymphoma, cells die and release their toxins into the blood stream. So what are the symptoms of lymphoma? People with lymphoma get fevers, night sweats and weight loss. So that combination of fevers, night sweats, and weight lose is a standard constitutional symptom of a Non-Hodgkin's or a Hodgkin's Lymphoma.
What tests are used to diagnose lymphoma?
So after someone comes to a physician with symptoms as I've described, being: weight loss, night sweats and fevers, with or without itching- I want to describe that Hodgkin's Lymphoma patients sometimes classically present to a physician with itching of unknown ideology: meaning that they just that itching, their entire body itches without any reason. Especially the itching is exacerbated by warm or hot showers as well as having excessive itching after drinking alcohol. So the night sweats, weight loss and fevers (plus or minus the itching) would prompt further evaluation. If the patient happens to have lymph nodes in their neck or in their armpit then they'd be referred to a surgeon to remove that lymph node for pathologic analysis and determination of their diagnosis. If there wasn't a particular lymph node group that was able to be biopsied; we'd pursue a bone marrow biopsy: a bone marrow biopsy is a non-invasive sampling of the bone marrow present, usually in the hips and allows the clinicians and the pathologist to review the different types of bloods cells in the bone marrow to determine whether there are abnormalities there, or cancer there, or lymphoma there.
What is a "bone marrow biopsy"?
There are quite a few reasons to do bone marrow biopsy from a cancer perspective, and specifically relating to diagnosis of lymphoma or cancer. We do bone marrow biopsy to evaluate if there is presence of cancer inside the bone marrow. Presence of cancer inside the bone marrow increases the stage of your illness, especially lymphoma. Lymphoma diagnosis with bone marrow involvement is a much more aggressive and much more advance presentation than a lymphoma that happens to not be in the bone marrow. It enables us to determine the stage of cancer, prognosis of a particular cancer, and determine what we need to do in terms of treatment.
What is a "lumbar puncture" or "spinal tap"?
You might ask why we woud do spinal taps and or lumbar punctures in patients diagnosed with lymphoma and the reason for that is: Some certain types of lymphomas, some particular types as well as some very aggressive lymphomas and lymphomas that involve the bone marrow have a high predilection for relapse or disease spread to the spinal cord and to the lining of the brain. In those certain situations we in addition to giving chemotherapy in the vein and esostemic chemotherapy or chemotherapy as we all know and understand it: we give chemotherapy into the spinal cord or column to bathe the cerebal spinal fluid with chemotherapy to prevent cancer from growing in the spinal fluid and the lining of the brain.
