Lymphoma is a cancer of lymphocytes, a type of white blood cell. Lymphocytes circulate in the body through a network referred to as the lymphatic system, which includes the bone marrow, spleen, thymus, and lymph nodes. The organs and vessels of the lymphatic system work together to produce and store cells that fight infection. Lymphomas can affect either B or T cell lymphocytes.

There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin's lymphoma (NHL). NHL is the most common type of lymphoma. There are more than 20 types of NHL, from indolent (slow-growing) to aggressive to highly aggressive. Diffuse large B cell lymphoma and follicular lymphoma are the first and second most common lymphomas. NHL can be fatal if left untreated, but with timely and appropriate treatment, many patients can be long-term survivors or possibly cured.

The initial signs and symptoms of non-Hodgkin’s lymphoma include painless swelling in one or more of the body's lymph nodes, particularly in the neck, armpit, or groin areas; this is called lymphadenopathy. Patients may also complain of fevers, night sweats, and/or weight loss.

Biopsy is required to make a diagnosis of non-Hodgkin’s lymphoma. It is always preferable to obtain a large amount of tissue for diagnosis and analysis. Surgery is sometimes required to obtain adequate tissue to make a diagnosis.

A number of diagnostic tests are available to help determine which areas of the body have been affected. Tests that may be done include CT scan of the chest, abdomen, and pelvis; blood tests; bone marrow biopsy (removal of tissue from the bone marrow, the spongy area in the middle of large bones); and PET scan (this test uses a small amount of a radioactive substance, which is injected into a vein; the radioactive substance is absorbed by the cancer cells and can be viewed with a special camera). These tests aid in the staging process: staging involves dividing patients into groups (stages) based upon how much of the lymphatic system is involved at the time of diagnosis. Staging helps determine a person's prognosis and what type of treatment is required.

Systemic chemotherapy is usually the preferred first-line course of therapy for NHL. Monoclonal antibody treatment is oftentimes used in conjunction with chemotherapy: a monoclonal antibody is a purified protein that targets a specific group of cells (usually cancer cells). This has advantages over other cancer treatments such as chemotherapy, which targets all rapidly growing cells. There are usually fewer side effects and long-term risks of monoclonal antibody therapies as compared to traditional chemotherapy. Radiation therapy may also play a role in particular instances, especially in “bulky” tumors or in early stage follicular lymphoma. In some cases of indolent lymphoma (follicular lymphoma for example), patients may not need upfront treatment and may be safely observed (called watchful waiting).

We have listed various tests, items, and consults you may need to determine your treatment plan:

1. Biopsy to make adequate tissue diagnosis. Adequate material is needed to send for special studies such as flow cytometry and cytogenetics. Sometimes repeat biopsy is needed.
2. Blood tests. Your blood will be drawn to evaluate your blood counts, kidney function, and liver function (CBC—complete blood count and CMP—comprehensive metabolic panel). LDH is a blood test that should be drawn as well.
3. CT scan of the chest/abdomen/pelvis. This type of X-ray looks at lymph nodes as well as organs like the lungs, liver, spleen, and kidneys.
4. PET/CT scan. This type of X-ray is an additional way to evaluate which areas of the body are affected by lymphoma.
5. Bone marrow biopsy. This is removal of tissue from the bone marrow, the spongy area in the middle of large bones. Lymphoma can sometimes be found in this area.
6. Echocardiogram/MUGA scan. These are tests to evaluate your heart function prior to receiving chemotherapy.
7. Medical oncology consult. Medical oncologists are experts in lymphoma and chemotherapy.
8. Radiation oncology consult. Radiation oncologists are experts in the administration of radiation therapy.
9. Surgery consult. Oftentimes surgeons become involved to obtain biopsy samples and to place a “port-a-cath” (long-term indwelling catheter to administer chemotherapy).
10. Useful in selected cases: CT scan of the neck, lumbar puncture (removal of cerebrospinal fluid), blood tests for HIV and hepatitis B/C, and discussion of fertility issues and/or sperm banking.

Websites:

www.leukemia-lymphoma.org/

www.cancer.gov/cancertopics/types/non-hodgkins-lymphoma

www.mayoclinic.com/health/non-hodgkins-lymphoma/DS00350

Resources:
www.uptodate.com