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Types of Cancer
Non-Hodgkin's Lymphoma

Non-Hodgkin's Lymphoma

General Information / Anatomy / Function / Statistics
May show up almost anywhere in the body
Often with primary sites outside the lymph nodes
Gastro-intestinal tract is a common site
There may be confusion with less serious diseases or other forms of cancer before diagnosis is made
Lymphomas can involve the coverings of the brain (the meninges) and the fluid that bathes the brain (cerebrospinal fluid (CSF))
Does not spread in a regular pattern like Hodgkin's disease. Hodgkin's disease is usually predictable and spreads to adjacent lymph nodes. Non-Hodgkin's lymphomas do not
For statistics, please click here.

Symptoms / Signs
  • Symptoms are similar to those of Hodgkin's disease
  • Painless enlarged lymph nodes in neck, groin or armpit
  • Fatigue
  • Shortness of breath
  • Itchiness on the trunk of the body
  • Unusual back or abdominal pain
  • Abdominal swelling
  • The following symptoms are called "B symptoms"
    • Persistent fever whose cause is unknown
    • Unexplained night sweats, sometimes so severe the bedclothes have to be changed
    • Unexplained weight loss
The above symptoms are also common in other disorders. Thus, it is more common for them not to be related to lymphoma but rather to be a sign of something else

Etiology / Carcinogens / Risks
Chronic disorders of the immune system or the chronic administration of drugs to suppress the immune system predispose a person to Non-Hodgkin's lymphoma.
Risk increases with age.
Prior exposure to radiation or chemotherapy.

Diagnosis / Staging / Grading / Types
  • Medical and physical examination with attention to lymph nodes, spleen, liver and pain in bones:
    • Laboratory tests of blood and urine
    • Chest x-ray
    • CT scan of the chest, abdomen and pelvis
    • Biopsy of affected node or other tissue
  • Diagnostic process is similar to Hodgkin's disease plus these tests may be used occasionally:
    • Upper and lower GI series (gastrointestinal), other GI tests including endoscopy
    • Spinal tap (lumbar puncture) to examine Cerebrospinal Fluid.
An accurate diagnosis is very important since lymphoma responds to very different forms of treatment than other cancers
Staging
Careful diagnostic and staging procedures will identify the exact cell type and the pattern of spread.
Staging is based on the Ann Arbor classification:
Stage I Involves a single lymph node region
Stage II Involvement of two or more lymph node regions on the same side of the diaphragm
Stage III Involvement of lymph node regions on both sides of the diaphragm
Stage IV Spread of the disease outside the lymph system
Each stage is divided into A and B categories:
"A" patients have no generalized symptoms.
"B" patients have had unexplained weight loss of more than 10% in the six months before diagnosis, or unexplained fevers above 38 C (100.4 F), or persistent heavy night sweats.
Types
New Classification, called the World Health Organization classification identifies many sub-types of Non-Hodgkin's lymphoma.
Based on various combinations of the following characteristics:
Whether the pattern is follicular (cells clumped in the lymph node) or diffuse (spread out).
Whether the types of cells affected are: large, small or a mixture of both and how well differentiated (mature) the cells are.
Molecular marker studies and gene rearrangement studies of the malignant cells.
Prognosis
Prognosis is affected by several factors:
The type of lymphoma;
The stage or extent of the lymphoma;
The age of the patient and whether any other illnesses are present; and
The other organs in the body that have been affected by the lymphoma.
Combination drug chemotherapy sometimes augmented by radiation therapy has produced excellent results for many subgroups with Non-Hodgkin's lymphoma.
Virtually all patients can be helped with proper treatment. Approximately 50% can be cured and 50% can have their disease made better for periods of time varying from several months to many years.

Treatment
Vary depending upon specific cell type of lymphoma, patient's condition and the stage.
Early stage follicular lymphomas are usually treated with radiation therapy and have an excellent prognosis.
Stages I and II diffuse lymphomas are usually treated with radiation and brief chemotherapy.
Stage III and IV follicular and diffuse lymphomas are primarily treated with chemotherapy. Radiation may be used as consolidation treatment after remission has been achieved.
Commonly used chemotherapy drugs include chlorambucil, fludarabine, cyclophosphamide, doxorubicin (adriamycin), vincristine and prednisone.
Advanced stage recurrent follicular lymphomas can sometimes be treated with a drug called Rituxin (a monoclonal antibody preparation).
Details of treatment are technically demanding.
Recent advances in knowledge have been rapid and cures have emerged only in the last 10 to 20 years.
Patients should be treated in major medical or cancer centers by physicians experienced in designing and administering curative forms of treatment.
The side-effects of the chemotherapy for the treatment of lymphoma are quite variable. Some programs do not cause any side-effects, the majority cause moderate side-effects and a few programs are quite intense and cause major side-effects. The side-effects associated with each program are specific to the drugs and schedule being used and should be discussed with the oncologist giving the treatment.
Extremely high dose chemotherapy and bone marrow transplantation are occasionally effective after regular dose chemotherapy fails.
If you will be undergoing a bone marrow transplant as part of your treatment, you may be interested in looking at the Leukemia/BMT Program of BC.

Revised April 2000

March 2007  We are currently reviewing and updating these pages.  If you have any questions about your cancer and its treatment, please discuss with your oncologist or physician.  Thank you.