The short answer
Lymphoma treatment depends on naming the exact subtype, and that needs enough tissue: a core needle gave a definite diagnosis in 92.3% of cases against 98.1% for a whole node. Hepatitis B and C screening and a fertility conversation are worth raising before treatment starts.
In a review of more than 32,000 lymphoma cases in France, core needle biopsy gave a definite diagnosis in 92.3% of cases and removing a whole node in 98.1%.
The FLIPI score for follicular lymphoma is built from age, LDH level, stage, hemoglobin, and how many node areas are involved.
CDC advises hepatitis B testing before chemotherapy or immunosuppressive treatment, with three tests: HBsAg, anti-HBs and total anti-HBc. Ask what your results mean for your plan.
Reducing radiation volume lowered the later risk of breast cancer after Hodgkin lymphoma, and proton therapy may be considered when the field covers the left side of the heart.
On this page
Choose how you want to read this
The whole article, with every detail and caution.
This page is for adults with lymphoma and the people helping them. It lists questions to ask your care team, from the biopsy through to fertility.
Lymphoma is dozens of diseases. Hodgkin lymphoma, follicular lymphoma, diffuse large B-cell lymphoma and the rarer T-cell types are staged, treated and monitored differently, and the evidence quoted here is drawn from more than one of them. Use these as questions to raise, and check every answer against your own named subtype.
The biopsy decides everything after it
Lymphoma treatment depends on naming the exact subtype. That needs enough tissue.
NCI reports a review of more than 32,000 lymphoma cases in France. A core needle biopsy gave a definite diagnosis in 92.3% of cases. Removing a whole node gave one in 98.1%.
That gap is small but real. If your diagnosis came from a needle and the subtype is unclear, ask whether a node should come out.
Prognostic scores you can ask for by name
Lymphoma has published risk scores, and your team can tell you yours.
For follicular lymphoma, NCI describes the FLIPI. Its five factors are age, LDH level (a blood test), stage, hemoglobin, and how many node areas are involved.
Ask what your score is. Ask what it predicts and what it does not.
Safety tests before the first dose
Some checks belong before treatment, not after.
NCI's Hodgkin lymphoma summary lists hepatitis B and hepatitis C blood tests in the work-up for a new diagnosis. NCI's non-Hodgkin summary advises hepatitis C screening before rituximab or chemotherapy in lymphoplasmacytic lymphoma. NCI also says knowing whether you have hepatitis B or C helps plan treatment.
CDC says people having treatment that targets B cells (rituximab is one such drug) are at higher risk of hepatitis B coming back after being quiet. CDC lists three starting tests, so it is worth checking that all three were sent:
- HBsAg — hepatitis B surface antigen.
- Anti-HBs — antibody to the surface antigen.
- Total anti-HBc — antibody to the core antigen.
CDC notes that testing positive for both HBsAg and anti-HBc carries a higher reactivation risk than anti-HBc with anti-HBs. Your oncology team decides what, if anything, to do about a result.
Ask whether your hepatitis screen was done, which results were positive, and whether you need antiviral treatment or extra monitoring.
Protecting the heart and the breast from radiation
Radiation fields in the chest reach organs you want to keep.
NCI notes that reducing radiation volume lowered the later risk of breast cancer after Hodgkin lymphoma.
It also says proton therapy, a type of radiation that stops more sharply at its target, may be considered where chest radiation would cover the left side of the heart, or would raise breast cancer risk in young women.
Questions to ask before treatment starts
- Was my diagnosis made from a needle sample or a whole node?
- Is there enough tissue to name my subtype with confidence?
- What is my risk score, and what does it change?
- Do I need a PET scan and a bone marrow biopsy, and would the marrow result alter treatment?
- Has my hepatitis B and C screening been done, and what do the results mean?
- Can radiation to my chest be reduced, or would proton therapy lower the dose to my heart?
- Should I see a fertility specialist before the first cycle?
When not treating is the plan
For advanced follicular lymphoma, NCI lists watchful waiting as an option: treatment is deferred until symptoms appear.
This is a real strategy, not neglect. Ask exactly what symptom or result would start treatment, and get it written down.
Fertility, before anything else starts
NCI notes that impaired fertility may occur after some lymphoma drugs (alkylating agents). Its Hodgkin summary names freezing eggs or sperm as the first choice for preserving fertility.
Ask about a fertility referral before treatment starts, even if you are unsure about children.
Related pages
Also read: Cancer Staging, Cancer Treatment Overview, Clinical Trial vs Standard Treatment, and Questions to Ask Your Doctor.
Where this comes from
- NCI — Adult Hodgkin Lymphoma Treatment (PDQ) Patient Version
- NCI — Adult Non-Hodgkin Lymphoma Treatment (PDQ) Patient Version
- NCI — Adult Non-Hodgkin Lymphoma Treatment (PDQ) Health Professional Version
- NCI — Adult Hodgkin Lymphoma Treatment (PDQ) Health Professional Version
- CDC — Clinical Overview of Hepatitis B
Common questions
Is a needle sample enough to name my subtype?
Usually, but not always. A core needle gave a definite diagnosis in 92.3% of cases against 98.1% for a whole node. If the subtype is unclear, ask whether a node should come out.
Why am I being screened for hepatitis before treatment?
CDC says people having treatment that targets B cells are at higher risk of hepatitis B reactivation. CDC lists three starting tests: HBsAg, anti-HBs and total anti-HBc. Ask whether yours were done and what the results mean for your plan.
Can chest radiation be made safer?
Ask about volume and about protons. Smaller radiation volumes lowered later breast cancer risk, and proton therapy may be considered where the field would cover the left side of the heart.
Why would my team suggest waiting instead of treating?
For advanced follicular lymphoma, watchful waiting is a real strategy, not neglect. Ask exactly what symptom or result would start treatment, and get it written down.
Questions to ask your doctor
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Sources last checked: 2026-07-30 what this meansLast updated: 2026-08-19Next planned review: 2027-07-30
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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