Haematology Cancer - The Dudley Group NHS Foundation Trust

Haematology Cancer services

The Haematology department based at Russells Hall Hospital within The Dudley Group NHS Foundation Trust treats patients with all types of blood disorders, including Myeloma, Lymphoma, leukaemia and myelodysplastic syndromes. We pride ourselves being at the cutting edge of Haematology and maintaining gold standard care in these conditions.

Our Haematology team consists of 8 Haematology consultants and 6 Clinical Nurse Specialists. Patients are treated on ward C4 and Georgina day case Unit; the unit has level III accreditation, which enables us to perform apheresis and autologous stem cell transplants.

C4 is a 22 bedded unit with six positive pressure isolation rooms which have en- suite facilities. All beds in the inpatient unit have individual televisions that are free for patients to use throughout their stay. The unit also has a day case, compromising of 12 reclining chairs and two triage trolley spaces. The triage service runs on the unit from 9am – 5pm, Monday to Friday, where patients can be assessed and treated as needed. Out of these hours, there is a 24 hour telephone advice line for patients. There is a home chemotherapy service available to haematology patients on selected treatments.

Within the unit, there are outpatient clinics that run each day with two dedicated waiting rooms, both with television screens and access to a free drinks machine. Within the POD waiting room, there is a phlebotomy service each morning to ensure that patients can have urgent blood tests performed.

The majority of patients have a diagnosis of cancer and are undergoing chemotherapy and/or stem cell transplantation, although we also care for patients with non-cancerous blood conditions. We strive for quality and best patient care through dedication and clinical trials.

Clinic times

Russells Hall Hospital

Monday 9am – 1pm
Tuesday 9am – 1pm and 1pm – 6pm
Wednesday 9am – 1pm (thrombosis clinic)
Thursday 9am – 1pm and 2pm – 6pm
Friday 10am – 1pm, 9am – 12pm (virtual haematology clinic)

Our Consultants

Dr Jeffrey Neilson
Dr Craig Taylor
Dr Savio Fernandes
Dr Rupert Hipkins
Dr Steve Jenkins
Dr Shereef Elmoamley
Dr Ovini Gamage
Dr Neil Smith

Our Clinical nurse Specialist’s (CNS’s)

CNS Angela Young
CNS Dawn Braznell
Sister Julie Bradley
Sister Judy Thompson
Sister Michelle Bourne
CNS-Rebecca Lockley

Haematological cancers

Myeloma

Multiple myeloma, also known as Myeloma, is a type of bone marrow cancer. Bone marrow is the spongy tissue at the centre of some bones that produces the body’s blood cells.

It’s called Multiple Myeloma as the cancer often affects several areas of the body, such as the spine, skull, pelvis and ribs.

Symptoms of multiple myeloma

In the early stages, myeloma may not cause any symptoms. It’s often only suspected or diagnosed after a routine blood or urine test.

Eventually, myeloma causes a wide range of problems, including:

a persistent dull ache or areas of tenderness in your bones
weak bones that break (fracture) easily
tiredness, weakness and shortness of breath – caused by anaemia
repeated infections
kidney problems
less commonly, bruising and unusual bleeding – such as frequentnosebleeds, bleeding gums and heavy periods

Myeloma doesn’t usually cause a lump or tumour. Instead, it damages the bones and affects the production of healthy blood cells.

See a GP if you have any of the symptoms of Multiple Myeloma. While they’re unlikely to be caused by cancer, it’s best to get a proper diagnosis.

Your GP will examine you to check for bone tenderness, bleeding, signs of infection and any other symptoms that suggest you might have myeloma. They may also arrange blood and urine tests.

If Myeloma is suspected, you’ll be referred to a consultant Haematologist (a specialist in blood conditions) for further tests and treatment.

In hospital you are likely to have X-rays taken of your arms, legs, skull, spine and pelvis to look for any damage.

