Diagnosis
If a person develops signs or symptoms of lymphoma, a doctor will take his or her medical history and conduct a physical exam to determine what might be causing them. During the physical exam, a doctor should thoroughly examine the lymph nodes, liver, and spleen, and look for any signs of an infection that may be causing symptoms. If the doctor suspects lymphoma, he or she will usually do laboratory/blood work, consider imaging with ultrasound or CT scan and conduct a lymph node biopsy of an enlarged lymph node that is found by exam or imaging to be certain. Here are some of the procedures a doctor may perform to diagnose mantle cell lymphoma:
Excisional/Incisional Core Lymph Node Biopsy
Excisional/Incisional/Core Lymph Node Biopsy: In this procedure, the doctor removes either an entire swollen lymph node (excisional biopsy) or a small piece of it (incisional biopsy) through a surgical procedure or takes a biopsy of a small piece of it (core biopsy) using an image (ultrasound or CT scan) to guide the biopsy and has it sent to a lab to be examined under a microscope for signs of lymphoma. Either test is a reliable method of diagnosing mantle cell lymphoma, and usually provides a large enough tissue sample for a pathologist to properly interpret.
Bone Marrow Aspiration & Biopsy
In this test, the doctor uses a thin needle to extract a sample of tissue from the hip bone, and sends it to a lab to be examined under a microscope. This procedure is used to determine whether a lymphoma has spread to the bone marrow, as well as one of the tests that can help determine the stage of the disease. Sometimes it can be helpful in diagnosing lymphoma when there are no other signs of the disease.
Immunophenotyping and Immunhistochemistry:
Diagnosing lymphoma can be difficult and sometimes examination of the cells under a microscope is not enough to provide a definitive diagnosis. The pathologist will use special stains to identify certain proteins found in mantle cell lymphoma to help correctly diagnose the disease. The pathologist can also request a specific genetic test of the lymphoma cells, which can be much more conclusive about the diagnosis when mantle cell lymphoma is present.
Blood Tests
A doctor may recommend blood tests, including a complete blood count (CBC) with differential to determine the levels of white and red blood cells and platelets in the blood, and a blood chemistry profile to monitor protein levels, liver function, kidney function and electrolytes. Lactate dehydrogenase (LDH) is a blood test that may be used, along with a number of other patient and disease factors, to determine prognostic indexes and also may be used to follow disease response to treatment; however, this is not a marker of lymphoma and can be elevated for other reasons. These tests are not used to diagnose the disease, but are useful in monitoring changes the lymphoma may be causing in the body and the side effects of chemotherapy.
Colonoscopy/Gastroscopy
In this test, the doctor uses a narrow, flexible tube with a camera and light on the end to examine the inner lining of the digestive tract for any abnormalities. A colonoscopy examines the colon and a gastroscopy upper endoscopy (EGD) examines the stomach. Mantle cell lymphoma is commonly found in these locations, so a colonoscopy is a diagnostic procedure for mantle cell lymphoma when gastrointestinal involvement is suspected, and biopsies of the colon or stomach can help in confirming the diagnosis when the disease is present.
Echocardiogram
Certain chemotherapy drugs used to treat lymphoma can cause heart damage. An ultrasound of the heart is called an echocardiogram. Ultrasounds bounce sound waves off of a patient's internal organs in order to create echoes that form a picture. The doctor may recommend regular echocardiograms while on these medications to monitor the size and function of the heart.
Computed Tomography (CT) Scan
For a CT scan, the patient lies flat on a table while a machine rotates around the body and takes pictures. A special dye may be injected into the veins and the patient may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan may reveal the presence of tumors and whether or not the cancer has spread to other parts of the body.
Magnetic Resonance Imaging (MRI) Scan
MRI scans use radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body.
Positron Emission Tomography (PET) Scan
Doctors use PET scans for various reasons: sometimes the lymphoma may involve areas that are not easily seen on a CT scan. They measure the activity of areas and not the size of areas. Often a PET is obtained before treatment to ensure there is an adequate assessment of all the areas involved by mantle cell lymphoma and then again after therapy is completed to measure the response to the treatment. When the PET no longer shows involvement, the patient is considered to have no active evidence of lymphoma. The picture on a PET is not as detailed as one from a CT or MRI scan, but can show the whole body and help spot areas of involvement by lymphoma not seen by CT. Most often a PET/CT is used which combines the images from both tests.
