Workup of Lymphoma case

• Lymphoma cases, either non-Hodgkins or Hodgkin’s, need the following workup.

How will you do the clinical Examination?

1. Carefully examine the lymph node, spleen, liver, etc.
2. Lymph nodes are painless and persistently increasing in size.
3. Fever >38 C.
4. Night sweating.
5. Weight loss over the last 6 months.
6. Fatigue, pruritus, alcohol-induced pain in lymph nodes (Hodgkin’s lymphoma).
7. Extranodal symptoms and involvement of CNS, bone marrow, and GITract.
8. How will you perform a physical examination?
   1. Examine the lymph nodes.
   2. Check for liver and spleen.
   3. Check for signs of anemia.
   4. Check for CNS involvement.

What will you order for a blood workup?

1. Total leukocytes (TLC).
2. Differential leukocyte count (DLC). Peripheral blood smears may show abnormal lymphocytes.
3. Hemoglobin.
4. Advise the Erythrocyte sedimentation rate (ESR) and CRP. They are raised in Hodgkin’s lymphoma.
5. Platelet count.

What is the purpose of a Bipedal lymphangiogram.?

1.  This is done for iliac and para-aortic lymph nodes.

What is the purpose of staging laparotomy?

1. Laparoscopy can be done for splenectomy, liver biopsy, abdominal lymph nodes, and bone marrow biopsy.
2. Nowadays, it is not done because of improved imaging.

What Biochemical tests are needed?

1. Liver function test (LFT) and lactate dehydrogenase (LDH) are needed.
2. Advise comprehensive metabolic panel.
3. Advise uric acid.
4. Advise calcium that is raised in bone involvement.

What is the purpose of ultrasonography?

1. CT scan and MRI are advised for further workup.

What is the purpose of liver and spleen scans?

1. 25% positive in the nonpalpable spleen by the pathologist.
2. 50% negative in the palpable spleen by the pathologist.

What is the purpose of Bone Marrow in lymphoma cases?

1. 9% to 29% may show as aggregates or diffuse infiltrates of lymphoma cells.
2. 25% positive in the nonpalpable spleen by the pathologist.
3. 50% negative in the palpable spleen by the pathologist.

• Now, because of modern advances in medical science, staging laparotomy is not needed.

How will you summarize the Lymphoma case workup?

1. Clinical evaluation of the patient:
   1. A thorough physical examination is needed.
   2. Take the detailed history of the patient.
   3. Ask for any other disease present in these patients.
2. Imaging studies:
   1. Imaging is very important in finding the spread of diseases.
   2. Imaging studies avoid staging laparotomy.
   3. Various imaging techniques are:
      1. CT scan (Computed tomography). It will evaluate the lymphadenopathy and any other organs involved.
      2. PET scan (positron emission tomography): This study involved injecting radioactive material. It detects the involvement of the lymph nodes throughout the body.
      3. MRI (magnetic resonance imaging) helps detect brain and spinal cord lymphoma.
      4. X-rays are done on specific areas of the body, especially the chest, for nodal and pulmonary disease.
3. Lab workup:
   1. Advise complete blood count.
   2. Advise liver and kidney function tests.
   3. Lactate dehydrogenase (LDH) helps as a marker and gives a prognosis.
   4. Advise the tumor marker for patient follow-up.
   5. Bone marrow examination for the infiltrate of the lymphoma.

Questions and answers: