- Molecular Descriptions and Other Sampling Techniques
In addition to the histopathology, other techniques may be used to assess the presence of cancer in the tissues, including fine needle aspiration cytology, and some of these techniques may be used more extensively in health care settings around the world.4
Leukemias and lymphomas are diagnosed using a combination of their appearance—how the cells look (morphology), their markers or surface proteins that can be detected using antibody tests (immunophenotype), their enzymes that can enable certain chemical reactions to occur (cytochemistry), and their chromosomal changes (karyotype).
Often times in lymphomas and other cancers, a technique called immunohistochemistry is used to help assess the tumor type, prognosis, and treatment.5
- Immunochemistry involves using antibodies to stick to particular tags or markers on the outside of the cancer cells. These markers that the antibodies stick to often have "CD" in their name, which stands for cluster of differentiation.
For example, CD23 and CD5 are microscopic tags that, if present in the cancer cells, might support the notion that chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is a possible diagnosis. These same markers are also present in other malignancies, however, so doctors use a sort of process of elimination based on the available information and what is known about the various malignancies and their "typical" CD markers.
Another example of a CD marker is CD20, which is present in some lymphomas but absent in others. Diffuse large B cell lymphoma, or DLBCL, is a very common lymphoma that is associated with the CD20 marker.
For a given sample of leukemia or lymphoma cells, markers can be tested using an entire panel of antibodies that stick to different markers, with positive and negative controls, built in.
Molecular and chromosomal studies may be done to look at gene rearrangements and specific changes to the chromosomes. Sometimes inserted or deleted genes are linked to information about prognosis. For instance, in chronic lymphocytic leukemia, or CLL, a specific piece of a chromosome is lost, and often times lost along with it is a gene that helps suppress cancer. The 17p deletion is found in about five to 10% of people with CLL, overall.6 The 17p deletion CLL is a form of CLL that is harder to treat with conventional chemotherapy.“