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The first step in treating NHL is making an accurate diagnosis. When the symptoms and findings on physical examination raise the possibility of a non-Hodgkin lymphoma diagnosis, laboratory tests and radiology tests will usually be done to help guide how best to determine the diagnosis. To make a definite non-Hodgkin lymphoma diagnosis, a sample of the tumor needs to be obtained for evaluation by the pathologist. This is usually done by having a surgeon or interventional radiology doctor remove a piece of tumor (biopsy). Sometimes the diagnosis may be made by evaluating fluid removed from the chest or abdomen or by removing a small piece of bone marrow to be examined under the microscope.
The second step in treating NHL is to determine how much the disease has spread within the body. The extent of disease is called the "stage" of the lymphoma. Knowing the stage helps to determine the strength of the treatment that is needed to cure the lymphoma. The process of finding all of the sites of disease in the body is called "staging." Staging involves doing radiology tests, such as PET, CT, and MRI scans; sampling the bone marrow with a needle into the hip bones; and obtaining spinal fluid with a needle into the space between the bones of the lower spine (lumbar puncture).
The information learned from the scans and from the bone marrow and spinal fluid evaluations is used to assign a "stage" that describes how extensive the lymphoma is. More than one staging system is used for non-Hodgkin lymphoma. While in adult non-Hodgkin lymphoma a system called the Ann Arbor Staging System is commonly used, in childhood non-Hodgkin lymphoma the most common system of staging is the St. Jude/Murphy Staging System. This system is summarized below:
Because the common childhood non-Hodgkin lymphomas often are located in the chest, abdomen, or next to the spine or brain, many children with non-Hodgkin lymphoma have stage III or IV disease when they are diagnosed.
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