Most people with lymphoma first notice enlarged lymph nodes in their neck, armpits or groin. They also may have a fever, weight loss, and other vague symptoms that can mimic other diseases. Your doctor may suspect lymphoma based on the symptoms you have or from scans of affected parts of your body.

Biopsy Is the First Step

To test for lymphoma, a doctor will perform an excisional biopsy, taking a small sample of tissue from the affected nodes or organs. The biopsy sample will be viewed under a microscope by a pathologist. Most patients will receive a lymph node biopsy, but if the lymphoma affects organs like the skin, brain, or the stomach, a biopsy from these organs may be required instead. If a doctor initially asks for a needle aspiration test (called FNAC) and it turns out to be lymphoma, it is worthwhile to do a biopsy to get more tissue for a more detailed diagnosis.

Determining the Type

The diagnosis of lymphoma is not enough information for a doctor to give proper treatment. He or she must also determine which of the two main types of lymphoma — Hodgkin or non-Hodgkin lymphoma (NHL) — a patient has. The type of lymphoma can be identified by the physical appearance of the cancer cells under the microscope, or by using markers that identify special molecules on the lymphoma cells. It's important that a pathologist skilled in lymphoma makes the determination.

Tests After Diagnosis

Once the diagnosis of lymphoma is clear, it becomes necessary to perform a number of tests to see how far the disease has spread and which organs are involved. Scans of different parts of the body, as well as a bone marrow test, may be done if the doctor feels it is required. Also, some blood tests can show how advanced the disease is, and if the patient is fit for treatment with chemotherapy. Once these tests are done, the oncologist can discuss treatment options with the patient.