Non-Hodgkin's Lymphoma
Table of Contents
What is adult non-Hodgkin's lymphoma?
- Stage Explanation
-
Stages of non-Hodgkin's lymphoma
- Stage I
- Stage II
- Stage III
- Stage IV
- Recurrent
- Treatment Option Overview
-
How non-Hodgkin's lymphoma is treated
- Treatment by stage
- Indolent, Stage I and Contiguous Stage II Adult NHL
- Aggressive, Stage I and Contiguous Stage II Adult NHL
- Indolent, Non-Contiguous Stage II/III/IV Adult NHL
- Aggressive, Non-Contiguous Stage II/III/IV Adult NHL
- Adult Lymphoblastic Lymphoma
- Adult Diffuse Small Non-Cleaved Cell/Burkitt's Lymphoma
- Indolent Recurrent Adult Non-Hodgkin's Lymphoma
- Aaggressive Recurrent Non-Hodgkin's Lymphoma
-
- To Learn More
What is adult non-Hodgkin's lymphoma?
Adult non-Hodgkin's lymphoma is a disease in which cancer (malignant) cells are found
in the lymph system. The lymph system is made up of thin tubes that branch, like blood
vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid
that contains white blood cells called lymphocytes. 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. The spleen (an organ in the upper abdomen that makes lymphocytes
and filters old blood cells from the blood), the thymus (a small organ beneath the
breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.
Because lymph tissue is found in many parts of the body, non-Hodgkin's lymphoma can
start in almost any part of the body. The cancer can spread to almost any organ or tissue
in the body, including the liver, bone marrow (the spongy tissue inside the large bones of
the body that makes blood cells), spleen, and nose.
Lymphomas are divided into two general types: Hodgkin's disease and non-Hodgkin's
lymphomas. The cancer cells in Hodgkin's disease look a certain way under a microscope.
Hodgkin's disease is discussed in the PDQ patient information summaries on Hodgkin's
disease (adult or childhood). Non-Hodgkin's lymphoma can also occur in children and is
treated differently (see the PDQ patient information summary on childhood non-Hodgkin's
lymphoma for treatment of non-Hodgkin's lymphoma in children).
There are many types of non-Hodgkin's lymphomas. Some types spread more quickly than
others. The type is determined by how the cancer cells look under a microscope. This
determination is called the histology. The histologies for adult non-Hodgkin's lymphoma
are divided into two groups: indolent lymphomas, which are slower growing and have fewer
symptoms, and aggressive lymphomas, which grow more quickly.
--Indolent-- --Aggressive--
follicular small cleaved cell lymphoma adult diffuse mixed cell lymphoma
follicular mixed cell lymphoma adult diffuse large cell lymphoma
follicular large cell lymphoma adult immunoblastic large cell
lymphoma
adult diffuse small cleaved cell lymphoma adult lymphoblastic lymphoma
small lymphocytic (marginal zone) adult small noncleaved cell lymphoma
Other types of indolent non-Hodgkin's lymphoma are lymphoplasmacytoid lymphoma,
monocytoid B-cell lymphoma, mucosa-associated lymphoid tissue (MALT) lymphoma, splenic
marginal zone lymphoma, hairy cell leukemia, and cutaneous T-cell lymphoma (Mycosis
fungoides/Sezary syndrome).
Other types of aggressive non-Hodgkin's lymphoma are anaplastic large-cell lymphoma,
adult T-cell lymphoma/leukemia, mantle cell lymphoma, intravascular lymphomatosis,
angioimmunoblastic T-cell lymphoma, angiocentric lymphoma, intestinal T-cell lymphoma,
primary mediastinal B-cell lymphoma, peripheral T- cell lymphoma, lymphoblastic lymphoma,
post-transplantation lymphoproliferative disorder, true histiocytic lymphoma, primary
central nervous system lymphoma, and primary effusion lymphoma. Aggressive lymphomas are
also seen more frequently in patients who are HIV-positive (AIDS-related lymphoma).
See specific PDQ patient information summaries for discussions of plasma cell
neoplasms, hairy cell leukemia, cutaneous T-cell lymphoma, chronic lymphocytic leukemia,
primary central nervous system lymphoma, and AIDS-related lymphoma, as well as childhood
and adult Hodgkin's disease and acute lymphoblastic leukemia.
A doctor should be seen if any of the following symptoms persist: painless swelling in
the lymph nodes in the neck, underarm, or groin; unexplained fever; drenching night
sweats; tiredness; unexplained weight loss in the past 6 months; or itchy skin.
If these symptoms are present, a doctor will carefully check for swelling or lumps in
the neck, underarms, and groin. If the lymph nodes don't feel normal, a doctor may need to
surgically remove a small piece of tissue and look at it under a microscope to see if
there are any cancer cells. This procedure is called a biopsy.
