BONE MARROW ASPIRATION AND BIOPSY Bone marrow aspiration and biopsy are done to help determine if the non-Hodgkin lymphoma cells have spread to the bone marrow, the blood-producing factory in the body. Aspiration involves inserting a special needle into one of the bones (usually the back of the hip bone) and drawing a small amount of bone marrow (liquid part) out into a syringe. The biopsy is done after the aspiration is completed and includes taking a very small piece of bone (bone chip) and sending it to the laboratory for review. This test helps determine the stage of the disease. The procedure is uncomfortable; most children are given pain medicine or sedated during the test. LUMBAR PUNCTURE This test is done to determine if any non-Hodgkin lymphoma cells have spread to the brain or spinal cord. A needle is inserted between the spaces of the spinal bones in order to obtain a sample of cerebrospinal fluid (CSF). This test can be slightly uncomfortable. Some children are given sedation to help them lie still. PLEURAL OR PERITONEAL FLUID ASSESSMENT Sometimes non-Hodgkin lymphoma cells can spread to the thin membranes inside the pleural (chest) or peritoneal (belly) cavities, causing fluid to accumulate. Testing of the fluid can be done by inserting a needle through the skin into the chest or belly and withdrawing a small sample of the fluid. Your child’s skin is numbed with a local anesthetic. Most children will be sedated for the procedure. This procedure may be done in place of a tumor biopsy in certain situations. TUMOR BIOPSY In order to obtain an accurate diagnosis and determine the type of non-Hodgkin lymphoma, a biopsy is needed. A biopsy is routinely done by removing one of the enlarged lymph nodes or removing a small part of the tumor. The biopsy is usually performed in the operating room by a surgeon. Some medical centers perform the biopsy in the radiology department. In some cases, the biopsy sample is obtained through a needle that is guided into the lymph node or tumor (fine-needle aspiration biopsy). In other cases, an incision is made. Your child’s comfort and anxiety level will always be considered in planning procedures that involve needles. VENOUS ACCESS DEVICE A venous access device (VAD), sometimes called a “central line,” is a permanent IV tube that can be used for the duration of your child’s therapy. A VAD can be used to administer medications, chemotherapy, blood products, and nutritional support when needed, as well as to draw blood for testing. It is inserted when your child is under heavy sedation or anesthesia. A VAD is used in some but not all children. n HOW IS NON-HODGKIN LYMPHOMA TREATED? Non-Hodgkin lymphoma is primarily treated with chemotherapy. Surgery is performed to obtain a biopsy to make a diagnosis. Surgical removal of the tumor may be done for children with Burkitt’s-type non-Hodgkin lymphoma. Radiation is not usually used to treat non-Hodgkin lymphoma, except in certain emergency situations, such as breathing problems.
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