Lymphoma (AIDS Related)
What is AIDS-related lymphoma?
AIDS-related lymphoma is a disease in which cancer (malignant) cells are found in the lymph system in patients who have AIDS (acquired immunodeficiency syndrome). AIDS is caused by the human immunodeficiency virus (HIV) which attacks and weakens the immune system. Infections and other diseases can then invade the body, and the immune system cannot fight against them.
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 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 there is lymph tissue in many parts of the body, the cancer can spread to almost any of the body's organs or tissues including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), spleen, or brain.
Lymphomas are divided into two general types, Hodgkin's disease and non-Hodgkin's lymphomas, which are classified by the way their cells look under a microscope. This determination is called the histology. Histology is also used to determine the type of non-Hodgkin's lymphoma of which there are ten. They types of non-Hodgkin's lymphomas are classified by how quickly they spread: low-grade, intermediate-grade, or high-grade. The intermediate- or high-grade lymphomas grow and spread faster than the low-grade lymphomas.
Both major types of lymphoma, Hodgkin's disease and non-Hodgkin's lymphoma, may occur in AIDS patients. Also, the intermediate-and high-grade types of non- Hodgkin's lymphoma are more commonly found in AIDS patients. Both types of lymphomas can also occur in adults and in children (Refer to Adult Hodgkin's Disease Treatment; Childhood Hodgkin's Disease Treatment; Adult Non-Hodgkin's Lymphoma Treatment; and Childhood Non-Hodgkin's Lymphoma Treatment for more information).
A doctor should be seen if any of the following symptoms persist for longer than 2 weeks:
-painless swelling in the lymph nodes in the neck, underarm, or groin
-weight loss without dieting
If a patient has AIDS and symptoms of lymphoma, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, the doctor may need to cut out a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.
In general, patients with AIDS-related lymphoma respond to treatment differently from patients with lymphoma who do not have AIDS. AIDS-related lymphoma usually grows faster and spreads outside the lymph nodes and to other parts of the body more often than lymphoma that is not related to AIDS. Because therapy can damage weak immune systems even further, patients who have AIDS-related lymphoma are generally treated with lower doses of drugs than patients who do not have AIDS.
Stages of AIDS-related lymphoma:
Once AIDS-related 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. The stage of a disease, ranging from stage I to stage IV, gives an indication of how far the disease has spread. To plan treatment, a doctor needs to know the stage of the disease.
The doctor may determine the stage of the disease by conducting a thorough examination which may include blood tests and different kinds of x-rays. This testing is called clinical staging. In some cases, the doctor may need to do an operation called a laparotomy to determine the stage of the cancer. During this operation, the doctor cuts into the abdomen and carefully looks at the organs to see if they contain cancer. The doctor will cut out (biopsy) small pieces of tissue 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 the doctor plan treatment.
For treatment, AIDS-related lymphomas are grouped based on where they started, as follows:
Lymphoma that has started in lymph nodes or other organs of the lymph system. The lymphoma may have spread from where it started throughout the body, including to the brain or bone marrow.
Primary central nervous system lymphoma
Lymphoma that has started in the brain or spinal cord, both of which are part of the central nervous system (CNS). This type of lymphoma is called a "primary CNS lymphoma" because it starts in the CNS rather than starting somewhere else in the body and spreading to the CNS.
Treatment Option Overview
How AIDS-related lymphoma is treated:
The treatment of AIDS-related lymphoma is difficult because of the problems caused by HIV infection, which weakens the immune system. The drug doses used are often lower than drug doses given to patients who do not have AIDS. Two types of treatment are used:
-chemotherapy (using drugs to kill cancer cells and shrink tumors)
-radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors)
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 inserting a needle into 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. Chemotherapy may be put into the fluid that surrounds the brain through a needle in the brain or back (intrathecal chemotherapy) to treat non-Hodgkin's lymphoma that has spread to the brain.
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 given to the brain is called cranial irradiation. Radiation therapy may be used alone or in addition to chemotherapy.
Additionally, clinical trials are testing the effect of giving drugs to kill the AIDS virus (antiviral therapy) in addition to treatment of lymphoma.
Treatment of AIDS-related lymphomas depends on the stage, histology, and grade of the disease, as well as the general health of the patient. A doctor must consider white blood cell count and any other diseases caused by AIDS that the patient had or currently has.
Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. 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. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615 or the AIDS Clinical Trials Information Service at 1-800-342-AIDS (1-800-342-2437).
AIDS-Related Peripheral/Systemic Lymphoma
Treatment may be one of the following:
1. Standard-dose systemic chemotherapy plus intrathecal chemotherapy.
2. Low-dose systemic chemotherapy plus intrathecal chemotherapy.
3. A clinical trial of new types of chemotherapy or new ways of giving
AIDS-Related Primary CNS Lymphoma:
Treatment will probably be cranial radiation therapy. A clinical trial of new types of treatment may also be an option.
The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.
The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.
The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.
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