Lymphoma (Non-Hodgkin’s)

– Neoplasms of the lymphoid tissue.

Causes and Incidence

The cause is unknown, but theories involving immune deficiencies and viral origins are under investigation. More than 43,000 cases are diagnosed annually in the United States, and 20,500 deaths occur from the disease. The peak incidence occurs in preadolescence, with a drop during adolescence and then a steady increase with age in adulthood. Men and whites are at slightly higher risk than women and blacks. The incidence is on the rise in the United States, for unknown reasons.

Disease Process

Normal cells in the lymph nodes are replaced with immature, rapidly progressive leukocyte cells of either the T-cell or B-cell type. Rare cases involve histiocytes. Spread is via the lymphatic system to regional and distal sites, including the skin, bone marrow, brain, and gastrointestinal system.

Symptoms

A wide variety of signs and symptoms is possible, but many individuals have painless lymphadenopathy, typically of the cervical or inguinal nodes. Other symptoms are fatigue, malaise, fever, anemia, weight loss, night sweats, abdominal pain, and skin lesions.

Potential Complications

The prognosis for those with low-grade tumors is good with early treatment. Rapidly progressive intermediate- and high-grade tumors have a poor prognosis. Complications include central nervous system disease, spinal cord compression, and superior vena cava syndrome.

Diagnostic Tests

A definitive diagnosis is made through lymph node biopsy.

Treatments

Surgery
Excision of tumors in advanced disease; therapeutic splenectomy.

Drugs
Systemic combination chemotherapy with radiation.

General
Radiation is the primary therapy, used alone or in combination with chemotherapy, particularly for stage III and stage IV cancer; bone marrow transplantation is used as a salvage treatment.