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Your GP will ask you questions about your symptoms, check your medical history and examine you.
If s/he thinks you may have cancer, s/he will send you to see a specialist doctor (a haematologist) at a nearby hospital. There are cancer referral guidelines to help GPs decide who may need to see a specialist, and how quickly.
Your specialist may arrange for you to have either a lymph node biopsy or a bone marrow test...
Lymph node biopsy
You have a local or general anaesthetic, then the doctor takes out part or all of a lymph node so that it can be looked at under a microscope.
Bone marrow test
The doctor usually takes some bone marrow from the back of the pelvis. (Bone marrow is a spongy substance inside the body's large bones.) Most patients have a local anaesthetic for this, but it can be done with a sedative injection. The sedative injection makes you sleepy and relaxed, and you are unlikely to remember the test later on. The doctor uses a fine needle to take the sample. It may be a bit painful for a little while afterwards, but taking normal painkillers should help.
The biopsy or bone marrow sample will show whether you have cancer and, if you do, whether you have a low grade lymphoma or a high grade lymphoma. The two types are treated in different ways.
Next, your doctor will arrange some more tests to find out how advanced the cancer is. These may include...
Blood test
This is a test to find out your blood count – the number of red cells, white cells and platelets in your blood.
Bone marrow test
You will have this test if you didn't have it at an earlier stage (see above).
Computerised tomography (CT or CAT scan)
This is a type of x-ray that creates a picture of the inside of the body. You lie on a couch while it passes through a large, hollow ring. The doctor uses the CT scan to measure the size of the lymph nodes and decide whether any of them have been affected by the lymphoma.
Lumbar puncture
This means taking a sample of fluid from the spine. You have a local anaesthetic, and the doctor uses a fine needle to take the sample. Only a few patients need to have this test.
There is more information about some of these tests in our cancer tests section.
After all the tests have been done, your doctors will be able to work out the stage your disease is at...
Stage I - One
one group of lymph nodes is affected, and the disease is on only one side of the diaphragm (above or below it)
Stage II - Two
two or more groups of nodes are affected, and the disease is on only one side of the diaphragm (above or below it)
Stage III - Three
the disease is in the lymph nodes above and below the diaphragm
Stage IV - Four
the disease has spread beyond the lymph nodes – for example to the bone marrow or the liver.
