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Non-Hodgkin's Lymphoma

Definition

Lymphoma is a general term for cancers of lymphocytes (a type of white blood cell). The most common type of lymphoma is called Hodgkin's disease. All other lymphomas are grouped together and are called non-Hodgkin's disease.

Description

There are about 10 different types of non-Hodgkin's lymphoma. Some types spread more quickly than others. The type is determined by how the cancer cells look under a microscope, which is called the histology. The histologies are grouped together, based on how quickly they spread, into low-grade, intermediate-grade, or high-grade lymphomas.

Adult non-Hodgkin's lymphoma is a disease in which malignant cells are found in the lymph system. The lymph system is made up of thin tubes that branch, like blood vessels, to all parts of the body. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The lymph nodes make and store infection-fighting cells.

Since there are lymph nodes in many parts of the body, non-Hodgkin's lymphoma can start in almost any organ or tissue of the body, including the liver, bone marrow, and the spleen.

Symptoms

Like most cancers, non-Hodgkin's lymphoma is best treated when it is found and diagnosed early. You should see your doctor if you have any of the following for more than two weeks: painless swelling in the lymph nodes in the neck, underarm, or groin; fever that does not go away; night sweats; fatigue all the time; and weight loss without dieting.

Diagnosis

If you have symptoms, your doctor will examine you carefully and check for swelling or lumps in your neck, underarms, or groin. If the lymph nodes do not feel normal, it may be necessary to cut out a small piece (lymph node biopsy) and examine it under a microscope to see if there any cancer cells. Blood tests may be done.

If you are diagnosed with 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.

Staging

The following is one example of staging for non-Hodgkin's lymphoma:

• Stage I - Cancer is found in only one lymph node or in only one area or organ outside of the lymph nodes.
• Stage II - Either of the following:
  • Cancer is found in two or more lymph nodes on the same side of the diaphragm (the thin muscle under the lungs that helps you breathe).
  • Cancer is found in only one area or organ outside of the lymph nodes and in the lymph nodes around it. Other lymph nodes on the same side of the diaphragm may also have cancer.
• Stage III - Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.
• Stage IV - Either of the following:
  • Cancer has spread in more than one spot to an organ outside of the lymph system.
  • Cancer cells may or may not be found in the lymph nodes near these organs.
• Relapsed - Relapsed disease means that the cancer has come back (recurred) after it has been treated. It may come back in the area where it first started or in another part of the body.

Treatment

The chances of recovery and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), your age, and your overall condition.

Types of treatment include: chemotherapy (drugs to kill cancer cells and shrink tumors); radiation therapy (high dose x-rays or other high-energy rays to kill cancer cells and shrink tumors); biological therapy (use of the body's immune system to fight cancer); and bone marrow transplantation.

Regular follow-up exams are very important for anyone who has been treated for non-Hodgkin's lymphoma. Most relapses occur in the first 2 years after therapy. Generally, checkups include a careful physical exam, x-rays, blood tests, and other laboratory tests.

Questions to Ask Your Doctor

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?