Understanding Cancer Staging

Unlike many other cancers, NHL staging is less about how advanced the disease is and more about identifying where it is located. It doesn't tell doctors how well a patient will respond to treatment, nor does it predict the outcome. So while David was diagnosed with Stage IV lymphoma, it is still considered very treatable.

The Role of Imaging

Imaging plays a critical role in diagnosing, staging, and managing lymphoma.

When a patient's medical history and physical exam suggest lymphoma may be present, doctors often order imaging tests. These tests can reveal enlarged lymph nodes in the chest, abdomen, or other areas of the body. They can also identify tumor masses outside the lymph nodes, such as in the lungs, bones, or other tissues.

Common imaging tests include:

• CT scans

• MRI scans

• X-rays

• PET-CT scans

These images help doctors evaluate the location and extent of lymph node involvement, determine whether organs outside the lymphatic system are affected, and identify tumor masses that may be present in multiple locations.

Blood Tests Tell Another Part of the Story

Imaging is only one piece of the puzzle.

Doctors also rely on blood tests to evaluate disease severity, assess organ function, and identify biological markers that can provide prognostic information for specific lymphoma subtypes.

Some of these tests include:

Complete Blood Count (CBC)

Measures red blood cells, white blood cells, and platelets. It can reveal conditions such as anemia, neutropenia, or thrombocytopenia.

Comprehensive Metabolic Panel (CMP)

Evaluates up to 14 different substances in the blood, including electrolytes, glucose, and markers of liver and kidney function.

Beta-2 Microglobulin Test

Measures a small protein produced by several types of cells, including lymphoma cells.

Lactate Dehydrogenase (LDH)

Measures a protein found in most cells. When cells are damaged, LDH is released into the bloodstream and can provide important information about disease activity.

Hepatitis B and C Testing

Certain lymphoma treatments can reactivate hepatitis infections, so doctors need to know if either virus is present before treatment begins.

HIV Testing

If HIV is present, it can influence how lymphoma treatment is managed.

Uric Acid Test

Measures the amount of uric acid in the blood. When cancer cells die, they release their contents into the bloodstream. If too many cells break down at once, the kidneys may struggle to remove these substances.

Immunoglobulin (Antibody) Testing

Measures proteins produced by B-cells that help the body fight infections.

Bone Marrow Biopsy

Some patients will also undergo a bone marrow biopsy.

This test helps doctors determine whether lymphoma has spread to the bone marrow and whether that involvement may affect treatment decisions. Not every patient requires this test, but it can provide important information when needed.

Making Sure the Heart Is Ready

As if all those tests weren't enough, doctors also need to make sure the heart is strong enough for treatment.

Certain chemotherapy drugs, including doxorubicin, can affect heart function. To evaluate the heart, doctors may order:

• An echocardiogram, which uses ultrasound technology to create images of the heart.

• A MUGA (Multigated Acquisition) scan, which measures how effectively the heart pumps blood. During this test, a small radiotracer is injected into a vein and special cameras capture images of the heart.

Additional Tests

Depending on the specific subtype of NHL, a patient may also undergo:

• Upper or lower endoscopy

• Colonoscopy

• Testicular ultrasound

• Lumbar puncture (spinal tap)

• MRI of the brain or spinal cord

Putting All the Pieces Together

Once all of these tests are complete, the medical team gathers the information to identify the specific subtype of NHL, determine where the disease is located throughout the body, and develop a treatment plan tailored to the patient.

What surprised us most was learning how much information is needed before treatment can even begin. The staging process isn't just about assigning a number. It's about giving the medical team the clearest possible picture of what they're fighting so they can choose the best path forward.

When we first heard "Stage IV," we thought it meant the worst. What we've learned is that in lymphoma, staging tells the doctors where the disease is, not whether hope is lost. And that's an important distinction.

We all hear about cancer staging, but I'm not sure everyone truly understands what it means.

In David's case, we went from knowing he had cancer to learning it was Stage IV cancer. That felt like a punch to the stomach. In an instant, it felt like we had gone from zero to four.

What we learned, however, is that staging in Non-Hodgkin lymphoma (NHL) doesn't necessarily mean what many people think it does.

Doctors determine a patient's stage by reviewing physical exams, imaging studies, and laboratory results. Staging helps them understand where the lymphoma is located throughout the body and guides treatment decisions.

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