Diagnosis and staging
Different types of non-Hodgkin’s lymphoma (NHL) can behave very differently. It is important that your doctor works out the exact type of lymphoma you have and how far it has progressed so you can be treated properly.
How important is diagnosis and staging?
There are more than 30 types of non-Hodgkin’s lymphoma (NHL), which all behave differently. Even if you have the same type of NHL as someone else, you may be affected in different parts of your body and to different extents. Your doctor must consider your individual circumstances before they can decide on the right treatment to give you.
This makes choosing your treatment a complex subject, and it is not possible to easily generalise across NHL types. The type of NHL you have also affects what you can expect from the disease. So accurate diagnosis and staging is a crucial first step in your treatment for NHL. It is therefore also important that you discuss any questions you might have with your specialist.
How are the types of non-Hodgkin’s lymphoma identified?
The doctor needs to know exactly what form of non-Hodgkin's lymphoma (NHL) a patient has, how fast it is developing, where it is in the body, and how far it has spread. To work this out, the disease is subdivided by:
- Classification or grading - this tells doctors whether the NHL is indolent (low-grade, or slow growing) or aggressive (high-grade, or fast growing)
- Type - within the classifications of indolent or aggressive, the disease is further divided into over 30 types, depending on how samples of cells, usually taken by biopsy, look under the microscope
- Stage - to indicate where the lymphoma is in the body and how much it has spread, the disease is divided into stages I, II, III and IV, with stage IV indicating the most widespread disease
This information - the classification, type and stage - helps doctors to predict the way in which a particular person’s NHL will behave and how they are likely to be affected. It is also very important to plan the correct treatment, so all the information must be available before treatment is planned.
How is non-Hodgkin’s lymphoma normally diagnosed?
- Indolent non-Hodgkin’s lymphoma (NHL) grows very slowly and often doesn’t cause many symptoms. It is very common for indolent NHL to be noticed when you are seeing the doctor or having a procedure such as a scan or a gastroscopy, for another reason
- Aggressive non-Hodgkin’s lymphoma grows rapidly, so symptoms usually appear quickly and are more noticeable than with indolent NHL. You will probably have gone to the doctor because of your NHL symptoms; such as noticing a lump, being very tired, or having significant night sweats
Most patients will need a biopsy for accurate diagnosis
A biopsy is when a piece of a swelling (lymphoma) is surgically removed so that the doctors can examine the cells under the microscope. This is a small routine procedure, which may be carried out under local or general anaesthetic, depending on where the swelling is.
How does staging work?
- The stage of a non-Hodgkin's lymphoma (NHL) tells the doctor where it is in the body, how many groups of lymph nodes are affected, and whether it has spread to other parts of the body
- As well as a patient's medical history and the physical examination, staging involves tests such as X-rays, CT scans, PET scans, bone marrow biopsies and blood tests
- The most common staging system uses four stages, numbered in Roman numerals I–IV as shown below
- Stage Description
