This comprises all lymphomas other than Hodgkin’s. Most of these occur in people above 50 years of age, though some occur in children as well. They differ from Hodgkin’s disease because of their different histological picture. These lymphomas grow rapidly, but are potentially curable.
Cause(s)
It is not known.
Symptoms
Lymph node enlargement is the most common presenting finding and is usually painless unless it has developed very quickly. The nodes are discrete and firm. Tissues and organs other than lymph node are involved more often than in the Hodgkin’s.
The other symptoms present are:
· Tiredness and lassitude.
· Loss of weight.
· Fever with sweating.
· Symptoms also depend on the site where the lymphoma is located. In the chest, there may be breathlessness and coughing; in the abdomen, there may be enlargement of the abdomen, discomfort, pain, obstruction in the intestinal tract or jaundice.
Diagnosis
Routine: Blood: TLC, DLC may be normal, Hb is decreased. ESR is raised.
Special: Biopsy examination of the involved lymph gland clinches the diagnosis.
Additional: If spread in other parts of the body is suspected, then ultrasound examination of the abdomen, or CT of the abdomen or chest, or X-ray of the chest is done.
Treatment
It depends upon the type of lymphoma and its staging. The staging process is similar to that of Hodgkin’s.
Surgery: Because the disease is generally widespread, surgery is not helpful.
Radiation: Majority of these lymphomas respond to radiation. The patient may live for many years after treatment, even though the disease is not eradicated.
Chemotherapy: The drugs commonly used are Cyclophosphamide or ChlorambuciL A combination of drugs called CVP (Cyclophosphamide, Vincristine and Prednisolone) is also useful. The period of treatment may be for up to 6 months.
Response to chemotherapy is good. Some patients live even after ten years.
Radiation and chemotherapy are, many a time, used together, leading to remission of disease for up to even ten years. But the disease docs get cured for ever.
For more rapidly progressive lymphomas, the chemotherapy combinations recommended arc as follows:
· Cyclophosphamide, Adriamycin, Vincristine, Prednisolone.
· Cyclophosphamide, Adriamycin, Prednisolone, Procarbazine Bleomycin, Vincristine.
· Bleomycin, Vincristine, Methotrexate, Cytosine rabinosidc, Leucovorin.
· Cyclophosphamide, Vincristine, Prednisolone. Any of these regimes is given intermittently usually at 3-weekly intervals for 6 cycles. Side-effects arc nausea, vomiting, tiredness, and increased risk of infection.
Prognosis
The patient may live for over 10 years. Chemotherapy has increased years of survival.
Early Detection
· Signs & Symptoms
· Painless lymph gland enlargement anywhere in the body.
· Tiredness and lassitude.
· Fever with sweating.
Investigations
· Raised ESR
· Biopsy examination of the involved lymph gland.