Pre- and post-treatment evaluation of non-Hodgkin's lymphoma

Once the diagnosis of a non-Hodgkin's lymphoma (NHL) has been established three critical steps in patient management must follow. The first is the pre-treatment evaluation and staging to identify prognostic factors (the subject of another chapter in this volume), impending problems, such as ureteral obstruction, spinal cord compression, biliary or vena caval obstruction. This assessment directs the best therapeutic approach, and also provides a baseline against which to assess response. The second step is the treatment itself. Third, conscientious follow-up after completion of therapy to monitor for disease recurrence as well as for long-term sequelae of therapy. A careful history and physical examination are the most important components of patient evaluation. Whereas some evaluation procedures have become standard practice (e.g. chest radiographs, CT scans, gallium scan, blood chemistry and assessment of hepatic and renal function), the role of other studies is still being defined (e.g. PET scan). The increased use of systemic therapies has somewhat reduced the requirement for precise staging to determine treatment strategies, but will become more critical to identify early patients with resistant disease and those with minimal residual disease following treatment so that novel therapies can be introduced at that point.