Lymphoma (Adult Non-Hodgkin's)


General Information

What is adult non-hodgkin's lymphoma?

Adult non-Hodgkin's lymphoma is a disease in which malignant (cancer) cells form in the lymph system. The lymph system is part of the immune system and is made up of the following:

Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.

Lymph vessels: A network of thin tubes that collect lymph from different parts of the body.

Lymph nodes: Small, bean-shaped structures that filter substances in lymph and help fight infection and disease. Lymph nodes grow along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen.

Spleen: An organ that produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.

Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.

Tonsils: Two small masses of lymph tissue in the throat. The tonsils produce lymphocytes.

Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow produces white blood cells, red blood cells, and platelets.

Because lymph tissue is found throughout the body, adult non-Hodgkin’s lymphoma can begin in almost any part of the body. Cancer can spread to the liver and many other organs and tissues.

Non-Hodgkin's lymphoma can occur in both adults and children. Treatment for children, however, is different than treatment for adults. (Refer to Childhood Non-Hodgkin's Lymphoma Treatment for more information.)

There are many different types of lymphoma. Lymphomas are divided into two general types:

Hodgkin's disease and non-Hodgkin's lymphoma.
This summary refers to the treatment of adult non-Hodgkin's lymphoma. For information about other types of lymphoma, refer to the following summaries:

-Adult Acute Lymphoblastic Leukemia (ALL) Treatment
-Adult Hodgkin's Disease Treatment
-AIDS-Related Lymphoma Treatment
-Childhood Acute Lymphoblastic Leukemia Treatment
-Childhood Hodgkin's Disease Treatment
-Chronic Lymphocytic Leukemia Treatment
-Hairy Cell Leukemia Treatment
-Multiple Myeloma and Other Plasma Cell
-Neoplasms Treatment
-Mycosis Fungoides and the Sezary Syndrome Treatment
-Primary CNS Lymphoma Treatment

Age, gender, and a weakened immune system can affect the risk of developing adult non-Hodgkin's lymphoma.

Risk factors for adult non-Hodgkin's lymphoma include the following:

1.Being older, male, or Caucasian.
2.Having one of the following medical conditions:
-An inherited immune disorder.
-An autoimmune disease.
-HIV/AIDS.
-Human T-lymphotrophic virus type I or Epstein Barr virus.
-A history of helicobacteria gastritis.
-Taking immunosuppressant drugs after an organ transplant.
-Being exposed to certain pesticides.
-A diet high in meats and fat.
-Past treatment for Hodgkin's disease or with radiation.

Possible signs of adult non-Hodgkin's lymphoma include fever, sweating, fatigue, and weight loss. These and other symptoms may be caused by adult non-Hodgkin's lymphoma or by other conditions. A doctor should be consulted if any of the following problems occur:

-Painless swelling in the lymph nodes in the neck, underarm, groin, or stomach.
-Unexplained fever.
-Drenching night sweats.
-Constant tiredness.
-Unexplained weight loss in the past 6 months.
-Skin rash or itchy skin.
-Unexplained pain in the chest, abdomen, or bones.

Tests that examine the body and lymph system are used to help detect (find) and diagnose adult non-Hodgkin's lymphoma. The following tests and procedures may be used:

Physical examination: A check of general signs of health, including looking for anything unusual such as lumps or enlarged lymph nodes.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

-The number of red blood cells, white blood cells, and platelets.
-The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
-The portion of the sample made up of red blood cells.

Blood chemistry studies: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into it by organs and tissues in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.

Lymph node biopsy: The removal of all or part of a lymph node that is then viewed under a microscope and checked for signs of disease.

One of the following types of biopsies may be done:

Excisional biopsy: The removal of an entire lymph node.

Incisional biopsy or core biopsy: The removal of part of a lymph node.

Needle biopsy or fine-needle aspiration: The removal of a sample of tissue from a lymph node with a needle.

Bone marrow biopsy: A needle is used to collect a sample of bone and bone marrow that is checked by a pathologist for signs of disease. This procedure is very similar to bone marrow aspiration.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer, the number of places outside of the lymph nodes to which the cancer has spread, the type of lymphoma, the size of the tumor, and the patient's age and general health.

Stages of Adult Non-Hodgkin's Lymphoma

After adult non-Hodgkin's lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body. The process used to find out the type of cancer and if cancer cells have spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan the best treatment. The following tests and procedures may be used in the staging process:

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan): A procedure that makes a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into a vein and the PET scanner rotates around the body to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

Gallium scan: A procedure that makes a series of pictures of areas inside the body, to check for disease. The body is scanned after gallium, a radioactive substance, is injected into a vein. The pictures show where the gallium has collected in the body. The gallium normally collects in the bones, liver, and spleen but can also collect where there is a tumor or build-up of white blood cells.

Bone marrow biopsy: A procedure in which a needle is used to collect a sample of bone and bone marrow that is checked by a pathologist for signs of disease. This procedure is very similar to bone marrow aspiration.

Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid. This procedure is also called a spinal tap.

The following stages are used for adult non-
Hodgkin's lymphoma:

Stage I
Stage I adult non-Hodgkin's lymphoma is divided into stage I and stage IE ("E" stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes).

Stage I: Cancer is found in a single lymph node area.
Stage IE: Cancer is found in an organ or tissue other than the lymph nodes.

Stage II
Stage II adult non-Hodgkin's lymphoma is divided into stage II and stage IIE ("E" stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes).

Stage II: Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
Stage IIE: Cancer is found in an organ or tissue other than the lymph nodes and may have spread to one or more lymph nodes on the same side of the diaphragm.

Stage III
Stage III adult non-Hodgkin's lymphoma is divided into stage III, stage IIIE ("E" stands for extranodal and means that the cancer is found in an organ or tissue other than the lymph nodes), stage IIIS ("S" stands for spleen and means that the cancer is found in the spleen), and stage IIIS+E.

Stage III: Cancer is found in lymph node areas on both sides of the diaphragm.
Stage IIIE: Cancer is found in lymph node areas on both sides of the diaphragm and in a nearby organ or tissue other than the lymph nodes.
Stage IIIS: Cancer is found in lymph node areas on both sides of the diaphragm and in the spleen.
Stage IIIS+E: Cancer is found in lymph node areas on both sides of the diaphragm, in a nearby organ or tissue, and in the spleen.

Stage IV
In stage IV adult non-Hodgkin's lymphoma, the cancer either:

-is found in at least one organ or tissue other than the lymph nodes and may be in nearby lymph nodes; or
-has spread to one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

Adult non-Hodgkin's lymphomas are also described in terms of how fast they grow and the location of affected lymph nodes.

Indolent or aggressive:

Indolent lymphomas: Low-grade lymphomas. These are slower growing and have fewer symptoms.

Aggressive lymphomas: Intermediate-grade and high-grade lymphomas. These grow and spread more quickly and have more severe symptoms.

Lymphoblastic lymphoma, diffuse small noncleaved cell lymphoma and Burkitt's lymphoma are 3 types of aggressive adult non-Hodgkin's lymphoma. Aggressive lymphomas are seen more frequently in patients who are HIV-positive (AIDS-related lymphoma).

Contiguous or noncontiguous:

Contiguous lymphomas: Lymphomas in which the lymph nodes containing cancer are next to each other.

Noncontiguous lymphomas: Lymphomas in which the lymph nodes containing cancer are not next to each other, but are on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

Recurrent Adult Non-Hodgkin's Lymphoma
Recurrent adult non-Hodgkin's lymphoma is cancer that has recurred (come back) after it has been treated. Recurrent adult non-Hodgkin's lymphoma may come back in the lymph system or in other parts of the body. Indolent lymphoma may come back as aggressive lymphoma. Aggressive lymphoma may come back as indolent lymphoma.

Treatment Option Overview

Different types of treatment are available for patients with non-Hodgkin's lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Adult non-Hodgkin's lymphoma is treated with external radiation.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called 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 adult non-Hodgkin's lymphoma that spread to the brain, CNS prophylaxis (chemotherapy given to kill cancer cells in the brain or spinal cord) may be used.

Watchful waiting
Watchful waiting is closely monitoring a patient’s condition but withholding treatment until symptoms appear or change.

Other types of treatment are being tested in clinical trials.

Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

There are different types of biological therapy used in treating adult non-Hodgkin's lymphoma, including the following:

Monoclonal antibody therapy: Monoclonal antibody therapy uses laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. Radiolabeled monoclonal antibodies can locate tumor cells and deliver tumor-killing substances to them without harming normal cells.

Vaccine therapy: Vaccine therapy uses a substance or group of substances meant to cause the immune system (the complex group of organs and cells that defends the body against infection or disease) to respond to a tumor and kill it.

High-dose chemotherapy with bone marrow transplantation
Bone marrow transplantation is a procedure to replace bone marrow destroyed by high doses of chemotherapy or by radiation. To replace the bone marrow, marrow is taken from the bones before cancer therapy 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 given to the patient to replace the marrow that was destroyed. If the bone marrow comes from the patient, the transplant is called an autologous bone marrow transplant. If the marrow is taken from another person, the transplant is called an allogeneic bone marrow transplant.

High-dose chemotherapy with peripheral stem cell transplantation
Peripheral stem cell transplantation is a method of replacing blood-forming cells destroyed by cancer treatment. Stem cells (immature blood cells) are removed from the blood of the patient or donor and frozen for storage. The patient is then given high doses of chemotherapy, which destroys not only the cancer cells, but also the body's blood cells. The stored stem cells are then thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into and restore the body's blood cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options By Stage

Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin's Lymphoma
Treatment of indolent, stage I and contiguous stage II adult non-Hodgkin’s lymphoma may include the following:

1.Radiation therapy directed at the area where cancer is located.
2.Radiation therapy directed at the area where cancer is located and nearby lymph nodes.
3.Radiation therapy directed at part or all of the lymph system.
4.Chemotherapy alone or watchful waiting for patients who cannot have radiation therapy.
5.A clinical trial of chemotherapy with radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Aggressive, Stage I and Contiguous Stage II Adult Non-Hodgkin's Lymphoma
Treatment of aggressive, stage I and contiguous stage II adult non-Hodgkin’s lymphoma is usually combination chemotherapy (chemotherapy using more than one drug) with radiation therapy. Chemotherapy alone may also be used.

Indolent, Noncontiguous Stage II/III/IV Adult Non-Hodgkin's Lymphoma
Treatment of indolent, noncontiguous stage II/III/IV adult non-Hodgkin’s lymphoma may include the following:

1.Watchful waiting for patients who do not have symptoms.
2.Chemotherapy with or without steroids (drugs used to relieve swelling and inflammation).
3.Combination chemotherapy with steroids.
4.Monoclonal antibody therapy with or without combination chemotherapy.
5.A clinical trial of radiolabeled monoclonal antibody therapy.
6.A clinical trial of chemotherapy and total-body irradiation (radiation therapy to the entire body) followed by autologous or allogeneic bone marrow transplantation or peripheral stem cell transplantation.
7.A clinical trial of chemotherapy with or without vaccine therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Aggressive, Noncontiguous Stage II/III/IV Adult Non-Hodgkin's Lymphoma
Treatment of aggressive, noncontiguous stage II/III/IV adult non-Hodgkin's lymphoma may include the following:

1.Combination chemotherapy alone.
2.Combination chemotherapy with radiation therapy or monoclonal antibody therapy.
3.Combination chemotherapy with CNS prophylaxis (to help prevent cancer from spreading to the brain).
4.A clinical trial of autologous or allogeneic bone marrow transplantation or peripheral stem cell transplantation for patients who are likely to relapse.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Adult Lymphoblastic Lymphoma
Treatment of adult lymphoblastic lymphoma may include the following:

1.Combination chemotherapy and CNS prophylaxis (to help prevent cancer from spreading to the brain).
2.A clinical trial of autologous or allogeneic bone marrow transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Diffuse Small Noncleaved Cell/Burkitt’s Lymphoma
Treatment of adult diffuse small noncleaved cell/Burkitt’s lymphoma may include the following:

1.Combination chemotherapy and CNS prophylaxis (to help prevent cancer from spreading to the brain).
2.A clinical trial of combination chemotherapy.
3.A clinical trial of autologous or allogeneic bone marrow transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Adult Non-Hodgkin's Lymphoma

Indolent, Recurrent Adult Non-Hodgkin's Lymphoma
Treatment of indolent, recurrent adult non-Hodgkin's lymphoma may include the following:

1.Chemotherapy with one or more drugs.
2.Radiation therapy.
3.Radiation therapy and/or chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
4.Monoclonal antibody therapy.
5.A clinical trial of radiolabeled monoclonal antibody therapy.
6.A clinical trial of monoclonal antibody therapy as palliative therapy to relieve symptoms and improve quality of life.
7.A clinical trial of autologous or allogeneic bone marrow transplantation.

Treatment of indolent lymphoma that comes back as aggressive lymphoma may include the following:

1.A clinical trial of autologous or allogeneic bone marrow transplantation.
2.A clinical trial of combination chemotherapy followed by radiation therapy or bone marrow transplantation and radiation therapy.
3.A clinical trial of peripheral stem cell transplantation.
4.A clinical trial of monoclonal antibody therapy.
5.A clinical trial of radiolabeled monoclonal antibody therapy.
6.A clinical trial of continuous-infusion chemotherapy (chemotherapy administered into a blood vessel over a prolonged period of time).

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Aggressive, Recurrent Adult Non-Hodgkin's Lymphoma
Treatment of aggressive, recurrent adult non-Hodgkin's lymphoma may include the following:

1.Peripheral stem cell transplantation.
2.Monoclonal antibody therapy.
3.A clinical trial of autologous or allogeneic bone marrow transplantation.
4.A clinical trial of combination chemotherapy followed by radiation therapy or bone marrow transplantation and radiation therapy.
5.A clinical trial of radiolabeled monoclonal antibody therapy.
6.A clinical trial of continuous-infusion chemotherapy.

Treatment of aggressive lymphoma that comes back as indolent lymphoma may include the following:

1.Chemotherapy.
2.Palliative therapy to relieve symptoms and improve quality of life.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






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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