Diagnosis of Non-Hodgkin Lymphoma

Diagnosis often starts when someone sees their doctor for certain symptoms like painless, swollen lymph nodes in the neck, collarbone, armpit, or groin. For some, swollen lymph nodes are found incidentally during a physical exam or chest x-ray.

There are several noncancerous reasons why lymph nodes maybe swollen. Your doctor will ask about your symptoms, and family and medical history. Lymph nodes throughout the body will be carefully examined. The doctor will check other areas of the body, such as the spleen and liver, for swelling. If there are no obvious reasons for these symptoms, a blood disorder may be suspected

Diagnosis of Non-Hodgkin Lymphoma

A lymph node biopsy is the only way to confirm a diagnosis. During the biopsy, all or part of a lymph node is removed. The tissue is examined under a microscope to look for specific types of cancer cells. The presence of these cells help determine the type of lymphoma present. Types of biopsies include:

  • Exisional —Most common. The entire lymph node is removed in an open procedure.
  • Incisional —A small part of the node is removed during an open procedure.
  • Fine needle aspiration —A thin needle is inserted into the lymph node. Lymph tissue and fluid removed with a syringe.
  • Core needle —A larger, hollow needle is inserted into the lymph node. Lymph tissue and fluid are removed with a syringe.

Staging of Non-Hodgkin Lymphoma

If non-Hodgkin lymphoma is confirmed, the results from the biopsy and new tests will help determine the stage of the cancer. Staging is used to identify characteristics of the cancer. Staging as well as other information like age and overall health will help develop the prognosis and treatment plan.

Staging Tests

Staging is determined by a number of factors. Tests will vary by individual, but may include:

  • Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
  • Flow cytometry and cell marker tests to examine cells for specific characteristics, like proteins.
  • Imaging tests may be used to evaluate the extent of cancer and involved organs. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may depend on suspected location of cancer based on symptoms, but may include:
  • Biopsies of other tissues to confirm the presence of cancer in a specific location:
    • Lumbar puncture to evaluate the cerebrospinal fluid that protects the brain and spinal cord
    • Bone marrow
    • Fluid tests from the cavities around the lungs and abdomen
  • Laparotomy to explore the abdominal cavity for the presence of tumors.
  • Ultrasound of the heart— electrocardiogram.
  • Pulmonary function tests.

Stages of Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is staged from 0-4:

  • Stage 0 —Cancer is INSIDE the lymphatic system in one the following places:
    • One lymph node or more than one in the same lymph node cluster OR
    • Lymphatic tissue in the throat (tonsils and/or adenoids) OR
    • Thymus OR
    • Spleen
  • Stage 1E —Cancer is OUTSIDE of the lymphatic system in ONE organ or area.
  • Stage 2 —Cancer is in 2 or more lymph node clusters either above OR below the diaphragm (the sheet of muscle that separates the chest and abdominal cavities).
  • Stage 2E —Cancer is in one or more lymph node clusters either above OR below the diaphragm AND in a nearby organ or area on the same side of the diaphragm.
  • Stage 3 —Cancer is in lymph node clusters above AND below the diaphragm.
  • Stage 3E —Cancer is in lymph node clusters above AND below the diaphragm AND in a nearby organ or area.
  • Stage 3S —Cancer is in lymph node clusters above AND below the diaphragm AND in the spleen.
  • Stage 3E, S —Cancer is in lymph node clusters above AND below the diaphragm AND in a nearby organ or area AND in the spleen.
  • Stage 4
    • Cancer is OUTSIDE of the lymphatic system in one or more organs AND MAYBE in the lymph nodes near the affected organs OR
    • Cancer is OUTSIDE of the lymphatic system in one organ AND has spread to areas or organs away from the affected organ OR
    • Cancer is found in the lungs, liver, bone marrow, or cerebrospinal fluid of the brain and spinal cord. The cancer is in these areas, but has not spread there from other nearby sites.

For treatment purposes, non-Hodgkin lymphoma may also be grouped as:

  • Indolent—slow-growing
  • Aggressive—fast-growing
  • Contiguous—the affected lymph nodes are next to one another
  • Noncontiguous—the affected lymph nodes are not next to one another, but are on the same side of the diaphragm


Adult non-Hodgkin lymphoma treatment (PDQ)—patient version. National Cancer Institute website. Available at: https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq. Accessed January 28, 2021.
Diagnosis. Leukemia & Lymphoma Society website. Available at:
...(Click grey area to select URL)
Accessed January 28, 2021.
Non-Hodgkin lymphoma (NHL). EBSCO DynaMed website. Available at: http://www.dynamed... . Accessed January 28, 2021.
Tests for non-Hodgkin lymphoma. American Cancer Society website. Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/detection-diagnosis-staging/how-diagnosed.html. Accessed January 28, 2021.
Last reviewed December 2020 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 1/28/2021

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