NON-HODGKIN'S LYMPHOMA

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Last Updated : 1/4/2011
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Bharat R Agarwal
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Table 3 Evaluation of

Patient with Non-Hodgkin's Lymphoma


- History and physical examination
- Blood count
- Serum electrolytes: blood urea nitrogen (BUN), creatinine, liver chemistries, calcium,phosphorus, magnesium
- Viral studies : HIV antibody, hepatitis A,B, C serology, cytomegalovirus (CMV) antibody,varicella antibody, herpes simplex virus (HSV) antibody
- Bone marrow aspiration and biopsy*
- Spinal fluid, peritoneal, pericardial, or pleural fluid examination - cytochemical, immunologic,cytogenetic, and molecular
- Adequate surgical biopsy for cytochemical, immunologic, cytogenetic, and molecular studies
- Evaluation of hepatic function (bilirubin, alkaline phosphatase, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), serum protein electrophoresis)
- Lactic dehydrogenase (LDH) levels
- Soluble interleukin-2 receptor (IL-2R) levels (if possible)
- Evaluation of renal function (urinalysis, BUN, uric acid, creatinine)
- Chest radiograph
- Computed tomography (CT) scan of the chest (when indicated)
- Ultrasonography of the abdomen
- CT Scan of the abdomen with contrast
- Plain radiograph and CT scan of afflicted site as deemed necessary on clinical grounds
- Gallium scan
- Diphosphonate bone scan: bone scan prior to gallium scan, because gallium will obscure the diphosphonate (if bone scan positive, radiographs or CT scan of bone or MRI of involved area indicated)
- Magnetic resonance imaging (MRI) especially for bone involvement (e.g. vertebrae)
- Dental evaluation in patients with Burkitt's lymphoma

* May establish diagnosis without lymph node biopsy.
Note : Avoid undue delay in carrying out investigations because of risk of rapid dissemination of the disease, especially to the bone marrow. In urgent medical situations (e.g. cord compression, cranial nerve palsy, or renal failure), minimum investigations prompted by the patient's particular clinical problems should be carried out and patient should be treated on day of admission.


DIAGNOSIS
Excellent cytologic and histologic preparations are essential for precise diagnosis; accurate classification of lymphomas and special precautions must be taken in handling the lymph node. Most diagnostic problems result from improperly and poorly prepared material and crushing artifacts. Selection of the appropriate node and histologic material is important. Histologic material that is obviously necrotic and that has been subject to vascular compromise creates major diagnostic problems.

STAGING

Staging of NHL

requires an expeditious investigation to determine the clinical extent of the disease, the degree of organ impairment, and the biochemical disturbance present.

Table 4 Staging System for

Childhood Non-Hodgkin's Lymphoma

: Murphy Classification

Stage I
- A single tumor (extranodal) or single anatomic area (nodal) with the exclusion of mediastinum or abdomen
Stage II
- A single tumor (extranodal) with regional lymph node involvement
- Two or more nodal areas on the same side of the diaphragm
- Two single (extranodal) tumors with or without regional lymph node involvement on the same side of the diaphragm
- A resectable primary gastrointestinal tract tumor, usually in the ileocecal area, with or without involvement of associated mesenteric nodes only
Stage III
- Two single tumors (extranodal) above and below the diaphragm
- Two or more nodal areas above and below the diaphragm
- All primary intrathoracic (mediastinal, pleural, thymic) tumors
- All extensive primary intra-abdominal disease
- All paraspinal or epidural tumors, regardless of other tumor site (or sites)
Stage IV
- Any of the above with initial involvement of central nervous system or bone marrow or both.

Staging laparotomy to determine precise pathologic staging of the disease is not indicated. Radiation therapy alone, with fields determined by an anatomic stating system, is not employed. Chemotherapy is the mainstay because of the multicentric origin of NHL.



Contributor Information and Disclosures Bharat R Agarwal
Pediatric Hematologist-Oncologist, Division of Pediatric Hem-Onco, B.J. Wadia Hospital for Children, Mumbai, India


First Created : 1/4/2001
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