How We Diagnose and Stage Lymphoma

To accurately diagnose lymphoma, the City of Hope care team may need to perform several tests to determine the lymphoma type and stage. Staging reveals whether the cancer cells have spread within the lymphatic system or to other parts of the body, which will guide our care team’s treatment planning.
In addition to a routine physical exam, taking medical history information and blood tests, City of Hope staff may also perform biopsies and imaging tests.
Biopsies for Lymphoma
Due to the diverse nature of lymphomas, a biopsy—an examination of the suspected tissue—is needed to accurately identify the type of lymphoma. This tissue may be taken from a lymph node and/or the bone marrow.
After the tissue is extracted, a pathologist will examine the cells under a microscope to see if lymphoma present and if so, what type. Additional tests, such as immunophenotyping, cytogenetics and molecular evaluation, may also be conducted on these cells to help determine the lymphoma type.
Imaging Tests for Lymphoma
In general, imaging scans are used to determine the extent of the disease and are repeated regularly during treatment to assess cancer response. These scans may include:
  • Chest X-ray
  • Ultrasound: High-energy sound waves are bounced off internal tissues or organs to create an image called a sonogram.
  • CT or CAT (Computerized Axial Tomography) Scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • PET (Positron Emission Tomography) scan: This scan measures the metabolism of a tumor relative to normal tissue and can help determine where in the body there is active tumor.
  • MRI (Magnetic Resonance Imaging): Using a powerful magnet, radio waves and computer imaging, this procedure creates a series of detailed pictures of areas inside the body.
Stages of Lymphoma
Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).

Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.

Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.

Recurrent: The disease returns after treatment.
In addition to these stage numbers, the stage may be described as A or B:
A: You have not had weight loss, drenching night sweats, or fevers.

B: You have had weight loss, drenching night sweats, or fevers.