Childhood lymphoma diagnosis

How is childhood lymphoma diagnosed?

At a general examination a doctor will look and feel for any swelling of the glands in your child’s neck, armpits and groin. Your child’s abdomen and chest will also be examined for any signs of enlarged organs or fluid collection.

The doctor will also ask about any other symptoms your child might be having. At this stage some blood samples may be taken to check how well the bone marrow, liver and kidneys are functioning.

If the doctor suspects that your child might have lymphoma, a biopsy will need to be done to help confirm the diagnosis.

Biopsy

A biopsy involves removing a lymph node or a sample of tissue from a suspicious lump for examination in the laboratory. To limit discomfort and distress, the biopsy is generally performed while the child is under a brief anaesthetic.

If the swollen gland is in the abdomen or pelvis, a surgical procedure called a laparoscopy may be performed in which a narrow tube with a microscope attached is inserted through a small cut in the skin. It allows the surgeon to see the inside the abdomen or pelvis, and to take a biopsy if needed. This is performed under general anaesthetic. Once the tissue samples are removed they are examined in the laboratory by a pathologist. It can take a few days for the final results of the biopsy to come through.

Knowing the exact type of lymphoma your child has is important because it provides information on the most likely course of the disease and the best way to treat it.

Further tests

Once a diagnosis of lymphoma is made further tests need to be done to find out the extent to which the disease has spread in the body (the stage), and the effect it is having on important body organs. These include:

• blood tests: these are important because they provide a baseline set of results regarding the disease and your child’s general health. These results can be compared with later results to assess how well they are progressing.
• CT (computerized tomography): scans of chest, abdomen and pelvis are often used to assess the spread of lymphoma in the body
• MRI (magnetic resonance imaging): may be done when the doctor needs very clear pictures particularly of the brain and spinal cord, to see if these areas are affected by cancer
• PET (positron emission tomography): uses radioactive glucose, which is injected into a vein in the hand or arm. Using this technology areas of lymphoma are often more clearly visible than with other scans. It can also be used to assess response to treatment.
• bone marrow biopsy: involves taking a sample of bone marrow (usually from the back of the hip bone) and sending it to the laboratory for examination under the microscope. The bone marrow biopsy may be done in the clinic or day procedure centre and is usually performed under a light anaesthetic or sedation given through a small drip in your child’s arm. The sample of bone marrow is examined in the laboratory to determine the number and type of cells present and the amount of haematopoiesis (blood forming) activity taking place there.
• CSF (cerebrospinal fluid) examination: a small sample of the CSF that surrounds your child’s brain and spinal cord is collected during a procedure called a lumbar puncture, and tested in the laboratory to check for the presence of lymphoma cells within the central nervous system (CNS).