It’s likely you will also need other scans, such as a CT Scan or an MRI Scan.

A bone marrow biopsy is usually needed to confirm multiple myeloma. (See investigations)

Treatment for Multiple Myeloma

Treatment can often help to control the condition for several years, but most cases of multiple myeloma can’t be cured. Research is ongoing to try to find new treatments.

Treatment for Multiple Myeloma usually includes:

anti-Myeloma medicines to destroy the Myeloma cells or control the cancer when it comes back (relapses)
medicines and procedures to prevent and treat problems caused by Myeloma – such as bone pain, fractures and anaemia

As part of your treatment, you may be asked if you want to take part in a clinical trial help researchers develop better treatments for Multiple Myeloma.

For more information about Myeloma, please see www.myelomauk.org.uk

Amyloidosis

Amyloidosis is the name for a group of rare, serious conditions caused by a build-up of an abnormal protein called amyloid in organs and tissues throughout the body.

The build-up of amyloid proteins (deposits) can make it difficult for the organs and tissues to work properly. Without treatment, this can lead to organ failure.

Cause of AL amyloidosis

AL amyloidosis is caused by an abnormality in certain cells found in the bone marrow, called plasma cells.

The abnormal plasma cells produce abnormal forms of light chain proteins, which enter the bloodstream and can form amyloid deposits.

Healthy people have normal light chain proteins in their blood that are part of their natural antibody proteins. These help protect the body from infection.

The abnormal light chains in patients with AL amyloidosis clump together into thread-like strings (amyloid fibrils) that the body cannot clear away easily.

Over time, amyloid fibrils build up as AL amyloid deposits in tissues and organs. This gradually stops them functioning properly, causing the many symptoms of AL amyloidosis.

Unlike some other types of amyloidosis, AL amyloidosis is not inherited, so a person with the condition cannot pass it on to their children.

Treating AL amyloidosis

There is not currently a cure for amyloidosis. The amyloid deposits cannot be directly removed.

But there are treatments to stop more of the abnormal proteins being produced and treat your symptoms.

These treatments can give your body time to gradually clear the deposits before they build up again. This can help prevent organ damage.

In most cases, the treatment will involve having chemotherapy. Chemotherapy damages abnormal bone marrow cells and stops them producing the abnormal proteins that form amyloid deposits.

Steroids are usually given together with chemotherapy to boost the effect of the chemotherapy drugs. They may also lessen your chances of having a bad reaction to chemotherapy.

Your doctor may also discuss using other treatments, such as a stem cell transplant..

You may also need special medicine if you have heart failure or kidney failure.

Your doctors and nurses will need to carefully control the amount of salt you have and how much you drink. You may also need dialysis you have end-stage kidney failure.

Some people with kidney failure may be suitable for a kidney transplant. But the underlying problem with your bone marrow will still need to be treated using chemotherapy as this will prevent a build-up of amyloid in the new kidney.

After chemotherapy, you’ll need regular check-ups every 6 to 12 months to look for signs of the AL amyloidosis returning. If it does return, you may need to start chemotherapy again.

Diagnosing AL amyloidosis

Diagnosing AL amyloidosis can be hard, as the symptoms are often vague.

A small tissue sample (a biopsy) can be taken from the affected part of your body. Your doctor will talk to you about how this will be done.

The biopsy will be examined under a microscope in a laboratory to see if there are any amyloid deposits in it.

Other tests

You may also have other tests to assess how the amyloid deposits have affected your individual organs.

For example:

taking a sample of your bone marrow
a heart ultrasound scan (an echocardiogram) to check the condition of your heart
various different blood tests to look for damage to your heart, kidneys or other organs
a CT Scan or MRI Scan to check the health of different organs in your body

The NHS National Amyloidosis Centre at the Royal Free Hospital in London also offers a type of body scan called an SAP scan.

This involves being injected with a small amount of a radio-labelled blood protein called serum amyloid P component (SAP). You are then scanned with a special camera that detects the radioactivity.

