Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
If a person has swelling or symptoms described in the Symptoms section, his or her health-care provider will ask many questions about the symptoms (when they began, recent illnesses, past or current medical problems, any medications, workplace, health history, family history, and habits and lifestyle). These questions are followed by a thorough examination.
If, after an initial interview and examination, the health-care provider suspects that a patient may have lymphoma, the patient will undergo a series of tests designed to provide further clarification. At some point in this workup, the patient will likely be referred to a specialist in blood diseases and cancer (hematologist/oncologist).
Blood is drawn for various tests.
Some of these tests evaluate the function and performance of blood cells and important organs, such as the liver and kidneys.
Certain blood chemicals or enzymes (lactate dehydrogenase
[LDH]) may be determined. High levels of LDH in cases in which NHL is
suspected may indicate a more aggressive form of the disorder.
Other tests may be done to learn more about lymphoma subtypes.
If there is a swelling (also called lump or mass), a sample of tissue from the swelling will be removed for examination by a pathologist. This is called a biopsy. Any of several methods can be used to obtain a biopsy of a mass.
Masses that can be seen and felt under the skin are relatively easy to biopsy. A hollow needle can be inserted into the mass and a small sample removed with the needle (called a core-needle biopsy). This is usually done in the health-care provider's office with a local anesthetic.
Core-needle biopsy does not always obtain a good-quality sample. For that reason, many health-care providers prefer a surgical biopsy. This involves removal of the entire swollen lymph node through a small incision in the skin. This procedure often is done with a local anesthetic, but it sometimes requires a general anesthetic.
If the mass is not immediately under the skin but is instead deep inside the body, access is somewhat more complicated. The tissue sample is usually obtained via laparoscopy. This means making a tiny incision in the skin and inserting a thin tube with a light and a camera on the end (a laparoscope). The camera sends pictures of the inside of the body to a video monitor, and the surgeon can see the
mass. A small cutting tool on the end of the laparoscope can remove all or
part of the mass. This tissue is withdrawn from the body with the
A pathologist (a physician who specializes in diagnosing diseases by looking at cells and tissues) examines the tissue sample with a microscope. The pathologist's report will specify whether the tissue is lymphoma and the type and subset of lymphoma.
If there is no palpable mass in the presence of persistent symptoms, imaging studies will likely be carried out in order to determine whether a mass is present and, if so, how then to direct a biopsy.
X-rays: In certain
parts of the body, such as the chest, a simple X-ray can sometimes detect
CT scan: This test provides a
three-dimensional view and much greater detail and
may detect enlarged lymph nodes and other masses anywhere in the body.
MRI scan: Similar to the CT scan, MRI gives three-dimensional images with
excellent detail. MRI provides better definition than CT
scan in certain parts of the body, especially the brain and the spinal cord.
approach, which provides an image of the lymphatic system by tracing a dye
that moves though the system, has essentially been replaced by either CT scan,
MRI, or PET (see below).
Lymphomas tend to collect a substance called gallium when injected into the body. For this test, a tiny amount of radioactive gallium is injected into the body. A scan is then done to find areas where the gallium has collected. Collections of gallium suggest a tumor.
Positron-emission tomographic (PET) scan: PET scan is a newer
alternative to lymphangiogram and gallium scan for detecting areas in the body
that are affected by lymphoma. A tiny amount of a radioactive substance is
injected into the body and then traced on the PET scan. Sites of
radioactivity on the scan indicate areas of increased metabolic activity, which implies the presence of a tumor.
Bone marrow examination
Most of the time, an examination of the bone marrow is necessary to see if the marrow is affected by the lymphoma. This is done by collecting a biopsy of the bone marrow.
Samples are taken, usually from a hip bone.
A pathologist examines the bone marrow under a
Bone marrow containing certain types of abnormal B or
T lymphocytes confirms lymphoma.
Bone marrow biopsy can be an uncomfortable procedure, but it can usually be performed in a medical office. Most people receive pain medication prior to the procedure to make them more comfortable.