Staging Your Lymphoma: The Workup

“Most of the time, PET/CT is our standard staging imaging method,” Dr. Svoboda says. This is a combination of two tests in one: computed tomography (CT) and positron emission tomography (PET).

A CT scan takes x-rays of your body from many different angles, to create very detailed cross-sectional images. It can show enlarged areas of lymphoma in places such as your neck, chest, and belly.

A PET scan uses a small amount of an injectable radioactive sugar. Because lymphoma cells are more metabolically active than healthy cells, they gobble up the sugar. Pictures taken with a special camera will reveal areas of radioactivity where the cancer is concentrated.

Combining both of these tests helps your doctor find areas of lymphoma more effectively than either test alone. And having this test might let you avoid a procedure “that no patient likes, which is called bone marrow biopsy,” Dr. Svoboda says.

Bone Marrow Biopsy — No Longer a Necessity

A bone marrow biopsy used to be routine for determining whether lymphoma had spread to the bone marrow — the spongy tissue in the center of bones where new blood cells are made. To perform this test, the doctor uses a large needle to remove a small piece of bone and marrow. Even with a local anesthetic to dull the pain, “It’s not a pleasant procedure,” says Dr. Svoboda.

With the introduction of the PET/CT scan, doctors don’t have to use bone marrow biopsies as often. If there’s no evidence on this scan that the cancer cells have made their way into your bone marrow, you may be able to skip it.

Spinal Tap

A lumbar puncture or spinal tap, which draws a small amount of fluid from around your spine with a hollow needle, can determine whether the cancer has spread to your spinal cord or brain. It’s not done routinely for most people with lymphoma, but those with a very aggressive cancer such as Burkitt lymphoma or diffuse large B-cell lymphoma with certain high-risk features may need this test.

Before you panic at the thought of having this procedure, know that it isn’t nearly as bad as it might seem. “It doesn’t sound great to have somebody putting a needle in your back and removing some spinal fluid,” Dr. Svoboda says. “But generally, when it’s done well and with a local anesthetic, it can be quite painless.”

He adds that most of his patients do better with a spinal tap than a bone marrow biopsy. Aside from a headache in the days following the test, the spinal tap is pretty well tolerated.

Blood Tests

These blood tests aren’t part of the diagnostic workup for lymphoma, but they can tell your doctor how advanced your cancer is:

• Complete blood count (CBC). This test measures the levels of different cells in your blood. A low blood cell count could mean that the cancer has made its way into your bone marrow.
• Lactate dehydrogenase (LDH). This test measures the amount of a protein called LDH, which is in almost all of the tissues in your body. A high LDH level is a sign that cancer has damaged your tissues, which then released this protein into your blood.
• Blood chemistry test. Your doctor will use this test to find out how well your liver and kidneys are working.

How Healthy is Your Heart?

A heart evaluation isn’t part of the staging process, but it is an important part of determining whether you’re healthy enough to start treatment. Some of the chemotherapy drugs used to treat diffuse large B-cell lymphoma, including doxorubicin (Adriamycin), can be harmful to your heart. “Therefore, you want to make sure that the heart is in good shape,” Dr. Svoboda says.

An echocardiogram uses sound waves to evaluate the structure of your heart and see how well it pumps. And a multiple gated acquisition (MUGA) scan creates a video image of your heart in action, to show how well it’s beating.

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