The radio-labelled protein sticks to any amyloid deposits in your body, so you can see the areas of your body that are affected.

Information about you

If you have amyloidosis, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS).

This helps scientist’s look for better ways to prevent and treat this condition. You can opt out of the register at any time.

The Leukaemias

Leukaemia’s are a cancer of the white blood cells. Acute leukaemia means it progresses quickly and aggressively, and usually requires immediate treatment.

Acute leukaemia is classified according to the type of white blood cells affected.

The 2 main types of white blood cells are:

lymphocytes – which fight viral infections
myeloid cells – which do different things, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage

Acute Myeloid Leukaemia (AML)

AML is a rare type of cancer, with around 3,100 people diagnosed with it each year in the UK.

The risk of developing AML increases with age. It’s most common in people over 75.

In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests.

A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate leukaemia.

If this is the case, you’ll be urgently referred to a a specialist in treating blood conditions (haematologist).

A haematologist may carry out further tests.

Acute Lymphoblastic Leukaemia (ALL)

Acute lymphoblastic leukaemia is a type of cancer that affects white blood cells. It progresses quickly and aggressively and requires immediate treatment. Both adults and children can be affected.

Acute lymphoblastic leukaemia is rare, with around 790 people diagnosed with the condition each year in the UK. Most cases of acute lymphoblastic leukaemia develop in children, teenagers and young adults.

Although it is rare, acute lymphoblastic leukaemia is the most common type of leukaemia that affects children. About 85% of the cases that affect children happen in those younger than 15 (mostly between the ages of 0 and 5). It affects slightly more boys than girls

The first step in diagnosing acute lymphoblastic leukaemia

If the blood sample contains a high number of abnormal white blood cells, it could be a sign of acute leukaemia. Your GP will refer you to a doctor who specialises in treating blood conditions (Haematologist).

Chronic Myeloid Leukaemia (CML)

Chronic myeloid leukaemia is a type of cancer that affects the white blood cells and tends to progress slowly over many years.

It can occur at any age, but is most common in older adults around 60-65 years of age.

In CML, the spongy material inside some bones (bone marrow) produces too many myeloid cells – immature white blood cells that are not fully developed and do not work properly.

Some cases of chronic myeloid leukaemia (CML) are detected during blood tests carried out for another reason.

But you should visit your GP if you have worrying symptoms of CML, such as persistent tiredness, unusual bleeding or bruising, unexplained weight loss or night sweats.

Seeing your GP

Your GP will ask about your symptoms and may carry out a simple examination to check for other problems, such as swelling in one side of your tummy.

They may also send a sample of your blood to a laboratory so it can be checked for

possible causes of your symptoms.

A very high level of white blood cells in your blood could be a sign of leukaemia. If this is detected, you’ll be referred to a haematologist (specialist in blood conditions) for further tests.

Chronic Lymphocytic Leukaemia (CLL)

Chronic lymphocytic leukaemia is a type of cancer that affects the white blood cells and tends to progress slowly over many years.

It mostly affects people over the age of 60 and is rare in people under 40. Children are almost never affected.

In chronic lymphocytic leukaemia (CLL), the spongy material found inside some bones (bone marrow) produces too many white blood cells called lymphocytes, which are not fully developed and do not work properly.

Over time this can cause a range of problems, such as an increased risk of picking up infections, persistent tiredness, swollen glands in the neck, armpits or groin, and unusual bleeding or bruising.

Most cases of chronic lymphocytic leukaemia (CLL) are detected during blood tests carried out for another reason.

But you should visit your GP if you have any symptoms of CLL such as persistent tiredness, unusual bleeding or bruising, unexplained weight loss or night sweats.

