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Principles of diagnosis, staging and management

Imperial Cancer Research Fund Medical Oncology Unit, St Bartholomew's Hospital, 45 Little Britain, London EC1A 7BE, UK

Summary

• The diagnosis of Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) must be based on a tissue biopsy. Re-biopsy should be performed at each recurrence when possible.
  
• The new WHO classification of NHL takes into consideration immunophenotype (90% of lymphomas are B-cell origin), cytogenetics and molecular biology.
  
• "Staging investigations", i.e. CT scans and a bone marrow aspirate and trephine biopsy, should be performed at presentation and at recurrence to determine the extent and distribution of disease.
  
• Treatment will depend on histological subtype, stage, and the age and performance status of the patient.
  
• Patients with HD, diffuse large B-cell NHL and lymphoblastic lymphoma/Burkitt's lymphoma are treated with curative intent. In other subtypes of NHL, recurrence is virtually inevitable with conventional therapy.
  
• Imaging is essential for staging, assessment of response and in the diagnosis of relapse. Standardized response criteria have been developed, and should be adopted for clinical usage.