Biopsy for Non-Hodgkin Lymphoma: What to Expect
Like with other forms of cancer, non-Hodgkin lymphoma diagnosis is a multi-step process. Your doctor will first perform a physical exam and ask about your symptoms. You also might have some imaging tests and some blood tests. But a biopsy—taking a sample of your cells and then checking them under a microscope—is the only way to know for sure if you have non-Hodgkin lymphoma. This also will show the type of non-Hodgkin lymphoma, also called non-Hodgkin’s lymphoma. Knowing the specific type is important for planning your treatment.
The type of biopsy you need for diagnosing non-Hodgkin lymphoma depends on where the cancer is located.
Non-Hodgkin lymphoma is a cancer of the lymphatic system. It is the more common than Hodgkin’s disease, another form of lymphoma. All through the lymphatic system are small, oval lymph tissues called nodes. Most non-Hodgkin lymphomas cause swelling in one or more lymph nodes. Lymphoma cells may also form a tumor inside your body.
A biopsy of a lymph node is the most common way to diagnose this cancer.
How you prepare for your biopsy will depend on the type of biopsy. Sometimes the biopsy area is just under your skin. Your doctor might inject a local anesthetic to numb the area. Some biopsies are from a lymph node or other tissue deep below your skin. For this type, you may need a sedative to make you sleepy and relaxed. Other biopsies require surgery to get to the biopsy site. For that, you may be given a drug that will make you sleep and not feel pain — this is general anesthesia.
Tips for anesthesia:
If you are having a general anesthetic: Do not eat or drink anything for at least eight hours before your surgery. Ask your doctor if you can take any regular medications with a sip of water before surgery.
If you are having a general anesthetic or a sedative: Make plans to have someone drive you home after your biopsy.
Tell your doctor about all medications and supplements you take. You might need to stop taking blood-thinning medicines before the biopsy.
Tell your doctor about any allergies you have and reactions you've had to anesthetic medicines or X-ray dyes. That's because you might need an imaging study—an ultrasound, CT scan or MRI—with a contrast dye for better results.
Here, too, the type of biopsy you need makes a difference. It may determine where you will go to have the biopsy. If you need just a local anesthetic, the biopsy may be done at your doctor’s office or an outpatient clinic. You might need to go to a hospital for a biopsy that requires sedation or general anesthesia.
Here's what happens during the most common types of biopsies:
Excisional or incisional biopsy. This type removes all of a lymph node (excisional) or part of a lymph node (incisional). If the lymph node is near your skin, your doctor will numb the area, make an incision to remove a tissue sample or the entire node, close the incision with a few stitches, and cover it with a bandage. If the lymph node is deep under your skin, you may need a sedative or general anesthetic.
Aspiration or core needle biopsy. This type removes a lymph node or tumor cells through a needle your doctor passes through your skin. Aspiration uses a fine needle attached to a syringe. A core biopsy uses a larger needle to remove a little more tissue. You will have a local anesthetic. If the lymph node or tissue is deep inside your body, your doctor may do the biopsy while looking at an imaging study to guide the needle. Sometimes a stitch and small bandage are necessary.
Bone marrow biopsy. Your doctor may perform this biopsy to find out if the cancer has spread to your bone. The tissue sample usually comes from inside the hip bone. Your doctor will numb the area with a local anesthetic and insert a hollow needle into the bone. You may feel some pain when the needle enters the bone. A stitch and a small bandage protects the wound.
Laparoscopic surgical biopsy. This type may be necessary if the scalpel or needle cannot reach the tumor or lymph nodes. Instead, your doctor will make a small incision and insert a tube with a light and camera on it. The doctor can put long, thin surgical instruments through the tube and use them to remove a tissue sample. You will need a general anesthetic for this type of biopsy.
The type of anesthesia you had will affect when you can go home:
If you had a biopsy under local anesthesia, you probably can go home right away and return to normal activities.
If you had a sedative, you will need to wait until the effects have worn off. You also will need someone else to drive you home. Ask your doctor when it's safe to return to normal activities.
If you had a general anesthetic, you may need to stay overnight at the hospital. Again, ask your doctor when you can return to your normal activities.
Once you're home, be sure to pay close attention to the area near your biopsy site. You want to watch for infection, bleeding, and signs of injury to nerves and blood vessels. Let your doctor know if:
The incision area bleeds or oozes other fluid.
The incision area looks red, feels warm or swells.
The area is painful or numb.
Also, if you had stitches, keep the area and bandage dry and clean. You might need to go back to your doctor to remove the stitches.
It may take a few days to get the results of your biopsy.