Lymphoma Diagnostic Approach and Management

Initial Evaluation and Diagnosis

The American College of Physicians recommends evaluating patients for constitutional symptoms, including fever, night sweats, weight loss, and fatigue, when suspected of having lymphoma 2
A thorough physical examination of all lymphoid regions, with special attention to the abdomen for hepatosplenomegaly and masses, is necessary for patients with suspected lymphoma 2
Documenting performance status is crucial as it impacts treatment decisions and prognosis in patients with lymphoma 2
Complete blood count with differential should be performed to assess for cytopenias in patients with suspected lymphoma 2
Comprehensive metabolic panel, including liver and renal function tests, is recommended for patients with suspected lymphoma 2
Lactate dehydrogenase (LDH) and uric acid levels should be measured as markers of tumor burden in patients with lymphoma 2
Hepatitis B, C, and HIV screening is mandatory before initiating rituximab therapy in patients with lymphoma 2
Protein electrophoresis is recommended for B-cell lymphomas, according to the European Society for Medical Oncology 3

PET/CT scan (skull base to mid-thigh) is essential for initial staging of lymphoma, as recommended by the National Comprehensive Cancer Network 1, 2
Diagnostic contrast-enhanced CT of neck, chest, abdomen, and pelvis may be used if PET/CT is not immediately available 2
The Ann Arbor classification system is used for staging lymphoma, as recommended by the International Lymphoma Study Group 4, 3, 2
International Prognostic Index (IPI) should be calculated for prognostic purposes in patients with lymphoma, according to the European Society for Medical Oncology 4, 3

Excisional lymph node biopsy is the preferred diagnostic method for lymphoma, as recommended by the College of American Pathologists 2, 1
Core needle biopsy should only be performed when excisional biopsy is not feasible, according to the World Health Organization 2, 1
Fresh frozen and formalin-fixed samples should be obtained for adequate pathological evaluation of lymphoma, as recommended by the European Society for Medical Oncology 4
The histological report should include diagnosis according to the WHO classification with appropriate immunohistochemistry, according to the International Lymphoma Study Group 4, 3

History and physical examination should be performed every 3 months for 2 years, every 6 months for 3 more years, and then once a year, as recommended by the European Society for Medical Oncology 4, 5
Blood count and LDH should be evaluated at 3, 6, 12, and 24 months, then only as needed for evaluation of suspicious symptoms, according to the National Comprehensive Cancer Network 5
Evaluation of thyroid dysfunction is recommended in patients with irradiation to the neck at 1, 2, and at least at 5 years, as recommended by the American Thyroid Association 5
Women who received chest irradiation at premenopausal age should be screened for secondary breast cancers, according to the American Cancer Society 5