Lymphoma is a type of cancer that affects the white blood cells. Having the symptoms of lymphoma, or being told by your doctor that they think you may have it, is an understandably worrying and upsetting time. But as with all cancers, the earlier a lymphoma is detected, the sooner you can start treatment and the better your chances of a successful recovery.
There are numerous tests that doctors use to diagnose lymphoma, including biopsies and a lymphoma MRI scan. In this article, we discuss the tests you may have in order to get a diagnosis, and how an MRI scan is extremely useful in determining where in your body might be affected by lymphoma.
What is Lymphoma?
Lymphoma is a type of cancer that affects the lymphatic system, an important part of the immune system. More specifically, it affects the lymphocytes, types of white blood cells that fight infection, causing them to malfunction and multiply out of control. There are two main types of lymphoma - non-Hodgkin lymphoma and Hodgkin lymphoma. The main difference between the two is the types of lymphocytes they affect.
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Non-Hodgkin lymphoma affects mostly lymphocytes called B cells (called a B cell lymphoma) but some can affect lymphocytes called T cells (a T cell lymphoma). B cell lymphomas can be slow-growing (referred to as low-grade lymphomas) or fast-growing (high-grade lymphomas). T cell lymphomas are usually high-grade, fast-growing lymphomas. Non-Hodgkin lymphoma causes the affected lymphocytes to divide uncontrollably and subsequently pool or collect in parts of the lymphatic system, most commonly, the lymph nodes in the armpit, groin or neck. As a result, your ability to fight infections is reduced. There are many different subtypes of non-Hodgkin lymphoma.
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Hodgkin lymphoma, sometimes called Hodgkin disease, is less common and affects lymphocytes called Reed-Sternberg cells. It causes them to divide abnormally and collect in parts of the lymphatic system in the same way as non-Hodgkin lymphoma.
Lymphoma Locations
Because lymphoma affects white blood cells, and because these cells travel around the body helping to fight infections, lymphoma tumours can be found in various places within the lymphatic system around the body. Most commonly, a lymphoma tumour will be found in the lymph nodes in the:
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Armpit
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Groin
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Neck
They can also be found in the lymph nodes in the abdomen, chest and spleen. Lymphomas can spread to the bone marrow or to organs near where a lymphoma originated, but they don’t usually cross over into your bloodstream.
Symptoms
The main symptom of lymphoma is a painless lump or swelling in the armpit, groin, neck, or elsewhere in the body. Other symptoms include:
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A high temperature
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Night sweats
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Fatigue
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Unexplained weight loss
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Itchy skin or skin lesions
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Feeling out of breath or persistent coughing
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Nose bleeds
Can an MRI Scan Detect Lymphoma?
MRI stands for magnetic resonance imaging, and a lymphoma MRI scan can detect lymphomas and indicate to doctors what part or parts of the body have been affected.
A lymphoma MRI scan cannot detect lymphomas on its own. Instead, it forms part of a range of tests that together, will either confirm or rule out a lymphoma diagnosis. Doctors will usually perform an MRI scan if they think that you may have a lymphoma in your:
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Bones
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Head and neck
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Brain and spinal cord (the central nervous system)
What Does it Look Like on MRI?
Radiologists use a number of techniques during an MRI scan to collectively detect lymphomas.
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A so-called T1 weighted image will show a lymphoma as darker than the surrounding fat and lighter than the muscle
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A T2-weighted image will show a lymphoma as brighter than the surrounding muscle
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A diffusion-weighted imaging (DWI) lymphoma MRI will show a lymphoma as brighter than the surrounding tissue
How an MRI Scan Detects Lymphoma
MRI scans work by using radio waves and a strong magnetic field to temporarily disrupt the hydrogen atoms in the body. As the magnets are switched on and off during MR scanning, these hydrogen atoms emit different types of energy, depending on the type of tissue. An MRI scanning machine then turns this energy into images - soft tissues and liquids appear different to bones, and an experienced radiographer will be able to use these images to look for the presence of abnormalities such as tumours caused by lymphomas.
You won’t feel anything during a lymphoma MRI scan but you may experience claustrophobic feelings inside the scanning machine. Your medical team can give you medications to calm your thoughts if you think you may struggle. An MRI scan usually takes around 30 minutes.
Diagnosing Lymphoma
There are a number of steps doctors will take in order to get a definitive diagnosis of a lymphoma, depending on your health and symptoms - called your clinical presentation. The common symptoms of lymphoma, including swollen lymph nodes, fatigue and weight loss, can be attributed to other conditions (a so-called differential diagnosis) such as mumps, other viral infections and flu. If you’re concerned, it’s important to speak to your doctor. Depending on your clinical presentation, you can expect to undergo some or all of the following tests.
Physical Examination
Your doctor will feel around your groin, armpits and neck area to check for swelling and lumps and will ask you questions about your overall health and your symptoms.
Blood Tests
They will then arrange for some blood tests that will check for the following:
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Red and white blood cell count
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Liver and kidney function
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Signs of infection or inflammation
X-Ray
You may have a chest x-ray to check for swelling or enlarged lymph nodes in your chest or lungs that may indicate the presence of a lymphoma, especially if you’ve been experiencing breathlessness and persistent coughing.
MRI Scan
MR scanning is effective in diagnosing non-Hodgkin and Hodgkin lymphomas that may be present in the following areas:
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Bones
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Head and neck
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Brain and spinal cord (the central nervous system)
Ultrasound
Your doctor may refer you for an ultrasound - a scan that uses soundwaves to produce images of the inside of the body. An ultrasound can be useful in detecting lymphomas that are sitting under the skin, for example in the neck, and also for guiding your doctor to the correct area to take a lymph node biopsy (see below).
