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Lymphoma, Non-Hodgkin's

What is it?

Lymphoma is a relatively rare form of cancer involving lymphatic tissue in the lymph nodes and spleen. Lymph nodes produce lymphocytes, a type of white blood cell that is crucial in regulating and carrying out most of the activities of the immune system. In lymphoma, cells in the lymphatic system begin to grow in a rapid and uncontrolled manner. Non-Hodgkin's lymphoma (nHL), the most common form of lymphoma, is a collective grouping of the types of lymphoma that differ from Hodgkin's lymphoma (see Lymphoma, Hodgkin's for more information). The more than 10 kinds of nHL are categorized according to cell type and how fast they grow: low-grade (slow growing), intermediate-grade, and high-grade (rapidly growing). People with lowgrade tumors may live for many years though the tumors usually prove incurable. High-grade tumors are more immediately life-threatening but are potentially curable with aggressive chemotherapy. The proliferation of abnormal lymphocytes reduces the number of healthy lymphocytes. The resulting impairment of the immune system leaves the body susceptible to serious infection. Prognosis depends upon the grade and the extent of the disease but is generally not as favorable as that for Hodgkin's disease. This is because nHL is more likely to spread to other organs and has usually done so by the time it is diagnosed.

What Causes It?

  • The cause of nHL is unknown, although there is evidence that a viral component may be involved.
  • Radiation treatment increases the risk of nHL.
  • Incidence appears to be higher in those with immune system disorders or those receiving immunosuppressant drugs.

Prevention

  • Non-Hodgkin's lymphoma is not preventable.

Diagnosis

  • Patient history and physical examination.
  • Lymph node or bone marrow biopsies.
  • Other tests, including blood tests, liver and spleen scans, chest x-rays, or abdominal CT (computed tomography) scans to determine the extent of lymph node and other organ involvement.

How to Treat It

  • Treatment choices are based upon a process known as staging, which depends upon the presence or absence of general symptoms, use of a battery of tests to determine how far the cancer has spread, and the microscopic appearance of the lymphatic tissue.
  • Radiation therapy alone is used for most lymphomas (especially low-grade varieties) confined to a single lymph node region or well-defined organ site.
  • Since nHL has usually spread by the time it is diagnosed, chemotherapy with a combination of several anticancer agents (like cyclophosphamide, doxorubicin, and vincristine) and corticosteroids may be used, with or without radiation.
  • In more severe cases, autologous bone marrow donation (in which healthy bone marrow is removed prior to treatment and replaced afterward) may be recommended to preserve marrow while the body is subjected to intensive chemotherapy or radiation.

When to Call a Doctor

  • While most incidences of enlarged glands are not a sign of cancer, see a doctor if the swelling persists longer than two weeks, especially if accompanied by fever or night sweats.
  • EMERGENCY See a doctor immediately for the sudden onset of a high fever, intractable constipation, urinary incontinence, or numbness in the arms or legs—potential signs of lymphoma complications.