Lymphoma

What is Lymphoma?

Lymphoma is cancer of the lymphatic system, a connective network of glands and vessels that circulate lymph throughout the body; lymph is a clear, watery fluid that contains lymphocytes, which is one kind of white blood cell.

The lymphomas are divided into Hodgkin's disease and non-Hodgkin's lymphomas. Either kind of lymphoma may spread beyond the lymph system, invading other organs such as the spleen, liver and bone marrow.

The diagnosis of non-Hodgkin's lymphoma (NHL) includes at least fifteen types of lymphomas. The distinctions are based on the type of cancer cells and their rate of growth. NHL may also be classified as high grade (highly aggressive), intermediate grade, or low grade (indolent).

Diagnosis of NHL in the US has tripled since 1950, occurring in approximately 51,000 individuals each year. Generally, NHL occurs in individuals between 30 and 70 years of age; but it is also the third most common childhood malignancy. No definite cause is known, though it has long been speculated that NHL may be a viral disease. Approximately 30% of all individuals with AIDS develop lymphoma. It may also appear following organ transplantation because these individuals receive drugs to suppress their immune system. Pesticides and other chemicals have been reported as possible causes related to non-Hodgkin's lymphoma.

How is it diagnosed?

History: Symptoms are varied at first and may include painless or slightly tender, swollen lymph nodes, unexplained fever, night sweats or significant unexplained weight loss. There may be a history of AIDS or suppressed immunity for other reasons.

Physical exam: Lymph node enlargement may be noted, as well as spleen and/or liver enlargement. Occasionally, a mass may be felt in the abdomen or pelvis.

Tests such as a complete blood count (CBC), liver and kidney function tests, and routine chemistry studies will typically be done. Chest x-ray, CT scan, bone marrow biopsy and biopsy of the enlarged node(s) will also likely be done. Once the diagnosis is confirmed by biopsy of involved tissue, other tests may be completed to determine the extent of the disease. If bone involvement is suspected, a bone scan is indicated. If brain involvement is suspected, a spinal tap is done. A liver and spleen scan will diagnose involvement of these organs, if suspected. A lymphangiogram may be done in preparation for abdominal surgery.

How is lymphoma treated?

Treatment of non-Hodgkin's lymphoma varies, depending on the type of cancer (lymphoma cells) and the extent of the disease. Anticancer drugs (chemotherapy) may be given orally or intravenously. Radiation therapy may also be used. In some cases, a combination of both chemotherapy drugs and radiation therapy is beneficial. Surgery is rarely needed, except to obtain an adequate biopsy. In extreme cases, bone marrow transplant may be necessary.

Medications

What might complicate it?

An unusually large tumor in the neck, throat or chest could create breathing and/or swallowing difficulties.

Radiation therapy may commonly produce fatigue as a side effect. Radiation to the mouth may result in painful mouth sores. Radiation to the spine may result in nausea and vomiting. Radiation to the abdomen and pelvis may cause diarrhea. Most chemotherapy drugs cause a decrease in white and red blood cell counts and platelet counts, leading respectively to anemia, susceptibility to infection, and bleeding. Additionally, there may be hair loss, greatly reduced appetite, confusion, and abnormal function of the liver, kidney, heart, or thyroid. Virtually all chemotherapy drugs can cause nausea and vomiting, which can be so severe that the individual will need antinausea medication and intravenous fluids to help control these problems.

Any other disease the individual has, such as HIV infection, makes treating the NHL more difficult. Advanced NHL is often associated with suppression of the immune system, making the individual susceptible to severe infections.

Predicted outcome

Survival rates in adults are widely variable, depending on the type of cancer cells and the extent of the disease. In general, overall survival after five years ranges between 50 to 60%. Some types of NHL have up to a 90% survival rate at ten years. If the cancer comes back (recurrence) after a disease-free period, survival rates significantly decline. The adverse effects of the disease, chemotherapy, and radiation therapy may lead to permanent disability.

Alternatives

Differential diagnoses include non-cancerous growth or tumor, HIV, leukemia, Hodgkin's disease, and generalized body infection.

Appropriate specialists

Medical oncologist, radiation oncologist, general surgeon, pain management specialist, and psychiatrist or psychologist.

Last updated 27 May 2015