Your GP may:

ask about your symptoms and your medical and family history
carry out a physical examination to check for problems such as swollen glands and a swollen spleen
send off a blood sample for testing

If your GP thinks you could have CLL, you’ll be referred to a hospital doctor called a haematologist, a specialist in blood disorders, for further tests.

Hairy Cell leukaemia

Hairy cell leukaemia is one of the rarest types of leukaemia, which is cancer of the white blood cells.

It gets its name from the fine, hair-like strands around the outside of the cancerous cells, which are visible under a microscope.

It’s not known what causes hairy cell leukaemia. The condition most commonly affects middle aged and older people and is more common in men than women.

The symptoms of hairy cell leukaemia develop slowly and are similar to those of other types of leukaemia. Symptoms include:

unintentional weight loss
pale skin
pain or swelling in your tummy (abdomen)

The abnormal white blood cells can accumulate in your spleen, causing it to increase in size. The spleen is an organ in the upper left side of your abdomen, behind your stomach and ribs.

If your spleen is enlarged it’s likely you’ll have a painful lump on the left side of your abdomen. If this is the case, you should visit a GP so the lump can be examined.

An enlarged spleen may remove normal blood cells from your blood, leading to a further reduction in the number of normal red and white blood cells and platelets in your blood.

This can cause:

- weakness, tiredness and breathlessness
- frequent infections
- bleeding or bruising easily

The Lymphomas

Non-Hodgkin lymphoma (NHL)

NHL is a type of cancer that develops in the lymphatic system, a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system.

Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes.

In NHL, the affected lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands).

The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.

The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.

Symptoms of non-Hodgkin lymphoma

The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.

Lymph nodes, also known as lymph glands, are pea-sized lumps of tissue found throughout the body.

They contain white blood cells that help to fight against infection.

The swelling is caused by a certain type of white blood cell, known as lymphocytes, collecting in the lymph node.

But it’s highly unlikely you have non-Hodgkin lymphoma if you have swollen lymph glands, as these glands often swell as a response to infection.

Other symptoms

Some people with non-Hodgkin lymphoma also have other, more general symptoms.

These can include:

night sweats
unintentional weight loss
a high temperature (fever)
feelings of breathlessness
persistent itching of the skin all over the body

Other symptoms depend on where in the body the enlarged lymph glands are (for example, swollen tonsils, a lump in the tummy, or skin rashes).

A few people with lymphoma have abnormal cells in their bone marrow when they’re diagnosed.

This may lead to:

persistent tiredness or fatigue
an increased risk of infections
excessive bleeding, such as nosebleeds, heavy periods and spots of blood under the skin

How NHL is diagnosed

The only way to confirm a diagnosis of non-Hodgkin lymphoma is by carrying out a biopsy.

This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory.

Treatments for non-Hodgkin lymphoma

There are many subtypes of non-Hodgkin lymphoma, but they can generally be put into 1 of 2 broad categories:

high-grade or aggressive non-Hodgkin lymphoma – where the cancer grows quickly and aggressively
low-grade or indolent non-Hodgkin lymphoma – where the cancer grows slowly and you may not experience any symptoms for many years

The outlook and treatment for non-Hodgkin lymphoma varies greatly, depending on the exact type, grade and extent of the lymphoma, and the person’s age. Low-grade tumours do not necessarily require immediate medical treatment, but are harder to completely cure.

High-grade lymphomas need to be treated straight away, but tend to respond much better to treatment and can often be cured.

The main treatments used for non-Hodgkin lymphoma are:

Chemotherapy
Radiotherapy
a type of targeted treatment called monoclonal antibody therapy

Overall, most cases of non-Hodgkin lymphoma are considered very treatable.

You can read more detailed information about the outlook for non-Hodgkin lymphoma

on the Cancer Research UK website.

But there’s a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future.

Hodgkins Disease

Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes.

In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.

The most common symptom of Hodgkin lymphoma is a swelling in the neck, armpit or groin. The swelling is usually painless, although some people find that it aches.