The chance of recovery (prognosis) and choice of treatment depend on the stage of the
cancer (whether it is just in one area or has spread throughout the body), and the
patient's age and overall condition.
Stages of adult non-Hodgkin's lymphoma
Once non-Hodgkin's lymphoma is found, more tests will be done to find out if the cancer
has spread from where it started to other parts of the body. This testing is called
staging. A doctor needs to know the stage of the disease to plan treatment.
A doctor may determine the stage of the disease by examining the patient, doing blood
and bone marrow tests, and taking x-rays called computed tomographic (CT or CAT) scans
that produce an image of the inside of the body. This type of staging is called clinical
staging. In some cases, the doctor may need to do a laparotomy to determine the stage of
the cancer. During this operation, a doctor cuts into the abdomen and carefully looks at
the organs to see if they contain cancer. A doctor will cut out (biopsy) small pieces of
tissue during the operation and look at them under a microscope to see whether they
contain cancer. This type of staging is called pathologic staging. Pathologic staging is
usually done only when it is needed to help a doctor plan treatment.
Occasionally, specialized staging systems are used. A doctor should be aware of the
system used.
A number of other factors are important in determining the staging and recovery
(prognosis) of patients with non-Hodgkin's lymphoma. Some of these include the patient's
age and responsiveness to treatment, tumor size, and number of places the tumor has spread
outside of the lymph nodes.
The following stages are used for non-Hodgkin's lymphoma:
Stage I
Cancer is found in only one lymph node area or in only one area or organ outside the
lymph nodes.
Stage II
Either of the following means that the disease is stage II:
- Cancer is found in two or more lymph node areas on the same side of the
diaphragm (the thin muscle under the lungs that helps breathing).
- Cancer is found in only one area or organ outside the lymph nodes and in
the lymph nodes around it. Other lymph node areas on the same side of the
diaphragm may also have cancer.
In contiguous stage II cancer, the positive lymph node areas are next to one another;
in non-contiguous stage II, the positive lymph nodes are not next to each other, but are
still on the same side of the diaphragm.
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 means that the disease is stage IV:
- Cancer has spread to more than one organ or organs outside the
lymph system. Cancer cells may or may not be found in the lymph nodes near
these organs.
- Cancer has spread to only one organ outside the lymph system, but lymph
nodes far away from that organ are involved.
Recurrent
Recurrent disease means that the cancer has come back after it has been treated. It may
come back in the area where it first started or in another part of the body.
How adult non-Hodgkin's lymphoma is treated
There are treatments for all patients with adult non-Hodgkin's lymphoma. Three types of
treatment are used:
- radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells
and shrink tumors)
- chemotherapy (using drugs to kill cancer cells and shrink tumors)
- biological therapy (using the body's immune system to fight cancer)
Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink
tumors. Radiation for non-Hodgkin's lymphoma usually comes from a machine outside the body
(external-beam radiation therapy). Radiation therapy given to the neck, chest, and lymph
nodes under the arms is called radiation therapy to a mantle field. Radiation therapy
given to the mantle field and to the lymph nodes in the upper abdomen, the spleen, and the
lymph nodes in the pelvis is called total nodal irradiation. Radiation given to the brain
to keep the cancer cells from growing there is called cranial irradiation. Radiation
therapy may be used alone or in addition to chemotherapy.
Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy
may be taken by pill, or it may be put into the body by a needle in a vein or muscle.
Chemotherapy is called a systemic treatment because the drugs enter the bloodstream,
travel through the body, and can kill cancer cells throughout the body. To treat certain
types of non-Hodgkin's lymphoma that spread to the brain, chemotherapy may be put into the
fluid that surrounds the brain through a needle in the brain or back (intrathecal
chemotherapy).
Biological treatment tries to help the body to fight cancer or infections. It uses
materials made by the body or made in a laboratory to boost, direct, or restore the body's
natural defenses against disease. Biological treatment is sometimes called biological
response modifier (BRM) therapy.
Bone marrow transplantation and peripheral blood stem cell transplantation are also
being tested in clinical trials for certain patients. Bone marrow transplantation is a
type of treatment that uses very high doses of chemotherapy to kill resistant lymphoma
cells in the body. The high doses of chemotherapy also destroy most of the bone marrow in
the body. To replace the bone marrow, marrow is taken from the bones before treatment and
treated with drugs or other substances to kill any cancer cells. The marrow is then
frozen, and the patient is given high-dose chemotherapy with or without radiation therapy
to destroy all of the remaining cancer cells. The marrow that was taken out is then thawed
and given to the patient through a needle in a vein to replace the marrow that was
destroyed. If the bone marrow comes from the patient, this type of transplant is called an
autologous transplant. If the marrow is taken from another person, the transplant is
called an allogeneic transplant. In peripheral blood stem transplantation, stem cells are
removed from the patient's circulating blood before treatment and then returned after
treatment. In peripheral blood stem cell transplantation, the stem cells usually come from
the patient.
