Cancers that begin in cells of the lymph system are referred to as malignant lymphomas. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating white blood cells called lymphocytes. Lymphocytes and the lymph system are part of the immune system that protects the body from disease and infection. Cancers of the lymph system are referred to as Hodgkin’s lymphoma or non-Hodgkin’s lymphoma.
Understanding treatment of lymphoma is fairly complicated because patients must know the correct histologic diagnosis and the stage of their lymphoma. Histologic classification of non-Hodgkin’s lymphomas has undergone considerable changes that can lead to confusion for patients and doctors. In order to learn about treatment options, patients need to know the answers to the following questions:
- Is the lymphoma classified as Hodgkin’s or non-Hodgkin’s lymphoma?
- If it is non-Hodgkin’s lymphoma, what kind (histologic type) of non-Hodgkin’s lymphoma is it?
- What is the stage or extent of spread of the lymphoma?
In order to understand the best treatment options available for lymphoma, it is important to determine the stage or where the cancer has spread in the body. All new treatment information is categorized and discussed by the stage, or extent, of the disease. Determining the extent of spread or the stage of the cancer requires a number of procedures including computerized tomography (CT) and/or Magnetic resonance imaging (MRI) scans and blood tests. The goal of staging lymphoma is to determine which patients have early and which have advanced stage cancer.
Stage I: Cancer is found only in a single lymph node, in the area immediately surrounding that node, or in a single organ.
Stage II: Cancer involves more than one lymph node area on one side of the diaphragm (the breathing muscle separating the abdomen from the chest).
Stage III: The cancer involves lymph node regions above and below the diaphragm. For example, there may be swollen lymph nodes under the arm and in the abdomen.
Stage IV: Cancer involves one or more organs outside the lymph system or a single organ and a distant lymph node site.
In some patients, the lymphoma may grow out of the lymph system into adjacent organs. This is referred to as extranodal extension and designated by an “E” following the stage. For example, a stage II lymphoma that extended into the lungs would be referred to as stage IIE.
Patients with malignant lymphoma may also experience general symptoms from their disease. Patients with fever, night sweats or significant weight loss are said to have “B” symptoms. If these specific symptoms are not present, patients are further classified as “A”.
Relapsed/Refractory: The cancer has persisted or returned (recurred/relapsed) following treatment.
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