Lymphoma: Diagnosis and Treatment

Diagnosis

Biopsy of a lymph node or extranodal site of involvement is diagnostic. Histologic findings determine the type and classification of lymphoma.

Following diagnosis, staging is done to determine the extent of disease. Necessary laboratory testing includes a complete blood count, chemistry panel, lactate dehydrogenase, uric acid, C–reactive protein, serum protein electrophoresis, and β2 microglobulin. Computed tomography (CT) scans of the thorax, abdomen, and pelvis are used to document both lymphadenopathy and extranodal involvement.

In many cases, a bone marrow biopsy will be performed to assess marrow involvement. Positron emission tomography (PET) scans are increasingly being used for both initial staging and assessment of treatment response.

Treatment

Radiation and/or chemotherapy are the mainstays of treatment.

Aggressive non–Hodgkin’s lymphoma types and advanced Hodgkin’s lymphoma require combination chemotherapy. In cases of bulky disease, radiation therapy to the affected area may be considered. Localized Hodgkin’s lymphoma is treated with radiation therapy to the affected area.

As the cure rate of Hodgkin’s disease has improved, research has focused on decreasing the toxicity and long–term consequences of treatment, especially second malignancies.

Observation alone without specific treatment is common in asymptomatic non–Hodgkin’s lymphoma patients with indolent histologies.

Bone marrow transplantation is an option for some patients.