Diagnosis

A tissue diagnosis is required before initiating definitive treatment, although one may have been performed before referral. Fresh and fixed tissue samples should be collected from the tissue biopsy for anatomical pathology, flow cytometry, cytogenetics and gene mutation testing.

Staging

The disease stage, including evaluation of bone marrow status if full blood test results are significantly abnormal, should be determined. This should include an FDG-PET/CT scan.

Genetic testing

Currently there are no genetic abnormalities known to predispose lymphoma. Any referral made to a familial cancer service should be based on multidisciplinary team recommendations. There are currently no known mutations that require routine testing in these disorders.

Treatment planning

A multidisciplinary meeting (MDM) should be conducted before implementing treatment. A meeting may not be possible if treatment is urgent, but the treatment plan should still be ratified.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs.

Checklist

Timeframe

Timing of diagnostic investigations should be guided by the initial severity of symptoms. Staging should be completed within 2 weeks.