Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma is a large group of cancers representing the lymph tissue. It can occur at any age but is most common in older people. There are aggressive and slow growing lymphomas; there are lymphomas involving the B cells or the T cells of the lymph system. B cell lymphoma involves Burkitt lymphoma, small lymphocytic lymphoma, diffuse large cell lymphoma, follicular lymphoma and precursor B cell anaplastic lymphoma. Mantle cell lymphoma is a B cell lymphoma. T cell lymphomas include mycosis fungoides and anaplastic large cell lymphoma, among others. The prognosis of the various lymphomas depends on the type of lymphoma and on the stage of the disease.

There are about 65,540 cases of non-Hodgkin's lymphoma occurring in the US every year. Of these, 20,210 have died. The treatment of non Hodgkin's lymphoma has improved greatly over the last several years. Slightly more men have lymphoma than women.

The exact cause of non Hodgkin's lymphoma is unclear. It starts in B cells or T cells and spread to the lymph glands and bone marrow. It can develop in those people who have a reduced immune system such as with HIV or with transplant patients. The tumour can be slow growing, intermediate growing or fast growing, such as with Burkitt lymphoma. This is the "grade" of the cancer. Certain genetic markers can be on the cells, which further differentiate the type of cancer a person has.

The symptoms of non Hodgkin's lymphoma include fever and chills, night sweats, severe itching, unintentional weight loss and swollen glands in the neck, groin or arm pits. There may be swelling or pain in the abdomen, which can lead to constipation, nausea, vomiting and loss of appetite. The brain can be affected, which can lead to headache, seizures, personality changes or problems with concentration.

Doctors do several tests to check for the presence of non Hodgkin's lymphoma. They do a complete history and physical examination which can show swollen glands or a swollen abdomen. Chemistry tests are done to see the protein level of the body along with the function of the liver and kidneys. A bone marrow biopsy will show if the cells are in the bone marrow. A CBC can be done which can show the white blood cell count, which may be low. CT scans of the chest, abdomen and pelvis can show enlarged clusters of lymph nodes. A Gallium scan can be performed to identify swollen lymph nodes. Doctors can do a lymph node biopsy to find the cancer and identify its type. A PET scan can show areas of increased activity in the lymph nodes or elsewhere in the body.

The treatment of non Hodgkin's lymphoma depends primarily on the type of lymphoma, your overall health and age, the stage of the cancer at the time of diagnosis, the symptoms you have and the grade of the cancer. Radiation therapy can be done if the disease is well confined to a single area. Chemotherapy is the most commonly used form of treatment for non Hodgkin's lymphoma. Combination chemotherapy is very common. Rituxan is used to treat B cell non Hodgkin's lymphoma. Another good treatment is radio-immunotherapy. This involves putting together a radioactive molecule with an antibody directed at the tumour. The radio-molecule goes directly to the cancer and the radioactivity kills it.

Another treatment that is relatively new is called "stem cell therapy". This involves collecting and growing stem cells in the patient's bone marrow and then killing off the rest of the bone marrow and other lymph cells. The stem cells are put back in the body and then replace the missing cells in the body. It is sometimes risky to do but works when nothing else does.

The prognosis of non Hodgkin's lymphoma depends on the grade and stage of the disease. Low grade lymphoma may not be treated well with chemotherapy alone but, as it is low grade, it may take years before it gets any worse. Chemotherapy can cure most types of high grade lymphoma. If the chemotherapy doesn't work, the patient usually dies quickly.