Further tests for non-Hodgkin lymphoma
If the biopsy shows you have NHL, your doctor will want you to have further tests to see if the lymphoma has spread to other parts of your body.
These tests help doctors find out the stage of lymphoma. Once your doctors know the stage, they can plan the most effective treatment for you.
You may also have tests to check your general health and to make sure you are fit for any planned treatment. Tests may include the following:
Samples of your blood will be taken regularly throughout your treatment to check your general health, the levels of red blood cells, white blood cells and platelets in your blood, and how well your liver and kidneys are working.
CT (computerised tomography) scan
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This is done to check for enlarged lymph nodes and for signs of lymphoma elsewhere in the body. A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body.
The scan takes 10-30 minutes and is painless. The photograph opposite shows someone having a CT scan.
The scan uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You’ll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan
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This scan is sometimes used to check for lymphoma in the head and neck area, the bones, or the brain.
An MRI scan uses magnetism to build up a detailed picture of areas of your body.
The scanner is a powerful magnet, so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips or bone pins. You should also tell your doctor if you’ve ever worked with metal or in the metal industry, as tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it’s likely that you won’t be able to have an MRI scan. In this situation, another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
A PET/CT scan may be done for some types of lymphoma.
It is a combination of a CT scan, and a positron emission tomography (PET) scan, which uses low-dose radiation to measure the activity of cells in different parts of the body. PET/CT scans give more detailed information about the part of the body being scanned.
It is a new type of scan and you may have to travel to a specialist centre to have one.
You can’t eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You’ll have the scan about an hour later. The scan usually takes 30–90 minutes.
Bone marrow sample (biopsy)
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This test may be done to check for lymphoma cells in the bone marrow.
The sample (biopsy) of bone marrow is usually taken from the back of your hipbone (pelvis). You’ll be asked to lie on your side on a couch. The doctor will give you a small injection of local anaesthetic into the skin over your hipbone to numb the area. This may sting for a few seconds. The doctor then passes a needle through the skin into the bone and draws a small sample of liquid marrow into a syringe (bone marrow aspirate). After this, they take a small core of marrow from the bone (a trephine biopsy). The samples are then sent to the laboratory for testing.
A bone marrow biopsy can be done in the ward or outpatient clinic. It takes about 15–20 minutes. You may be offered an injection to make you feel drowsy and more relaxed during the procedure. If you have this, you’ll need to have someone with you to take you home afterwards and stay with you until the effects wear off.
It’s normal to feel bruised and a bit sore for a few days after the test. Taking a mild painkiller, such as paracetamol, usually helps.
The spinal cord and the brain are surrounded by a fluid called cerebrospinal fluid (CSF). In some types of lymphoma, the lymphoma cells may get into this fluid. Some people may have a lumbar puncture test to check for lymphoma in the CSF.
The test is done on the ward or in the day unit. The doctor numbs the area of skin over the lower spine with a local anaesthetic. They then feel for a space between two bones (vertebrae) in your lower spine and put a thin needle into the space to collect a sample of the cerebrospinal fluid. After this, they take the needle out and put a small dressing over the skin. The sample of CSF will be sent to the laboratory so it can be tested for lymphoma cells.
Most people have no problems with this test, although when the needle is put in, it can sometimes cause a tingling down the back of your legs. This is harmless, but can be worrying if you’re not expecting it. Some people have a headache for a few days afterwards and may need to take painkillers.
It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home.
Waiting for the results of tests can be an anxious time. You may find it helpful to talk things over with a relative or close friend. You can contact us or another support organisation.