Non-Hodgins lymphoma cancer symptoms, treatment

Lymphoma is a disease in the lymphocytes. Lymphomia is similar to cancer in that the affected lymphocytes no longer can be controlled in a normal way. They start to grow too fast, or in an abnormal way, or they will not die as they should normally in a patient with lymphomia cancer symptoms.

These abnormal lymphocytes are concentrated in the lymph nodes which is the reason these swell up. Since the lymphocytes circulate around the whole body, lymphoma - or collections of anormal lymphocytes - can develop in other parts of the body than the lymph nodes. Other places where lymphoma often is seen are splean and bone marrow, liver or stomach. In rare cases the cancer can also develop in the brain. A lymphoma canser can actually develop almost anywhere in the body and it is common that the disease spread to more than one place.

Since the lymph is circulating in the whole body, lymphoma is normally considered belonging to the group of diseases affecting the whole body, not only the area of the swollen lymph nodes. This type of diseases is called systemic.

Many of the symptoms in a patient with lymphoma comes from the swelling up that follows from the concentration of abnormal lymphocytes. Exactly which symptoms that develop will depend on where in the body these swellings show up. The abnormal lymphocytes can no longer carry out their normal tasks in the bodys immune defence system and a person that is not treated will therefore be more sensitive to infections.

Lymphoma can be split into two main groups

• Non-Hodgins lymphoma (sometimes called Non-Hodgkin lymphoma or non-Hodgekins disease) 
• Hodgins disease (also called Hodgekins or Hodgkins lymphoma) 

Non-Hodgin lymphoma

Non-Hodgin lymphoma (non-Hodgkins) is one of the two main groups of the lymphoma cancer disease (the other is Hodgkins disease). The cells in a patient with non-Hodgin limphoma will look different and behave in a different manner compared to a patient with Hodgkins disease.

It is important to diagnose exactly what type of non-Hodgkin lymphoma the patient is suffering from, how fast it is developing, where exactly in the body it is developing and how far it has spread. In order to establish this, the disease is further divided into subgroups according to:

The stage of the NHL. Where in the body the cancer is located, how much it has spread. The stages are I, II, III and IV. The division into stages is made from the patients disease history and the physical examination together with different tests such as X-ray, computer tomography, positron emission tomography, bone marrow biopsy and blood sample testing.

Type, there are around 30 different types depending on the cells appearance in a microscope.

This classification into type and stage, will help the doctor in predicting how a certain NHL will progress and the likely effect it will have on the patient. It is very important to plan for the right treatment and all information must be in place first in order to plan and start adequate treatment of the lymphoma.

The stages of non-Hodgkins lymphoma

Stage I

In this stage, the cancer is still located in one region only, normally that is in a lymph node and the area around it.

Stage II

This means the cancer is located in two different and separate areas, typically one an lymph node or organ belonging to the lymphatic system and a also secondary affected area. Both the affected places are restricted to one side of the diaphragm, either above it, or below it.

Stage III

This is when the cancer has spread to both sides of the diaphragm. It also includes one organ near the lymph nodes or possibly the spleen.

Stage IV

This is when the cancer has spread further outside the lymphatic system and now includes one or more of the major organs, including possibly also skin and bone marrow.

Indolent or aggressive non-Hodgkin lymphoma's

The classification of the non-Hodgkins lymphoma's are made from a number of criteria. One simplified, but fully appropriate way of looking at it is to divide the lymphomas into two main groups of NHL which makes it easier for the doctor to decide on the treatment:

• The indolent (low grade, slow growing) lymphomas
  
• Aggresive (high grade, fast growing) lymphomas 

Indolent NHL grow slowly and will usually not result in any symptoms in the early stages and it can therefore take a while before they are found. Even after the diagnosis, it is common to wait with the treatment, sometimes months or even years. When the treatment later is commenced, it is usually very effective and leads to the shrinking or total disappearance of the lymphomas. The patient will then have a period of no disease symptoms, the so called remission. It is not uncommon unfortunately that the disease comes back later and another round of treatment is required.

The aggressive NHL's grow faster. They will typically result in more symptoms than the indolent NHL's and usually require immediate treatment. The word "aggressive" may sound frightening, but the fact is that these lymphomias will often react very well to treatment and the probability that they will reach remission is actually better than with the indolent NHL's.

By looking at the lymphomas in a microscope, it is possible to see the difference between an indolent non-Hodgkin lymphoma and an aggresive one. That is why a tissue sample is always required. Mostly this is taken via a biopsy in where a small part of the lymph node is taken as a sample via internal or external (needle) surgery. In some other cases, the diagnosis may be arrived at "by mistake" such as via a gastroscopy.

It is important that a non-Hodgin lymphoma is classified properly since the treatment of lymphomia can be very different for the different types of lymphoma.

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