The swelling is caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph node (also called lymph glands). Lymph nodes are pea-sized lumps of tissue found throughout the body. They contain white blood cells that help to fight infection.

However, it’s highly unlikely that you have Hodgkin lymphoma if you have swollen lymph nodes, as these glands often swell as a response to infection.

Other symptoms

Some people with Hodgkin lymphoma also have other more general symptoms. These can include:

night sweats
unintentional weight loss
a high temperature (fever)
a persistent cough or feeling of breathlessness
persistent itching of the skin all over the body

Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion.

A few people with lymphoma have abnormal cells in their bone marrow when they’re diagnosed. This may lead to:

persistent tiredness or fatigue
an increased risk of infections
excessive bleeding – such as nosebleeds, heavy periods and spots of blood under the skin

In some cases, people with Hodgkin lymphoma experience pain in their lymph glands when they drink alcohol.

Stages of Hodgkin lymphoma

When testing is complete, it should be possible to determine the stage of your lymphoma. “Staging” means scoring the cancer by how far it’s spread.

The main stages of Hodgkin lymphoma are:

stage 1 – the cancer is limited to 1 group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs)
stage 2 – 2 or more lymph node groups are affected, either above or below the diaphragm
stage 3 – the cancer has spread to lymph node groups above and below the diaphragm
stage 4 – the cancer has spread through the lymphatic system and is now present in organs or bone marrow

Health professionals also add the letters “A” or “B” to your stage, to indicate whether or not you have certain symptoms.

“A” is put after your stage if you have no additional symptoms other than swollen lymph nodes. “B” is put after your stage if you have additional symptoms of weight loss, fever or night sweats.

Treatment

The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. In a few cases, chemotherapy may be combined with steroid medication.

Surgery isn’t generally used to treat the condition, except for the biopsy used to diagnose it.

Overall, treatment for Hodgkin lymphoma is highly effective and

on the Cancer Research UK website.

But there’s a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future.

Hodgkins Disease

Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes.

The most common symptom of Hodgkin lymphoma is a swelling in the neck, armpit or groin. The swelling is usually painless, although some people find that it aches.

However, it’s highly unlikely that you have Hodgkin lymphoma if you have swollen lymph nodes, as these glands often swell as a response to infection.

Other symptoms

Some people with Hodgkin lymphoma also have other more general symptoms. These can include:

night sweats
unintentional weight loss
a high temperature (fever)
a persistent cough or feeling of breathlessness
persistent itching of the skin all over the body

Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion.

A few people with lymphoma have abnormal cells in their bone marrow when they’re diagnosed. This may lead to:

persistent tiredness or fatigue
an increased risk of infections
excessive bleeding – such as nosebleeds, heavy periods and spots of blood under the skin

In some cases, people with Hodgkin lymphoma experience pain in their lymph glands when they drink alcohol.

Stages of Hodgkin lymphoma

When testing is complete, it should be possible to determine the stage of your lymphoma. “Staging” means scoring the cancer by how far it’s spread.

The main stages of Hodgkin lymphoma are:

stage 1 – the cancer is limited to 1 group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs)
stage 2 – 2 or more lymph node groups are affected, either above or below the diaphragm
stage 3 – the cancer has spread to lymph node groups above and below the diaphragm
stage 4 – the cancer has spread through the lymphatic system and is now present in organs or bone marrow

Health professionals also add the letters “A” or “B” to your stage, to indicate whether or not you have certain symptoms.

Treatment

The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. In a few cases, chemotherapy may be combined with steroid medication.

Surgery isn’t generally used to treat the condition, except for the biopsy used to diagnose it.

Overall, treatment for Hodgkin lymphoma is highly effective and most people with the condition are eventually cured.

Myelodispalstic Disorders

Myelodysplastic syndromes (MDS) are a type of rare blood cancer where you don’t have enough healthy blood cells.

It’s also known as myelodysplasia.

