How is lymphoma diagnosed?

The most-effective treatment starts with an accurate diagnosis. And the sooner treatment starts, the better chance your child will have of beating cancer. At MSK Kids, we have an efficient and thorough approach to diagnosing lymphoma. First, your child will have a biopsy. For this test, a doctor will perform a minor surgical procedure to remove all or part of an enlarged lymph node. We use a short course of anesthesia to make sure your child is comfortable during the biopsy. A pathologist (a doctor with special training in diagnosing cancer) will look at the sample under a microscope to see if lymphoma cells are present.

What is staging?

If we learn your child has lymphoma, the next step is to see what stage it is. Staging is a process to find out if the lymphoma has spread. It is a vital part of your child’s care because doctors use the results of staging to determine the most effective treatment.

What tests will my child have?

To stage your child’s cancer, we may perform one or more of these tests:

• chest X-ray
• CT scan of the neck, chest, belly, or pelvis to measure the size of the lymph nodes and see if there are any tumors in the organs
• MRI to pinpoint the location and extent of cancer in the organs
• PET scan to distinguish whether a mass seen on a CT is a scar or an active, growing tumor
• bone marrow biopsy, which is performed under anesthesia, to look for lymphoma in the bone marrow
• lumbar puncture, performed under anesthesia, to detect lymphoma cells in the spinal fluid
• tests of your child’s overall health, such as heart and lung function, to make sure your child is able to receive certain therapies safely

We understand that hearing about all of these tests may seem overwhelming. The MSK Kids team does all we can to make sure your child is comfortable during these procedures. We will also explain everything to you so you know why we are doing certain tests and you’ll know what to expect.

What stage of lymphoma does my child have?

After the tests are complete, your doctors will explain what stage of lymphoma your child has.

• Stage I: One lymph node or lymph node group is affected.
• Stage II: More than one group of lymph nodes either above or below the diaphragm is affected.
• Stage III: More than one group of lymph nodes both above and below the diaphragm is affected.
• Stage IV: Lymphoma has spread outside the lymphatic system to an area such as the bone marrow, lungs, or liver.

For children with Hodgkin lymphoma, letters may be added to the stage to better describe the cancer.

• A: Absence of symptoms.
• B: Unexplained fever, loss of more than 10 percent of body weight, or night sweats.
• E: Extranodal disease, meaning the cancer has spread beyond the lymph nodes to surrounding tissue.
• S: The spleen is affected.

A child has “bulky” disease when the size of the lymph nodes is greater than 6 centimeters or when the disease has spread to more than one-third of the chest.