CT Scan
A CT scan (computed tomography) uses x-rays to produce images of the inside of the whole body and can detect enlarged lymph nodes and abnormalities in the chest, abdomen, pelvis, head and neck.
PET Scan
An FDG PET (fluorodeoxyglucose positron emission tomography) scan uses low doses of radioactivity to produce an image of the whole body to detect enlarged lymph nodes and abnormalities as well as to assess the activity of potentially cancerous cells. It’s often used alongside a CT scan to provide a more detailed picture.
Lymph Node Biopsy
A lymph node biopsy is a procedure carried out under a local anaesthetic that involves using a long needle to remove cells from an enlarged lymph node. They are then sent for testing to see if cancerous cells are present. In some cases, an entire lymph node can be removed for testing, and sometimes the procedure is carried out alongside a CT scan for accuracy.
If a lymph node biopsy discovers the presence of affected Reed-Sternberg cells (see above), you will be diagnosed with Hodgkin lymphoma. If there are no Reed-Sternberg cells present and other tests confirm a lymphoma, you will be diagnosed with non-Hodgkin lymphoma and further tests will determine which subtype.
Bone Marrow Biopsy
A bone marrow biopsy is another type of biopsy that takes cells from the bone marrow (the relatively soft centre of the bones). Most commonly, a sample is taken from the pelvic bone, under local anaesthetic, which is then tested for the presence of cancerous cells. This procedure is usually carried out after a diagnosis of a lymphoma to see if it’s spread to the bone marrow.
Molecular and Genetic Tests
You may have some blood taken for genetic testing if you have a family history of lymphoma.
Flow Cytometry
Flow cytometry laboratory tests are normally used to check blood or bone marrow samples to determine how well treatment is working and to detect any return of cancerous cells early on.
Fine Needle Aspiration
A fine needle aspirate (FNA) is a procedure for taking a bone marrow biopsy (see above).
Immunohistochemistry
Immunohistochemistry is a laboratory technique used to test blood and biopsy samples for the presence of cancerous cells.
Complete Blood Count
A complete (or full) blood count is a blood test (see above) that checks your levels of red and white blood cells and platelets (which are responsible for blood clotting).
Cytogenetic Analysis
A cytogenetic analysis is a laboratory technique used to test blood and biopsy samples for abnormal genetic material that may indicate the cause of a lymphoma.
Lumbar Puncture
If your doctor suspects your lymphoma may have reached your brain, they will check this using a lumbar puncture. This involves using a long, thin needle to extract some cerebrospinal fluid (CSF), the liquid that supports the spine and brain, to test for abnormal cells.
Causes of Lymphomas
Lymphomas are caused by a mutation in the DNA of the lymphocytes, causing them to grow out of control. The exact reason why this mutation happens isn’t yet fully understood. However, there are some factors that may mean that you have a higher risk of developing a lymphoma. These include:
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Having a condition that lowers your immune system, such as HIV
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Having an autoimmune condition such as lupus or rheumatoid arthritis
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Taking medications that lower your immune system, such as those taken after an organ transplant
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Having a viral infection such as Epstein Barr virus (that causes glandular fever)
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Having previously had chemotherapy or radiotherapy for a different cancer
There tends to be a higher incidence of Hodgkin lymphoma in males and in those aged 70 and above, but both types of lymphoma can occur in people of any age or gender.
Prognosis and Treatment
Your treatment plan will depend on factors such as your age and overall health and wellbeing, the type and subtype of your lymphoma, how advanced it may be and where it is.
Sometimes, a small lymphoma can be removed at the biopsy stage, and others with low-grade lymphoma may require active monitoring—a wait-and-see approach that requires regular checkups to see how it may be progressing.
However, on the whole, non-Hodgkin and Hodgkin lymphomas are treated with chemotherapy and radiotherapy. Some non-Hodgkin lymphomas can be treated with medications called monoclonal antibodies in conjunction with chemotherapy to help prevent the lymphoma from returning, or with steroids to help chemotherapy drugs work more effectively. Hodgkin lymphoma is sometimes treated with drugs called biological medicines, or targeted therapies.
Your long-term prognosis after being diagnosed with lymphoma will again depend on your health and the type and stage of lymphoma you were diagnosed with. However, in many cases of both non-Hodgkin and Hodgkin lymphoma, treatment is successful.
Find an MRI Scan for a Lymphoma
If you have the symptoms of lymphoma, or you’d like a second opinion, give yourself peace of mind by booking a private lymphoma MRI scan with us. We also offer private CT scans, ultrasounds and x rays. If you’re unsure what scan might be right for you, or you’d like to discuss your symptoms, book an appointment with one of our private consultants.
References
Blood Cancer UK | Lymphoma. (n.d.). Blood Cancer UK. https://bloodcancer.org.uk/understanding-blood-cancer/lymphoma/
Website, N. (2023b, August 10). Non-Hodgkin lymphoma. nhs.uk. https://www.nhs.uk/conditions/non-hodgkin-lymphoma/
Website, N. (2022, August 11). Hodgkin lymphoma. nhs.uk. https://www.nhs.uk/conditions/hodgkin-lymphoma/
Radiological Society of North America (RSNA) and American College of Radiology (ACR). (n.d.-c). Lymphoma. Radiologyinfo.org. https://www.radiologyinfo.org/en/info/lymphoma
Lymphoma. (2024, May 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22225-lymphoma
