Once the diagnosis of a lymphoma has been made, tests may be performed to determine how far the cancer has spread. This is called staging. These tests are essential because they assist physicians in determining the most effective type of treatment to cure the lymphoma. These include:
Chest X-ray
The chest x-ray is used to identify masses in the upper chest (mediastinum) or lungs.
Computed Tomography (CT) Scan
A CT scan is used to obtain clear picture of the internal organs and can be used to identify the size and location of a mass that could be a lymphoma.
Gallium Scan
The gallium scan provides the best measure of the activity of cancer tumors. In this study, a small quantity of radioactive gallium is introduced into the body. A scan is then taken of the patient to determine where the gallium is concentrated in the body. Most lymphomas will absorb more gallium than normal tissues of the body (except for the liver and spleen). After treatment has been completed, the gallium scan can be used to look for evidence of active tumor and to monitor for a recurrence of cancer. Scans that have shown abnormal lymph nodes are repeated during and after therapy to see how well the treatments have worked.
Bone Marrow Biopsy
The bone marrow may be affected with malignant lymphoma, and thus may be biopsied to detect disease. During a bone marrow biopsy, marrow is taken from the back of the pelvis. To minimize pain and discomfort, the procedure is performed with anesthesia.
Magnetic Resonance Imaging (MRI)
In selected cases, MRI can provide information about the location of the disease. This procedure is often helpful in distinguishing the extent and location of lymphoma in the bone or bone marrow.
Positron Emission Tomography (PET)
Recent studies have indicated that the PET scan is very sensitive in determining whether active sites of tumor involvement are present in patients with lymphomas. At Memorial Sloan-Kettering Cancer Center and many centers nationwide, physicians have replaced the use of the gallium scan with the PET scan.
In addition to the tests performed for staging, further studies are performed to determine the safety of administering particular therapies to individual patients. A test called an echocardiogram is performed that uses high-frequency sound waves to examine the structure and function of the heart. A study called pulmonary function testing is performed to determine the function of the lungs as a baseline before treatment is given. Depending on the diagnosis, staging and evaluation studies may differ among patients.
Determination of Disease Stage
Once physicians have gathered all the information available from tests, they will stage the disease, or determine the extent of its spread. The stages of the disease are described as follows:
Stage I
Involvement of a single lymph node or one lymph node group.
Stage II
Disease in more than one group of lymph nodes on one side of the diaphragm.
Stage III
Disease in two or more lymph nodes on both sides of the diaphragm.
Stage IV
Disease outside the lymphatic system such as the bone marrow, spleen, lung, or liver.
