The importance of staging in Hodgkin’s and Non-Hodgkin’s Lymphoma

Dear Ask The Doctor: My husband and I were made aware of his FNA boipsy of lower neck lymph nodes. They stated no Non-Hodgkins, but that they couldn't "rule out" Hodgkins. Husband is set for a PET scan tomorrow. I assumed a biopsy was a sure way to tell if there was any cancer. The doctor said the PET scan would show the lymph nodes lighting up "if" it was cancer. Is there any way the biopsy could not have shown cancer cells? The doc mentioned the PET scan would be for "staging?" What does that mean? Should he have told us up front it was Hodgkins? Thank you in advance.

Dear Allison: Hodgkin's lymphoma is a type of lymphoma, which is a type of cancer originating from white blood cells called lymphocytes. Non-Hodgkin lymphoma refers to any kind of lymphoma except Hodgkin's lymphomas. From the result of the FNA you describe, it seems that the diagnosis is one of lymphoma, but the type of lymphoma present remains unclear, hence the need for further investigation with PET scanning. It is important to know what type of lymphoma is present, as treatment and prognosis is dependent on the specific diagnostic type. Staging refers to what area of the body is affected and is also important for prognosis. Stage I is involvement of a single lymph node region; Stage II is involvement of two or more lymph node regions on the same side of the diaphragm; Stage III is involvement of lymph node regions on both sides of the diaphragm; Stage IV is dispersed throughout the body.