There are many different types of MDS. Some types can stay mild for years and others are more serious.

MDS can affect people of any age, but is most common in adults aged 70 to 80 years.

What happens in MDS?

Normally, the spongy tissue found inside bones (bone marrow) produces:

red blood cells to carry oxygen around your body
white blood cells to help fight infection
platelets to help your blood clot

But in MDS, your bone marrow doesn’t make enough of these healthy blood cells. Instead, it makes abnormal cells that aren’t fully developed (immature).

As the condition develops, your bone marrow gets gradually taken over by the immature blood cells, which don’t work properly.

They squeeze out the healthy ones, making the number of cells that manage to get into the bloodstream lower and lower.

The condition can develop slowly (indolent) or quickly (aggressive), and in some people it can develop into a type of leukaemia called Acute Myeloid Leukaemia (AML)

Main types of MDS

MDS can affect just one type of blood cell or many, depending on the type of disease you have.

Until 2016, the types of MDS were called:

refractory anaemia – you don’t have enough red blood cells
refractory cytopenia – you don’t have enough red blood cells, white blood cells or platelets
refractory anaemia with excess blasts – you don’t have enough red blood cells, white blood cells or platelets, and have a higher risk of developing AML

In 2016, the World Health Organization (WHO) changed the terms to:

MDS with single lineage dysplasia (replacing refractory anaemia)
MDS with multilineage dysplasia (replacing refractory cytopenia)
MDS with excess blasts (replacing refractory anaemia with excess blasts)

There are other types of MDS, and your doctor may also talk to you about the “risk group” of your MDS. This refers to how likely it is that your MDS might develop into AML.

Symptoms of MDS

The symptoms you have will depend on the type of MDS. For most people, symptoms are mild at first and slowly get worse.

They can include:

weakness, tiredness and occasional breathlessness (because of the low number of red blood cells)
frequent infections (because of the low number of white blood cells)
bruising and easy bleeding, such as nosebleeds because of the low number of platelets)

Some people with MDS don’t have any symptoms and it’s only picked up after they have blood tests for something else.

If you have any of these symptoms, you should speak to your GP about them.

Treatments for MDS

The type of treatment you get will depend on the type of MDS you have, your risk of developing AML, and whether you have any other health conditions.

The aim of treatment is to get the number and type of blood cells in your bloodstream back to normal and manage your symptoms.

If your MDS has only a low risk of transforming into cancer, you may not need any treatment at first and may just be monitored with regular blood tests.

Risk of development into leukaemia

Some people with MDS go on to develop Acute Myeloid Leukaemia which is cancer of the white blood cells.

This is known as “transformation”. It can take a few months or up to several years before transformation takes place.

The risk of this happening depends on what kind of MDS you have, and the number of normal and abnormal blood cells you have.

Ask your doctor about your risk of developing AML.

Treating your symptoms (supportive treatment)

Symptoms of MDS can often be controlled with a combination of the following treatments:

- injections of growth factor drugs, such as erythropoietin or G-CSF – to increase the number of healthy red or white blood cells
- a blood transfusion – of either red blood cells or platelets, depending on which you need
- drugs to get rid of the excess iron in your blood – which can build up after a lot of blood transfusions

antibiotics to treat infections – if your white blood cell count is low

Haematological Cancer investigations may include:

Blood Test– samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidney are working
Chest Xray – this can check whether the cancer has spread to your chest or lungs
Bone marrow test bone marrow sample – another biopsy may be carried out to see if the lymphoma has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic
CT Scan– this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread of the cancer
MRI Scan– this scan uses strong magnetic fields to build up a detailed picture of areas of your body to check the spread of the cancer

PET Scan– this scan measures the activity of cells in different parts of the body, and can check the spread of the cancer and the impact of treatment; it’s usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working
Lumbar Puncture – using a thin needle, a sample of spinal fluid is taken and examined to see if it contains any lymphoma cells