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If the biopsy| shows that non-Hodgkin lymphoma cells are present, your doctor will want you to have some further tests to see if the lymphoma has spread to other parts of the body.
These tests show the stage| of the lymphoma. Once your doctor knows where the lymphoma is in your body, they can plan the most effective treatment| for you.
Tests to find out the stage may include any of the following:
Samples of your blood will be taken regularly throughout your treatment to check your general health, the levels of red cells, white cells and platelets in your blood, and how well your liver and kidneys are working.
This is taken to see if the lymphoma is in the lymph nodes in the chest.
A CT scan takes a series of x-rays, that build up a three-dimensional picture of the inside of the body. The scan will show up any lymph nodes that are larger than normal. It’s painless but takes from 10-30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will 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. If you are allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand.
You’ll probably be able to go home once the scan is over.
A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in the arm. A scan is then taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue and show up on the scan.
It can be used to find whether a lymphoma has spread beyond the original area of the body. It can also be used to show how quickly the lymphoma cells disappear after treatment, and examine any lumps that remain after treatment to see if they contain scar tissue or cancer cells.
PET scans are a fairly new type of scan and you may have to travel to a specialist centre to have one.
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan, because the scanner is a powerful magnet. The checklist asks about any metal implants you may have – for example a pacemaker, surgical clips, bone pins etc. You should also tell your doctor if you have ever worked with metal or in the metal industry as very 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 having 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 will be asked to 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 during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You will be able to hear, and speak to, the person operating the scanner.
A sample of bone marrow is taken, usually from the back of the hip bone (pelvis), and examined to see if it contains any lymphoma cells. The test doesn’t take very long and can be done on the ward or in the outpatient department.
Before the sample is taken, a local anaesthetic is used to numb the area. A needle is then passed through the skin into the bone marrow. A tiny piece of the bone and bone marrow are taken to be examined under the microscope. A small dressing is applied to the area after the procedure. The test can be painful and you may have some discomfort in the area for a few days. This can be eased with mild painkillers. If you’re anxious about having the test a mild sedative may be helpful. You can ask your doctor about this beforehand.
A bone marrow sample being taken
This test is done on the ward or in the day unit. First, you are given an injection of local anaesthetic. A thin needle is then put through the skin of your back into the fluid around your spine and a sample of spinal fluid will be taken. This will be examined in the laboratory to see if it contains any lymphoma cells. You will be asked to stay lying flat for at least an hour after the test, to reduce the chance of getting a headache.
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 are not expecting it. Some people get 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. Obviously this waiting period is an anxious time and it may help you to talk things over with a close relative or friend. You can also contact us or a support organisation. You can ask your doctor when your results will be available, so that you know how long you will have to wait.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.