The term “stage” refers to the level of severity of a cancer, and is determined by a combination of physical exam, blood tests and studies (collectively called “staging”).
There are published guidelines (NCCN) for each type of cancer that medical professionals generally follow to determine the stage. Cutaneous lymphomas are staged differently than other cancers, and different types of cutaneous lymphoma are staged differently from each other.
Required procedures to stage cutaneous lymphoma include a complete physical exam (including a thorough skin exam), skin biopsy (removal of a small piece of tissue) for examination under the microscope by a pathologist (a doctor who studies tissues and cells to identify diseases), and blood tests (labs). Other tests that might be performed could include lymph node biopsy, bone marrow biopsy, and imaging tests such as CT (computerized axial tomography and/or PET (positron emission tomography) scans.
Blood tests are recommended for patients who are newly diagnosed with cutaneous lymphoma. The most common blood tests ordered when a patient is first diagnosed with cutaneous lymphoma are complete blood count (CBC), which includes the number of white blood cells, red blood cells, and platelets, and a comprehensive metabolic panel (CMP), which measures electrolytes, liver and kidney function.
Other lab tests may be ordered depending on the type and suspected stage of the cutaneous lymphoma, and include:
Peripheral blood flow cytometry
Flow cytometry of the blood tests for circulating lymphoma cells in the blood (also called Sézary cells), and is often done for newly diagnosed patients with CTCL.
Lactate dehydrogenase level (LDH)
LDH is not a specific lab test, but can be elevated if there is a high rate of cells turning over in the body (such as in an aggressive cancer).
Human T- cell leukemia virus-1 (HTLV-1)
HTLV-1 is a virus that is common in some regions (such as Japan and the Caribbean Islands) and is associated with a subtype of CTCL.
Hepatitis B or C testing
Carrying the Hepatitis B or C viruses can cause chronic liver inflammation, which may interfere with some treatments for cutaneous lymphoma.
Serum protein electropheresis (SPEP)
SPEP screens for elevated proteins in the blood which are associated with some types of B-cell lymphomas.
Bone marrow biopsy
Your providers might recommend evaluating your bone marrow for involvement by cutaneous lymphoma if there are any unexplained abnormal blood counts.
For more information related to staging and pathology reports, we suggest the following videos:
Overview, Diagnosis And Staging of Cutaneous Lymphoma
Joi Carter, MD, Dartmouth-Hitchcock Medical Center, Lebanon
Diagnosis and Staging of Cutaneous Lymphomas
Keri S. Chaney, MD, Wisconsin College of Medicine
Node Pathology and Flow Cytometry
Sherif Rezk, MD, UC Irvine Medical Center