Lymphoma - Non-Hodgkin - Childhood: Diagnosis

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of the medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests on the lymphoma cells to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How childhood non-Hodgkin lymphoma is diagnosed

There are different tests used for diagnosing non-Hodgkin lymphoma (NHL). Not all tests described here will be used for every person. Your child’s doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your child's signs and symptoms

  • Your child's age and general health

  • The results of earlier medical tests

The doctor will first perform a physical examination and take a complete medical history to help determine if a child has NHL. In addition, the following tests may be used:

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If the tumor is near the surface, a local anesthetic is usually given to numb the biopsy area before the procedure. If it is deeper inside the body, a general anesthetic is usually given to block the awareness of pain.

  • Bone marrow aspiration and biopsy. These 2 procedures are done to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy removes a small amount of solid tissue using a needle. These procedures are often done at the same time and may be called a bone marrow examination.

    A pathologist then analyzes the sample(s). A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. Doctors generally give anesthesia beforehand to numb the area. Anesthesia is medication that blocks the awareness of pain. Stronger types of anesthesia can also be used to lessen the pain.

  • Lumbar puncture (spinal tap). A lumbar puncture looks for cancer cells, blood, or tumor markers in a sample of cerebral spinal fluid (CSF), which is removed using a needle. Tumor markers are substances found in higher-than-normal amounts in the blood, urine, or body tissues of people with certain types of cancer. CSF is the fluid that flows around the brain and the spinal cord. Doctors generally give an anesthetic to numb the lower back before the procedure.

  • Cytogenetic analysis. A pathologist may examine the tumor sample removed during biopsy to see if the pairs of chromosomes (strings of DNA that contain genes) in the tumor sample have abnormalities. This helps the doctor identify the subtype of NHL and plan treatment.

  • Flow cytometry and immunocytochemistry. These tests help the doctor determine the subtype of NHL. In a flow cytometry test, cells from the lymph nodes, bone marrow, or blood are removed and treated with a fluorescent, dye-equipped antibody that attaches to DNA. The cells are then passed in front of a laser beam, which allows a special computer to measure their DNA level. Higher-than-normal amounts of DNA may indicate cancer. During an immunocytochemistry test, cells are tested with specific antibodies and stains to determine the subtype of NHL.

Imaging tests

To determine where the cancer is and whether it has spread, the doctor may use the following imaging tests. Imaging tests show pictures of the inside of the body.

  • X-ray. An x-ray creates a picture of the tissues and organs inside of the body using a small amount of radiation. A chest x-ray is the most common type of x-ray taken for diagnosing NHL.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Bone scan. A bone scan looks at the inside of the bones using a radioactive tracer. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. But you may hear your child's doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

The information from PET scans is often used with the information from a CT scan, MRI, and physical examination to find out if cancer is in tissues. It can help show the difference between benign (noncancerous) findings from a CT scan or MRI and malignant (cancerous) tumors that may not be clearly identified on a CT scan or MRI. The exact accuracy and role of PET scans in NHL is not yet clear, although tumors that contain lymphoma cells often show up on a PET scan. A PET scan may be used to determine where the lymphoma has spread and how well treatment is working.

After diagnostic tests are done, your child’s doctor will review the results with you. If the diagnosis is NHL, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.