What tests should I get after a Follicular Lymphoma diagnosis

Essential Tests After a Follicular Lymphoma Diagnosis

After being diagnosed with follicular lymphoma (FL), your care team will order several important tests to understand your specific situation and plan the best treatment approach. Here's what you should expect:

Blood Tests

According to the NCCN Guidelines for Follicular Lymphoma, these blood tests are essential:

Complete Blood Count (CBC) with Differential

• Measures red blood cells, white blood cells, and platelets
• Gives an overall picture of your blood health
• The differential counts each type of white blood cell to see if they're balanced

Comprehensive Metabolic Panel (CMP)

• Checks how well your kidneys and liver are working
• Measures important substances in your blood
• Important because some treatments can affect organ function

Lactate Dehydrogenase (LDH)

• A protein released when cells break down or grow rapidly
• Helps assess disease activity and prognosis
• Elevated levels may indicate more aggressive disease

Hepatitis B and C Testing

• Critical because certain lymphoma treatments can reactivate these viruses
• Testing includes hepatitis B surface antigen (HBsAg) and core antibody
• If positive, your doctor will monitor viral load closely

Additional Blood Tests (Often Ordered)

• Beta-2-microglobulin (helps calculate prognostic scores)
• Uric acid (important before treatment starts)
• Quantitative immunoglobulins (antibody levels)
• Serum protein electrophoresis (SPEP)

Imaging Studies

PET/CT Scan (Preferred)

• Combines positron emission tomography (PET) with CT imaging
• Shows where lymphoma is located throughout your body
• Helps determine your disease stage (how far it has spread)

Alternative: CT Scan with Contrast

• Used if PET/CT isn't available
• Covers chest, abdomen, and pelvis
• Provides detailed images of lymph nodes and organs

Tissue Biopsies

Lymph Node Biopsy (Already Done for Diagnosis)

• Your pathologist should review this with specialized testing including:
  • Immunohistochemistry (IHC) - identifies specific markers on cancer cells
  • Flow Cytometry (FCM) - detects cell characteristics
  • Genetic testing - looks for specific chromosome changes

Bone Marrow Biopsy and Aspirate

• Removes a small sample of bone marrow (usually from your hip bone)
• Determines if lymphoma has spread to the bone marrow
• May be deferred if you're starting with "watch and wait" (active surveillance)
• Helps evaluate unexplained low blood counts if present

Physical Examination

Your doctor will perform a thorough exam paying special attention to:

• Lymph nodes in your neck, armpits, and groin
• Size of your liver and spleen
• Overall performance status (how well you're functioning)

Assessment of Symptoms

Your care team will ask about B symptoms:

• Fever
• Drenching night sweats
• Unintentional weight loss (more than 10% of body weight over 6 months)

These symptoms affect treatment planning and prognosis.

Additional Tests (When Needed)

Depending on your situation, your doctor may also order:

• Echocardiogram or MUGA scan - if you'll receive certain chemotherapy drugs that can affect the heart
• Neck CT with contrast - if there's concern about lymph nodes in the neck
• Pregnancy test - if you're of childbearing age and chemotherapy or radiation is planned
• Fertility preservation discussion - before starting treatment if relevant to you

Timeline and Next Steps

According to the NCCN Guidelines, testing can take days or weeks for all results to come in. Here are important questions to ask your care team:

1. What grade and stage of follicular lymphoma do I have?
2. What do these results mean for my treatment options?
3. How soon will I have all my test results?
4. Who will explain these results to me, and when?
5. Will my insurance cover these tests?
6. How often will these tests be repeated during treatment?

Important Reminders

• Request a copy of your pathology report and all test results
• Don't hesitate to ask your care team to explain anything you don't understand
• Consider bringing someone with you to appointments to help take notes
• Keep organized records of all your test results and medical documents
• Online patient portals (like MyChart) can help you access results, but discuss them with your doctor before drawing conclusions

The NCCN Guidelines emphasize that accurate testing is essential to diagnose and treat follicular lymphoma properly. These tests help your care team understand your specific disease and create a personalized treatment plan.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.