Article updated and reviewed by Corey Cutler, MD MPH FRCP©, Instructor in Medicine, Harvard Medical School, Dana-Farber Cancer Institute on May 11, 2005.
Lymphomas are cancers of the immune system and involve white blood cells. The immune system prevents and fights infectious diseases. The lymphomas are divided into two categories, the non-Hodgkin’s lymphomas and Hodgkin’s disease (Hodgkin’s lymphoma).
The body’s lymphatic system includes a network of thin tubes that branch, like blood vessels, into the tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting white blood cells, called lymphocytes. Along this network of vessels are groups of small, bean-sized organs called lymph nodes that filter the white blood cells in the lymph. Clusters of lymph nodes are found in the underarms, groin, neck, abdomen, and other minor locations. Other components of the immune system include the spleen, thymus, tonsils, and bone marrow.
In non-Hodgkin’s lymphoma, lymphocytes grow abnormally within the lymph nodes and can involve the other organs of the immune system.
There are numerous subtypes of non-Hodgkin’s lymphoma There are several different criteria that differentiate the various subtypes. The non-Hodgkin’s lymphomas can arise in both subtypes of lymphocytes, which are known as B and T cells, but the vast majority arise in B lymphocytes. The non-Hodgkin’s lymphomas can also be divided by their rate of growth. The majority of the non-Hodgkin’s lymphoma are considered low-grade, or indolent, which means that the lymphoma grows slowly. The second most common form are considered high-grade, or aggressive, referring to their rapid growth pattern. There are a small proportion of non-Hodgkin’s lymphomas that are referred to as very high grade, or very aggressive. These non-Hodgkin’s lymphomas grow very rapidly. The differentiation of the various subtypes of non-Hodgkin’s lymphomas is based on their microscopic appearance.
Non-Hodgkin’s lymphoma is an uncommon cancer whose incidence is rising rapidly in North America for unclear reasons. Although non-Hodgkin’s lymphoma can occur at any age, the incidence rises with increasing age. There are no commonly identified risk factors for non-Hodgkin’s lymphoma.
The symptoms of non-Hodgkin’s lymphoma vary from person to person. Often, a painless swelling in the neck, armpit, or groin, caused by an enlarged lymph node can be noted by the affected individual. Enlarging lymph nodes in the abdomen may cause an increase in abdominal girth. Constitutional symptoms, including persistent, recurrent, or cyclical fevers, night sweats, fatigue, and weight loss may be the initial sign of non-Hodgkin’s lymphoma.
Although all of these symptoms can be present in other illnesses, they may suggest Hodgkin’s disease particularly when lymph-node swelling lasts more than six weeks and does not respond to antibiotics.
Like most cancers, non-Hodgkin’s lymphoma, the doctor will determine the extent of involvement in your body. A chest X-ray, CT (computed tomography) scans of the abdomen and pelvis, and a bone marrow biopsy will be performed.
- painless swelling in the lymph nodes of the neck, underarm, or groin
- fever that does not go away
- night sweats
- tired feeling all the time
- weight loss without dieting
Upon showing any of these symptoms, a doctor should provide an exam and check for swelling or lumps in the neck, underarms, or groin. A lymph node biopsy and/or biopsy of the bone marrow is the most reliable way of establishing the diagnosis of non-Hodgkin’s lymphoma. In order to determine the extent of the non-Hodgkin’s lymphoma, several scans will be performed, including CT scans, PET scans, and or Gallium scans. A bone marrow biopsy may also be performed under certain clinical circumstances.
Non-Hodgkin’s lymphoma is staged according to the number of lymph node groups involved.
Stage I: One lymph node group involved
Stage II: Multiple lymph nodes either above or below the diaphragm involved
Stage III: Multiple lymph nodes on both sides of the diaphragm involved
Stage IV: Multiple lymph nodes involved with involvement of other organs such as the bone marrow
Treatment of non-Hodgkin’s lymphoma depends mainly on the aggressiveness of the lymphoma (indolent, aggressive, and very aggressive).
With the exception of a few patients with a low volume Stage I disease, indolent lymphomas are generally considered incurable with chemotherapy and/or radiation therapy. As such, since chemotherapy will not cure the disorder, chemotherapy and radiation therapy are generally reserved to treat symptoms, such as progressive fatigue or painful swollen lymph nodes.
Aggressive non-Hodgkin’s lymphomas are treated with chemotherapy upon diagnosis, as these lymphomas are curable with chemotherapy. The likelihood of cure is dependent on the age of the patient, the stage at diagnosis, the general health of the patient, and certain laboratory tests.
The very aggressive non-Hodgkin’s lymphomas are treated with chemotherapy. Unless treated rapidly, these lymphomas can be life-threatening, although they can be cured with chemotherapy as well.
Stem cell transplantation can be used to treat both the indolent and aggressive non-Hodgkin’s lymphomas. For the indolent lymphomas, stem cell transplantation is reserved for individuals with multiple recurrent disease. For the aggressive lymphomas, stem cell transplantation is used at the time of first and subsequent relapses.
What type of non-Hodgkin’s lymphoma is it?
What is the staging?
What treatments do you recommend?
What side effects can be expected from treatment and how can
they be minimized?
What is the prognosis?
What is the likelihood of cure?
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