Diagnosis of Non-Hodgkin's Lymphoma

Medically Reviewed by Carol DerSarkissian, MD on July 25, 2021
5 min read

If your doctor wants to check if you have a type of cancer called non-Hodgkin's lymphoma, they'll likely do a physical exam and ask you to take a bunch of tests. The results will confirm that you have the disease, and help you and your medical team figure out the best way to treat it.

Non-Hodgkin's lymphoma starts in your lymph tissue -- nodes and vessels found throughout your body. They help your immune system -- your body's defense against germs -- work better. Swollen lymph nodes are one of the most common signs of the disease, so see your doctor if you notice this problem.

Also let your doctor know about symptoms that may happen with non-Hodgkin's lymphoma, such as:

  • Chills
  • Feel really tired
  • Sweat through your clothes at night
  • Have a fever that comes and goes

You may have some digestive problems from non-Hodgkin's lymphoma, like:

  • Get full when you only eat a small meal
  • Lose your appetite or drop pounds without trying
  • Have belly pain or throw up

You might notice problems like feeling pressure or pain in your chest, face, or neck. You could notice weakness in your arms or legs. You might feel confused.

Some other symptoms to let your doctor know about are:

It's rare, but if you're a man, you might have a swollen testicle.

If anyone in your family has had non-Hodgkin's lymphoma, tell your doctor. They will also want to know if you've been sick with infections or other diseases in the past. Your genetics, lifestyle, overall health, age, gender, and race can give your doctor clues about your chances of getting lymphoma.

When your doctor does a physical exam, they'll look over your whole body for signs of swollen tissue, disease, or infection. They'll pay close attention to your armpits, neck, groin, spleen, and liver.

Your doctor may ask you to get blood and urine tests. These can't diagnose non-Hodgkin's lymphoma, but they can give an idea of how well organs like your kidney, heart, and liver are working. They can also show if your body is sick from something other than lymphoma.

Additional tests you may get include:

Biopsy. In this procedure, a surgeon takes out some of your lymph node or tumor to send it to a specialist in a lab. They'll look at your cells under a microscope to see if you have lymphoma. If you do, they can also find out what type it is.

A biopsy is the only way to find out for sure if you have non-Hodgkin's lymphoma.

There are two main ways your surgeon can get a sample of your tissue:

  • Excisional or incisional biopsy. Your doctor will clean and numb the area they want to cut into. They may take out the whole lymph node (excisional) or only a small part (incisional). If the node or tissue is hard to get to, your doctor may give you drugs to make you drowsy (a sedative) or sleep (general anesthesia). Once your lymph tissue is removed, they'll close the area with stitches. You may have a very small scar or might not have one at all.
  • Core needle biopsy. Sometimes a surgeon may use a hollow needle to get a tissue sample from inside your body. They'll numb your skin and may use an ultrasound or CT scan (machines that help them see inside your body) to make sure the needle is in the right place. You may still need an excisional biopsy later.

Your doctor will tell you how to prepare for the biopsy. You may need to:

  • Stop taking medicine that thins your blood
  • Not eat or drink for 6 hours before the procedure

Imaging tests. These are good ways to get pictures of swollen lymph nodes that aren't easy to see or feel. Your doctor will decide which one you need.

Some imaging tests you may get include:

  • Chest X-ray. Your doctor might want to get a look at your bones and lungs if you have pain in your chest or a hard time breathing.
  • CT scan. This gives your doctor a lot of different X-ray pictures from inside your belly, pelvis, chest, head, and neck.
  • MRI. You may need one if your doctor thinks cancer has spread to your brain or spinal cord.
  • Ultrasound. You may get this test if your doctor needs a better look inside your belly. It can show if your liver, spleen, or kidneys are swollen.
  • PET scan. Your doctor will put some radioactive sugar into your bloodstream. This is a material that collects in cancer cells, which can show your doctor if swollen masses are from scar tissue or lymphoma.

Fluid removal. Non-Hodgkin's lymphoma can cause fluid to build up in your chest or belly. Your doctor may numb your skin and use a hollow needle to take out some of the liquid. They will look for cancer in the cells.

Spinal tap. Your doctor may order this test if they think you have cancer in your brain. It's also called a lumbar puncture.

To get some cerebrospinal fluid, your doctor will put a hollow needle into your spine. They'll numb the area, but you may feel some pressure. You usually lie on your side with your knees pulled to your chest. You may not have any side effects from the procedure. But it's possible to get a headache, infection, or bleeding after it's over.

Bone marrow tests. You may get two tests at once if your doctor thinks you have cancer that has spread to your bones. They are called a bone marrow aspiration and biopsy.

The bone sample will most likely come from the back of your pelvic hip bone. A doctor will numb the area before they use a hollow needle to remove the fluid and another needle to get a piece of your bone. Even with the numbing cream, you may feel some pain during the test.