Peripheral T-Cell Lymphoma: Diagnosis and Staging

Recognizing PTCL
The most common sign of NHL is one or more enlarged lymph nodes in the neck, armpit or groin. Enlarged lymph nodes also can be near the ears or elbow. Some of these symptoms are similar to those of a cold, the flu or some other respiratory infection. Most people who have these non-specific symptoms will not have lymphoma.

However, it is important that anyone with persistent symptoms be examined by a doctor to make sure lymphoma is not present. To diagnose PTCL, physicians will need to conduct a number of tests to distinguish between T-cell and B-cell lymphoma and to determine the PTCL subtype. Confirmation of the diagnosis will require a tissue biopsy rather than a needle biopsy.

How is PTCL different from other types of lymphoma?
Compared with B-cell non-Hodgkin lymphomas, PTCL is more likely to present with cancer cells that have spread beyond the lymph nodes to skin and other organs and bone marrow. It may also have a more aggressive clinical course.

PTCL versus CTCL
PTCLs are distinct entities from CTCLs and follow a different clinical course. While some PTCL may present with skin involvement, CTCLs originate in and are characterized primarily by localization of neoplastic T lymphocytes to the skin. CTCLs primarily follow an indolent course of disease, while PTCLs are more aggressive.
 

Lymphomas, including PTCLs, are divided according to how fast they grow: "indolent lymphomas" grow slowly and "aggressive lymphomas" grow quickly. When doctors describe lymphoma, they will often use these terms.

The Ann Arbor system is commonly used to identify a cancer’s stage (the degree to which a cancer has spread). Knowing what stage your disease is will help you and your healthcare team plan for your future and determine the right treatment for you.

  • Stage I - disease in single lymph node or lymph node region.
  • Stage II - disease in two or more lymph node regions on same side of diaphragm.
    • Note: Stage II contiguous means two or more lymph nodes in close proximity (side by side).
  • Stage III - disease in lymph node regions on both sides of the diaphragm are affected.
  • Stage IV - disease is wide spread, including multiple involvements at one or more extranodal (beyond the lymph node) sites, such as the bone marrow.

The aggressive PTCL subtypes are more likely to present with late stage disease. Prognosis is typically poor with 25 percent to 40 percent of patients surviving for five years from diagnosis.