Pediatric Lymphomas: Diagnosis

Children and young adults with lymphoma have the best outcomes when they begin treatment as soon as possible. At Memorial Sloan Kettering, we diagnose patients with lymphoma using a quick and thorough approach.

To diagnose this disease, we remove a piece of the tumor through one of two surgical procedures: a fine-needle aspiration or a biopsy. To limit discomfort, these procedures are performed while the child is briefly placed under anesthesia. Our surgeons remove an enlarged lymph node, a portion of the lymph node, or any other suspected area of tumor growth, also called a mass. We examine the tissue under a microscope to determine if any lymphoma cells are present.

Determining the Stage of Lymphoma

If the aspiration or biopsy reveals that a child has lymphoma, we perform additional testing to identify the type of the tumor and the stage. Staging — or determining how far the disease has spread — helps doctors select the treatment that will be most effective in curing the lymphoma.

We may perform one or more of the following diagnostic tests to stage the tumor:

  • Chest x-ray
  • CT scan of the neck, chest, abdomen, and pelvis to determine the size of the lymph nodes and location of any masses involving the internal organs
  • MRI to pinpoint the location and extent of lymphoma in internal organs
  • PET scan to distinguish whether a particular mass seen on CT is a scar or an active, growing tumor
  • Bone marrow biopsy, which is performed under anesthesia, to detect lymphoma in the bone marrow
  • Lumbar puncture, performed under anesthesia, to detect lymphoma cells in the spinal fluid

We also perform additional tests to make sure that particular therapies will be safe for your child's overall health. For example, we may examine your child's heart through an echocardiogram or the lungs through pulmonary function tests, depending on your child's diagnosis.

Stages of Lymphoma

Once we have gathered all of the information from diagnostic tests, we will determine the stage of your child's disease.

  • Stage I - One lymph node or lymph node group is affected
  • Stage II - More than one group of lymph nodes either above or below the diaphragm is affected
  • Stage III - More than one group of lymph nodes both above and below the diaphragm is affected
  • Stage IV - Lymphoma has spread outside the lymphatic system to an area such as the bone marrow, lung, or liver

In Hodgkin lymphoma, letters may be added to the stage to better describe the cancer.

  • A - Absence of symptoms
  • B - Unexplained fever, loss of more than 10 percent of body weight, or night sweats
  • E - Extranodal disease, which has spread from lymph nodes to surrounding tissue
  • S - Spleen is affected

The disease is referred to as “bulky” when the size of the lymph nodes is greater than 6 centimeters, when the disease has spread to more than four lymph node groups, or when the disease has spread to more than one-third of the chest or abdomen.