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Non-Hodgkin's Lymphoma

non hodgkins lymphoma


A lymphoma is a cancer of cells in the lymphatic system. Lymphomas are divided into two types - Hodgkin's lymphoma and non-Hodgkin's lymphoma. There are different types of non-Hodgkin's lymphoma.

What is the lymphatic system?

The lymphatic system consists of lymph nodes (lymph glands), a network of thin lymphatic channels (similar to thin blood vessels), and organs such as the spleen and thymus. Small lymph nodes occur throughout the body. Lymph nodes are joined together by a network of lymphatic channels. Lymph mainly consists of a fluid that forms between the cells of the body. This contains nutrients and waste products which go into and out of cells.

The lymphatic system is also a major part of the immune system. Lymph and lymph nodes contain white blood cells called lymphocytes and antibodies which defend the body against infection.

What causes a non-Hodgkin's lymphoma and how does it develop?

The cause is not known. If your immune system does not work well (for example, if you have AIDS) your risk of developing a non-Hodgkin's lymphoma is increased. The cancer seems to start from one abnormal cell. In the case of non-Hodgkin's lymphoma, the cancer develops from a lymphocyte cell which becomes abnormal.

The cancerous lymphocytes tend to collect in lymph nodes. The lymph nodes become bigger and form cancerous tumours. Some abnormal cells may travel to other parts of the lymphatic system such as the spleen. So you may develop lots of large cancerous lymph nodes and an enlarged spleen.

Who gets non-Hodgkin's lymphoma and how common is it?

Anyone can be affected. Most cases occur in people over the age of 60.

What are the symptoms of non-Hodgkin's lymphoma?

Swollen lymph nodes
Other symptoms
Other general symptoms may develop. For example: sweats (especially at night), fevers, weight loss, tiredness, being off food, anaemia, itch all over the body.

How is non-Hodgkin's lymphoma diagnosed and assessed?

To confirm the diagnosis

If your doctor suspects that you may have a lymphoma you will be referred to a specialist. A specialist will normally arrange a biopsy of one of the swollen nodes.

Grade of the lymphoma

Although there are many types of non-Hodgkin's lymphoma, they are generally divided (graded) into two categories - high-grade and low-grade.
High-grade (fast-growing). The cancerous cells tend to grow and multiply quite quickly and are more aggressive.
Low-grade (slow-growing). The cancerous cells tend to grow and multiply quite slowly and are not so aggressive.

Assessing the extent and spread (staging)

You may have a CT or MRI scan, blood tests, a bone marrow biopsy or other tests. This assessment is called staging. The aim of staging is to find out how much the lymphoma has grown locally, and whether it has spread to other lymph nodes or to other parts of the body. The staging system that is commonly used for non-Hodgkin's lymphomas is:

  1. Stage 1 - the lymphoma is confined to one group of lymph nodes only.
  2. Stage 2 - the lymphoma affects two or more groups of lymph nodes. However, they are all on the same side of the diaphragm. (The diaphragm is the large muscle that separates the chest from the abdomen and helps us to breathe.)
  3. Stage 3 - the lymphoma affects nodes on both sides of the diaphragm.
  4. Stage 4 - the lymphoma affects parts of the body outside of the lymphatic system.

Each stage is also divided into A or B. A means that you do not have symptoms of night sweats, fevers or weight loss. B means that you do have one or more of these symptoms.
By finding out the type, grade and stage of the lymphoma it helps doctors to advise on the best treatment options.

What are the treatments for non-Hodgkin's lymphoma?

The treatment advised for each case depends whether it is high or low-grade, your age, your general health, the size of the affected nodes, and which parts of the body are affected.

Treatments which may be considered include the following:

Chemotherapy

Chemotherapy is a treatment which uses anti-cancer medications to kill cancer cells, or to stop them from multiplying. High-grade non-Hodgkin's lymphomas are usually treated with chemotherapy medicines given straight into the vein (intravenous chemotherapy). A combination of medicines is usually used. The most common combination used is with the medicines: cyclophosphamide, doxorubicin, vincristine and prednisolone. (This combination is often called CHOP.)
For low-grade non-Hodgkin's lymphomas, when active treatment is advised then intravenous chemotherapy or chemotherapy tablets are the most commonly used treatments.

Monoclonal antibodies

This treatment is sometimes used in addition to chemotherapy. (For example, a product called rituximab is the commonly used monoclonal antibody.) Monoclonal antibodies are small proteins that work by attaching to the abnormal lymphocytes, which helps to destroy them without harming other cells.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It tends to be mainly used if you just have one or two affected lymph nodes.

Stem cell transplant

Stem cells are the immature cells that develop into mature blood cells (including lymphocytes) in the bone marrow. First high-dose chemotherapy (and sometimes radiotherapy) is given to kill all the abnormal lymphocytes. However, this also kills the stem cells that make normal blood cells. So, after the chemotherapy, you are given a transplant of stem cells which then make normal blood cells.

Surgery

Surgery is not used very often. Occasionally, an operation may be done to remove an organ (such as the spleen) or part of an organ that is badly damaged by a lymphoma. Sometimes a large mass of tumour may be removed to de-bulk the tumour prior to chemotherapy.

Watch and wait

No treatment may be advised initially for low-grade non-Hodgkin's lymphomas. This approach is called watch and wait. This approach is mainly used if you feel generally well and have no symptoms from the lymphoma (apart from painless swollen nodes). Chemotherapy or other treatments may be delayed until the disease causes symptoms.

What is the outlook?

The outlook depends on various factors which include the exact type, grade and stage of the lymphoma. Very generally:

Many people with a high-grade non-Hodgkin's lymphoma will be cured. A cure is most likely in cases which are at an early stage, but there is still a good chance of a cure even with those in more advanced stages. With slow-growing low-grade non-Hodgkin's lymphomas, chemotherapy is less likely to be curative than with high-grade non-Hodgkin's lymphomas. However, treatment may control the disease and keep you free of symptoms for months or years.


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