Further tests after diagnosis for non-Hodgkin lymphoma

If you are diagnosed with NHL, your specialist will arrange further tests for you. These will check your general health and show the stage of the lymphoma – whether it has spread to other parts of your body. Knowing this helps your doctors plan your treatment.

You will have blood tests and usually a CT scan to check for enlarged lymph nodes and signs of lymphoma elsewhere in the body.

Other tests that are sometimes used include:

  • MRI scan – to check for lymphoma cells in the bones, brain or head and neck area.
  • PET/CT scan – to measure the activity of cells in different parts of the body. This may be done for certain types of NHL.
  • Bone marrow sample (biopsy) – to check for lymphoma cells in the bone marrow.
  • Lumbar puncture – to check for lymphoma cells in the fluid that surrounds the brain and spinal cord.

Waiting for test results can be a difficult time. It may help to talk to your family, friends or specialist nurse.

Further tests

You will have more tests before you start treatment for lymphoma. Some tests help to show the stage of the lymphoma. You may have other tests, such as blood tests or x-rays, to check your general health and how well your heart, lungs, liver and kidneys are working.

Information from these tests help your doctors plan your treatment safely and effectively.

You may have some of the following tests.


CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.

CT scan
CT scan

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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 is 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 will probably be able to go home as soon as the scan is over.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan 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. You may have to travel to a specialist centre to have one. You cannot 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 will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.


MRI scan

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 is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.


Bone marrow sample (biopsy)

A doctor or nurse takes a small sample of bone marrow from the back of the hip bone (pelvis). The sample is sent to a laboratory to be checked for abnormal cells.

A bone marrow sample being taken
A bone marrow sample being taken

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You may have this test on a ward or outpatient clinic. It takes about 20 to 30 minutes and you can usually go home shortly afterwards.

Before the bone marrow sample is taken, you have local anaesthetic injections around the area to numb it. You may also be offered a sedative to relax you. Or, you may be given gas and air (Entonox®) to breathe in through a mouth piece or mask. This helps reduce any discomfort during the test.

The doctor or nurse passes a needle through the skin into the bone. They then draw a small sample of liquid from inside the bone marrow into a syringe. This is called a bone marrow aspirate. It can feel uncomfortable for a few seconds when the marrow is drawn into the syringe.

They may also take a small sample of the spongy bone marrow tissue (a trephine biopsy). To do this, the doctor or nurse passes a thicker hollow needle through the skin into the bone marrow. When they take the needle out, it contains a small strip of bone marrow tissue.

You may feel bruised and achy for a few days after this test. Mild painkillers can help. If the pain gets worse, or you notice any bleeding from the area, let your doctor know.


Lumbar puncture

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 (ver-tebrae) in the lower spine and put a thin needle into the space to collect a sample of CSF. After this, they take the needle out and put a small dressing over the skin. The sam-ple of CSF is 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 may cause tingling down the back of your legs. This is harmless, but it can be worrying if you are 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.


Watch and wait

Your doctor may suggest that you don’t need to start treatment straight away. Instead you have regular tests and appointments to monitor the lymphoma and check for signs that you need to start treatment. This is called watch and wait. It is a way of delaying treatment until it is needed.

Watch and wait is an option for some people with low-grade lymphoma. It is not suitable for high-grade lymphoma.

Watch and wait is most likely to be offered to people who have low-grade lymphoma but who do not have symptoms.

A watch and wait treatment plan lasts an average of about three years. For some people, it is shorter than this, and for others it can be much longer.

Sometimes people worry about not having treatment immediately. But there can be advantages to delaying treatment.

Advantages of watch and wait

  • Studies have shown that people who decide to put off having treatment until it is needed live as long as people who start their treatment immediately. They also respond just as well to treatment.
  • You will not experience side effects from treatment until it is absolutely necessary.
  • Effective treatments can be kept in reserve for you until they are needed.
  • Low-grade lymphoma can go through periods when it is more active and others when it is stable or even shrinks. In some people, the lymphoma may shrink without any treatment. This is called spontaneous regression.

Monitoring

Even when you are not having any treatment for lymphoma, you will still see your cancer specialist regularly. At each appointment, they will check you for signs that you may need to start treatment. These signs might include:

  • unexplained weight loss, severe night sweats or unexplained fever (B-symptoms)
  • a lower than normal number of red blood cells (anaemia), white blood cells or platelets in your blood
  • the lymphoma starting to grow quickly
  • the lymphoma starting to affect an important organ, such as a kidney
  • the lymph nodes getting bigger and bulky
  • a build-up of fluid in the tummy area (ascites) or in the lining of lungs (pleural effusion).

Coping with watch and wait

If you are worried about delaying treatment, here are some helpful tips from people who have experienced watch and wait:

  • Make sure you understand why watch and wait is recommended and what other treatment options there may be. If you have any concerns, talk to your doctor.
  • Think of your time without treatment as an opportunity to make the most of your quality of life. Use it to do things you enjoy, and to get as fit and healthy as you can. We have more information about maintaining a healthy lifestyle
  • Try to focus on the present rather than what might happen in the future.
  • Express your feelings – you can do this by talking to family and friends, joining a support group or online forum, or by keeping a journal.

Although watch and wait can be difficult to adjust to at first, many people find it gets easier as time goes on.

An image of Linda, affected by non-Hodgkin lymphoma.

Lymphoma - watch and wait

In this cancer information video, Dr Robert Marcus explains how patients with lymphoma are regularly monitored until treatment starts. This is called watch and wait. Linda talks about her experience.

About our cancer information videos

Lymphoma - watch and wait

In this cancer information video, Dr Robert Marcus explains how patients with lymphoma are regularly monitored until treatment starts. This is called watch and wait. Linda talks about her experience.

About our cancer information videos

Back to Diagnosing

Causes and risk factors of NHL

For most people with NHL, a cause is never found. But there are factors that are known to increase the risk of developing it.