All checks include anamnesis and clincal exam with special emphasis on lymph node status, examination of the heart, lungs, and abdomen. Focus should be on areas previously infiltrated with lymphoma and areas treated with radiation to find recurrences and side effects after treatment.
Blood tests are taken at all checks and include hematological testing, liver function, and renal function tests. Endocrine tests are more important in children and youth during growth and puberty, and are important for assessment of fertility after treatment. For irradiation of the neck, hypothyroidism is an important and common result. Thyroid function should be checked every time for these patients.
- Imaging of peripheral lymph node regions. These can be done using ultrasound as a supplement to the clinical examination.
- Imaging of thorax. Either CT or X-ray is used. MRI should be considered if the examinations are frequent to limit radiation exposure. Lung parenchyma cannot be adequately assessed with MRI.
- Imaging of the abdomen and pelvis. Ultrasound of the liver, spleen, and retroperitoneum in thin patients should be used instead of CT. Multiple CT examinations involve a significant amount of radiation exposure over time. As an alternative to CT, MRI should be considered.
In children and youth, MRI and ultrasound should be considered routine.
There is no reason to recommend PET or PET-CT for routine follow-up of patients with malignant lymphoma outside of treatment protocols.
Examinations in the first years should focus on excluding recurrences, while after 5 or 10 years they will be directed more toward complications from treatment.
Each protocol specifies the frequency of follow-up checks including the extent of diagnostics.
This is a general guideline:
- Every 3 months the first 2 years
- Every 4 months the 3rd year
- Every 6 months the 4th and 5th year after treatment.
- Annually until 10 years after treatment.
Annual screening for breast cancer (either MR and/or mammography) is recommended for girls and women 35 years and younger who receive radiation therapy to the thorax (mediastinum, axilla, and/or modified mantle field). This should start 8-10 years after treatment, but not before the patient is 25 years old.
Cardiological testing should take place for many years after treatment for patients assumed to have a significant risk for heart damage (cardiac problems during treatment, large anthracycline doses, radiation to parts of the heart). Assessment by a cardiologist with EKG and echocardiography is recommended for 5 years after treatment and is repeated every 5 years.