NON-HODGKIN LYMPHOMA (LYMPHOSARCOMA)

ICD-9: 202.8x

Description

Non-Hodgkin lymphomas, or lymphosarcomas, are a group of malignant diseases of the lymphatic system that can occur at any age. They are far more common in the United States than Hodgkin lymphoma. There were nearly 66,000 cases in 2009.

They are categorized as follows:

  1. Well-differentiated lymphatic
  2. Poorly differentiated lymphocytic
  3. Histiocytic (formerly called reticulum cell sarcoma)
  4. Mixed lymphocytic and histiocytic
  5. Undifferentiated or stem-cell malignant lymphoma

Etiology

Abnormal lymphocytes grow and divide uncontrollably, gathering in the lymph nodes and causing swelling. What causes this phenomenon is essentially unknown, but researchers believe that activation of certain abnormal genes may be involved. About 85% of non-Hodgkin lymphomas occur in the B cells that help to fight infection in the body.

Signs and Symptoms

Usually a person is asymptomatic until the disease progresses. Swollen lymph nodes in the neck, axilla, and groin are common presenting symptoms. Coughing, dyspnea, fatigue, sweating, fever, and weight loss may follow.

Diagnostic Procedures

Non-Hodgkin lymphomas are to be distinguished from Hodgkin disease. Diagnosis includes a complete physical examination, CBC, lymph node biopsy, and/or bone marrow biopsy. CT scans, x-rays, MRI, and occasionally cerebrospinal fluid analysis are used to determine the extent of the disease.

Treatment

Staging is important before beginning any treatment. Refer to Chapter 5 for further information on staging and to “Stages of Adult Non-Hodgkin Lymphoma” on the National Cancer Institute website (http://www.cancer.gov) for an excellent and detailed description of cancer staging. Treatment considerations include chemotherapy, radiation, combination chemotherapy and radiation, stem cell transplant, biotherapy and radioimmunotherapy used separately or in combination with chemotherapy, and interferon therapy.

Complementary Therapy

See Complementary Therapy for leukemia.

CLIENT COMMUNICATION

Educate clients about the side effects of chemotherapy and radiation. The risk of infection is great, so prevention of infection is essential. Secondary malignancies can occur. Encourage routine check-ups.

Prognosis

Prognosis depends largely on the stage of the cancer, its type, and the age and general health of the client. Liver function tests that check for lactate dehydrogenase (LDH) levels help to determine prognosis. Prognosis also depends on whether the lymphoma is newly diagnosed or has recurred. The prognosis is good if the person is in remission; however, if a remission cannot be produced by treatment, the prognosis is poor.

Prevention

There is no known prevention for non-Hodgkin lymphoma.