Other clinical trials are being conducted that are testing experimental drugs and
improved therapies. Radioimmunotherapy, which is treatment with a radioactive substance
that is linked to an antibody that will attach to the tumor when injected into the body,
is also being performed in clinical trials.
Treatment by stage
Treatment of adult non-Hodgkin's lymphoma depends on the stage of the disease, the
histology and grade of the disease, and the patient's age and general health. Radiation
therapy to the pelvis or large doses of chemotherapy may increase the risk of permanent
sterility.
Standard treatment may be considered, based on its effectiveness in patients in past
studies, or participation in a clinical trial. Not all patients are cured with standard
therapy, and some standard treatments may have more side effects than are desired. During
the 20 years after treatment, some patients develop another form of cancer, such as lung,
brain, kidney, or bladder cancer; a doctor should be visited regularly to be checked for
this possibility. For these reasons, clinical trials are designed to find better ways to
treat cancer patients and are based on the most up-to-date information. Clinical trials
are ongoing in most parts of the country for most stages of adult non-Hodgkin's lymphoma.
For more information, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
Treatment options are the same whether the disease is above or below the diaphragm.
Treatment options:
- 1. Radiation therapy to the area where the cancer cells are found.
2. Radiation therapy to the area where the cancer cells are found and extended to nearby
lymph nodes.
3. Radiation to part or all of the lymphatic system.
4. Chemotherapy plus radiation therapy are being evaluated.
5. Chemotherapy alone or watchful waiting if radiation therapy is not possible.
If the patient had clinical staging, treatment may be one of the following:
- 1. Chemotherapy plus radiation therapy.
2. Chemotherapy alone.
3. Radiation therapy alone.
Treatment may be one of the following:
- 1. Watchful waiting until symptoms appear.
2. Chemotherapy with a single drug.
3. Combination chemotherapy with more than one drug.
4. Chemotherapy plus radiation therapy plus bone marrow transplantation or peripheral stem
cell transplantation is being tested in clinical trials.
Treatment may be one of the following:
- 1. Combination chemotherapy.
2. Bone marrow transplantation or peripheral stem cell transplantation is under clinical
evaluation.
3. Clinical trials are evaluating new combination chemotherapies.
This is an aggressive form of adult non-Hodgkin's lymphoma. Treatment is usually
patterned after acute lymphocytic leukemia (refer to the PDQ summary on adult acute
lymphocytic leukemia for more information).
Treatment may be one of the following:
- 1. Combination chemotherapy including treatment of the central nervous system.
2. Combination chemotherapy plus radiation therapy.
3. Bone marrow transplantation is being evaluated in clinical trials.
Treatment may be one of the following:
- 1. Combination chemotherapy including treatment of the central nervous system.
2. Combination chemotherapy plus bone marrow transplantation.
Indolent lymphomas often come back (relapse) after they have been treated. Sometimes,
the lymphoma will come back as a different cell type (histology), most commonly as an
aggressive lymphoma. If this is the case, see the treatment section for aggressive,
recurrent non-Hodgkin's lymphoma.
If the lymphoma comes back and it is still a low-grade lymphoma, treatment may be one
of the following:
- 1. Chemotherapy with a single drug.
2. Combination chemotherapy with more than one drug.
3. Radiation therapy.
4. Radiation therapy plus chemotherapy.
5. A clinical trial of bone marrow transplantation.
6. A clinical trial of radioimmunotherapy.
Treatment may be one of the following:
- 1. Bone marrow transplantation.
2. Bone marrow transplantation plus radiation therapy.
3. A clinical trial of chemotherapy, bone marrow transplantation or peripheral stem cell
transplantation, and radiation therapy.
4. A clinical trial of radioimmunotherapy.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about adult non-Hodgkin's lymphoma, call the National Cancer Institute's
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By
dialing this toll-free number, you can speak with a trained information specialist who can
help answer your questions.
The Cancer Information Service also has a variety of booklets that are available on
request. The following booklet about adult non-Hodgkin's lymphoma may be helpful:
- What You Need To Know About non-Hodgkin's Lymphomas
The following general booklets on questions related to cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
Research Report: Bone Marrow Transplantation and Peripheral Blood Stem Cell
- Transplantation
There are many other places where people can get material and information about cancer
treatment and services. The social service office at a hospital can be checked for local
and national agencies that help with getting information about finances, getting to and
from treatment, getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 07/98
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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