The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating white blood cells called lymphocytes. Lymphocytes and the lymph system are part of the immune system that protects the body from disease and infection. Cancers of the lymph system are referred to as Hodgkin’s lymphoma or non-Hodgkin’s lymphoma.

Newly diagnosed lymphoma patients are required to undergo a number of tests and procedures to ensure accurate diagnosis and staging. Tests may include a lymph node biopsy, blood tests, a CT scan, PET scan and bone marrow biopsy. Some patients report that of these, the most difficult is the bone marrow biopsy.

Bone marrow, found in the center of most large bones, is a spongy material that produces red blood cells, white blood cells and platelets. A bone marrow biopsy is used to evaluate how well the bone marrow is functioning and to determine if lymphoma is present. This is important because the presence of lymphoma in the bone marrow may change a patient’s therapy. In order to obtain a bone marrow sample, the physician must insert a needle through the skin, muscle and outer edge of bone. Although a bone marrow biopsy is typically associated with little pain and only takes about 10 to 20 minutes, many patients have fear and anxiety before this procedure.

A bone marrow biopsy is typically performed by inserting a needle into the back of the hip bone. Although not always necessary, some doctors will give their patients intravenous medication for relaxation prior to the procedure. The patient typically lies face down and when comfortable, the skin is cleaned and a local anesthetic is administered to numb the skin and periosteum covering the bone. A hollow, stainless steel needle is then inserted into the back part of the hip bone. First, a sample of the liquid marrow is drawn into the syringe (aspiration). The patient might feel some minor discomfort such as a pulling or drawing feeling down the leg. Next, the physician will take a biopsy from the bone marrow by pressing the needle forward and rotating in both directions in order to break away a small sample. Most physicians use the same needle for both aspiration and biopsy collection. After the aspiration and biopsy, the needle is removed, pressure is applied and a bandage is placed on the biopsy site. Most patients report that after the procedure, the pain immediately diminishes, but they are left with minor discomfort for a few hours. The doctor performing the biopsy may provide specific follow-up instructions, depending on sedation and individual circumstances.

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Patients should talk to their doctor before the procedure in order to understand how to manage or minimize any discomfort or anxiety associated with a bone marrow biopsy. If properly performed, a bone marrow biopsy should not cause patients significant pain and should provide useful information for the appropriate management of lymphoma. For more information on a bone marrow biopsy for the staging of lymphoma, talk to your doctor.

Information presented in The Daily Tip is offered as a guide to augment a patient’s research of cancer and treatment and does not replace the advice of a doctor. For more information on a specific cancer, go,, and consult your physician. For more information on lymphoma, patients can visit the Leukemia and Lymphoma Society’s Web site