Non-Hodgkin Lymphoma, Part 1 — Introduction, incidence, symptoms, and treatment
What is Non-Hodgkin lymphoma?
Non-Hodgkin lymphoma is a malignant solid tumor or cancer of
the immune system. The cells of origin are malignant undifferentiated
lymphoid cells. The cells of the immune system are located throughout
the body and normally circulate throughout the body therefore non-Hodgkin’s
lymphoma can arise anywhere and should be considered a generalized disease
from the onset with patterns of spread that follow the circulation patterns
of normal lymphoid cells. These lymphoid cells spread in a random diffuse
unpredictable and aggressive pattern. There are found in lymph tissues
such as the lymph nodes and the spleen, but they can also be outside the
lymph nodes and can infiltrate bone marrow and spinal fluid. They grow
very rapidly and contribute to a large tumor burden, Quick diagnosis and
treatment are critical. Several different tissue types of non-Hodgkin
lymphoma exist including Lymphoblastic, Undifferentiated and Large Cell.
It occurs more often in males than in females.
Incidence and prevalence
Collectively, lymphomas are the third most common childhood malignancy
after acute leukemias and brain tumors. Lymphomas constitute 10-12% of
childhood cancers. In older adolescents, lymphomas surpass brain tumors
in incidence, largely due to the increased frequency of non-Hodgkin lymphoma
in this age group.
Table 1
| Location of Cancer | Incidence per 100,000 |
| All Sites | 15.9 |
| Leukemias | 3.8 |
| Brain and other nervous tissue | 2.8 |
| Hodgkin Lymphoma | 1.3 |
| non-Hodgkin Lymphoma | 1.1 |
| Bone and joint | 1.0 |
| Soft tissue | 1.0 |
| Kidney and renal pelvis | 0.7 |
Data from the US Surveillance, Epidemiology, and End Results (SEER) program
(1994-98) are exhibited in Table 1. In children, NHL is somewhat less
common than non-Hodgkin lymphoma.
However, the incidence of NHL appears to be rising in the US. This trend
largely reflects the occurrence of NHL in patients who are immunocompromised
(eg, HIV positive) and in patients previously exposed to chemotherapy
and radiation as treatment for an unrelated cancer. Table 1. Age-Adjusted
Incidence of Selected Cancers for Children Aged 0-19 Years
Symptoms
Presenting symptoms depend largely on the location of the largest or
original tumor. In the abdomen it may cause abdominal pain, distention,
obstruction of the intestine, a large mass, obstruction of the bile duct
or bleeding in the gut. In the head and neck it may present as increased
lymph nodes in the neck, jaw swelling, tonsil enlargement, obstruction
of the nose or dysfunction of the cranial nerves. In the chest it may
cause venous obstruction with distended neck veins, swell of the head
and neck, trouble breathing, fluid in the chest or fluid around the heart
with heart failure. Bone marrow involvement may result in abnormal blood
counts. Staging of the tumor depends on the number of tumors, the number
of anatomic areas involved, whether or not the disease is on one side
of the diaphragm or both sides, whether the disease involves the spinal
cord or whether it extends to the central nervous system, the bone marrow
or both.
Treatment
Surgery is primarily a diagnostic biopsy only. Sometimes it is done for
resection in emergency or for taking a second look at the extent of disease
after treatment. Radiation adds little, if any, therapeutic benefit in
conjunction with chemotherapy. It is sometimes used in emergency situations
in patients with central nervous system disease or airway obstruction.
Multi-agent chemotherapy is the therapeutic modality for all children
with non-Hodgkin’s lymphoma. The tumor responds to many different
agents. Many children with non-Hodgkins lymphoma receive intrathecal agents,
that is drugs placed directly in the spinal fluid such as Methotrexate
and/or Cytosine Arabinoside. The tissue type of non-Hodgkin’s lymphoma
and the Stage determine the exact chemotherapy treatment. Drugs include
Cytoxan, Vincristine, Methotrexate, Prednisone and/or L-asparinginase,
cytarabine, daunorubincin, 6-Mercaptopurine, and Thioguanine.
Non-Hodgkin Lymphoma Part 1 — Introduction, incidence, symptoms, and treatment
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305