Lymphoma - Diagnosis, Evaluation and Treatment

If lymphoma is diagnosed, bone marrow aspiration and biopsy, lumbar puncture, chest x-ray, body CT, PET, bone scan, body MRI or abdominal ultrasound may be ... Togglenavigation TestsandTreatments PediatricCare Screening DiseasesandConditions Safety EnEspañol Lymphoma Lymphomaisacancerthatdevelopsinthewhitebloodcellsofthelymphaticsystem.Symptomsmayincludeenlargedlymphnodes,unexplainedweightloss,fatigue,nightsweatsandshortnessofbreath,coughortroublebreathing. Yourdoctorwillperformaphysicalexamandmayorderbloodtestsorlymphnodebiopsytohelpevaluateyourcondition.Iflymphomaisdiagnosed,bonemarrowaspirationandbiopsy,lumbarpuncture,chestx-ray,bodyCT,PET,bonescan,bodyMRIorabdominalultrasoundmaybeusedtolookforenlargedlymphnodesthroughoutthebodyanddeterminewhetherthelymphomahasspread.Treatmentdependsonthetypeandstageofthelymphomaaswellasyourageandoverallhealth.Sometypesoflymphomamayonlyrequiremonitoringwhileothersmayrequirechemotherapy,radiationtherapy,radioimmunotherapy,biologictherapyorstemcelltransplant. Whatislymphoma? Howislymphomadiagnosedandevaluated? Howislymphomatreated? Whatislymphoma? Lymphomaisacancerthatdevelopsinthewhitebloodcells(lymphocytes)ofthelymphaticsystem,whichispartofthebody'simmunesystem. Thelymphaticsystemincludesanetworkofsmallchannelssimilartobloodvesselsthatcirculatefluid(calledlymph),lymphnodes (alsocalledglands),bonemarrowandseveralorgansincludingthespleen,allofwhicharemadeupoflymphocytes. Therearetwomajortypesoflymphoma:Hodgkin(HL) andnon-Hodgkin(NHL),eachofwhichhasseveralsubtypes.Hodgkinlymphoma—alsoknownasHodgkin'sdisease—isfarlesscommonthannon-Hodgkinlymphoma. Individuallymphomasdifferinhowtheybehave,spreadandrespondtotreatment.Thetypeoflymphomaisdeterminedbyexaminingsomeofthecancercellsunderamicroscope.WhenanabnormalcellcalledaReed-Sternbergcell ispresent,thelymphomaisclassifiedasHodgkin.Whenitisnotpresent,thecancerisclassifiedasnon-Hodgkin. Symptomsoflymphomamayinclude: enlargedlymphnodesintheneck,armpitsorgroin unexplainedweightloss fever drenchingnightsweats generalizeditching fatigue lossofappetite coughingortroublebreathing painintheabdomen,chestorbones swollenabdomen feelingfullafteronlyasmallamountoffood shortnessofbreathorcough topofpage Howislymphomadiagnosedandevaluated? Yourprimarydoctorwillbeginbyaskingyouaboutyourmedicalhistoryandsymptomsandperformaphysicalexam.Yourdoctormayalsoorderoneormoreofthefollowingtests. Bloodtests:Thenumberofwhitebloodcells,plateletsandredbloodcellsmaybecomelowwhenlymphomaspreadstothebonemarrow.Bloodtestresultshelpdeterminehowtheliverandkidneysarefunctioning. LymphNodeBiopsy:Aprocedureinwhichaportionoforanentirelymphnodeissurgicallyremovedsoitcanbeexaminedunderamicroscopetolookforthepresenceoflymphomacells.Occasionally,aneedlebiopsymaybesufficienttomakeadiagnosis.Otherlaboratorytestsmaybeperformedonthebiopsysample,includingmoleculargenetictests. Bonemarrowaspirationandbiopsy:Asurgicalprocedureinwhichathin,hollowneedleisinsertedintothehipbonetoremoveasmallamountofliquidbonemarrowsoitcanbeanalyzedunderamicroscope.Thisprocedureistypicallyperformedafterlymphomahasbeendiagnosedtohelpdetermineifthediseasehasspreadtothebonemarrow.SeetheBiopsypageformoreinformation. Lumbarpuncture(spinaltap):Aminimallyinvasivetestthatinvolvestheremovalofasmallamountofcerebrospinalfluid(CSF)—thefluidthatsurroundsthebrainandspinalcord—soitcanbeanalyzedforthepresenceoflymphomacells.Thistestistypicallyonlyperformedforcertaintypesoflymphomaorifthepatienthassymptomsthatsuggestthelymphomamayhavereachedthebrain. Chestx-ray:Achestx-rayisusedtolookforenlargedlymphnodes. BodyCT:ACTofthebodyisusedtodetectenlargedlymphnodesororgansandabnormalitiesintheabdomen,pelvis,chest,headandneck. Insomecases,CTmaybeusedtoguideabiopsyneedlepreciselyintoasuspiciousareasothatatissuesamplecanberemovedandexaminedunderamicroscope.ThisprocedureiscalledaCT-guidedneedlebiopsy. PETscan:APETscan,whichusesasmallamountofradioactivematerial,canhelpshowifanenlargedlymphnodeiscancerousanddetectcancercellsthroughoutthebodythatmaynotbeseenonaCTscan.SomepatientswithlymphomaundergoPETscanningafterreceivingtherapytodetermineifthecancerisrespondingtotreatment.APETscaniscombinedwithaCTorMRIscantoprovidehighlydetailedviewsofthebody. Bonescan:Inabonescan,aradioactiveisotopecalledtechnetium-99misinjectedintoaveinandtravelstodamagedareasofbone.Thistestistypicallyperformedifthepatientishavingbonepainorothertestssuggestlymphomahastraveledtothebone. MRI:AnMRIscanishelpfulindetectinglymphomathathasspreadtothespinalcordorbrain.Itcanbehelpfulinotherareasofthebodyaswell,suchastheheadandneckarea. Abdominalultrasound: Abdominalultrasoundmaybeusedtoexamineenlargedlymphnodes,especiallyintheabdomen.Ultrasoundisalsousedtoimagetheabdominalorgansandkidneys,whichmaybeaffectedbyenlargedlymphnodes. Womenshouldalwaysinformtheirphysicianorx-raytechnologistifthereisanypossibilitythattheyarepregnant.Forpregnantwomenwithlymphoma,MRIandultrasoundmaybeusedtostagethediseasewhileprotectingthefetusfromharmfulradiation.SeetheSafetypage formoreinformationaboutpregnancyandradiation. topofpage Howislymphomatreated? Treatmentoptionsarebasedonthetypeandstageoflymphomaandtheageandoverallhealthofthepatient.Forsometypesoflymphoma,ifthediseaseisadvancedbutslow-growing(indolent),await-and-seeapproachmaybeanoption.Whentreatmentisrequiredforlymphoma,oneormoreofthefollowingtherapiesmaybeused. Chemotherapy:Chemotherapy,usedaloneorincombinationwithradiationtherapy,isoneofthemainmethodsoftreatmentforlymphoma.Itinvolvestheuseofcancer-killingdrugsthataregivenbymouthorinjection. CNSprophylaxis,inwhichchemotherapyisinjectedintothespinalcolumnthroughalumbarpuncture,maybeusedtotreatcertaintypesofnon-Hodgkinlymphomathathavespreadtothebrainorareathighriskforsuchspread.Inaddition,steroiddrugsmaybeusedtorelieveswellingandinflammation. Radiationtherapy:Radiationtherapyuseshigh-energyradiationtoshrinktumorsandkillcancercells.Patientswithlymphomamaybetreatedwithexternalbeamtherapy inwhichbeamsofhighenergyx-raysaregeneratedbyamachineoutsidethepatientanddirectedatthetumorandcancerouslymphnodes.Externalbeamtherapymaybeusedaloneorincombinationwithchemotherapy. Monoclonalantibodytherapy(alsocalledtargetedtherapy):Thisisatreatmentinvolvinglaboratory-producedmoleculescalledmonoclonalantibodiesthatareengineeredtorecognizeandbindtothesurfaceofcancercells.Monoclonalantibodiesmimicnaturallyproducedantibodiesinthebodythatattackinvadingforeignsubstances,suchasbacteriaandviruses.Monoclonalantibodiesmaybecombinedwithachemotherapydrugorradioactivematerial,allowingtheantibodytodeliveradirectdoseofthecancer-killingagenttothecancercell. Twocommonmonoclonalantibodiesusedforlymphomaare: Rituximab®,amonoclonalantibodydesignedtoseekoutandlockontotheproteinreceptor(CD20)foundonaspecifictypeoflymphocyte(Bcells),whichcausesthelymphomacelltodie.Thistreatmentisusedformanypatientswith"B-cell"lymphomaandmaybecombinedwithchemotherapyand/orradiationtherapy. Brentuximabvedotin(Adcetris®),whichcombinesachemotherapydrugwithamonoclonalantibodythatattachestoaspecificmolecule(CD30)onthesurfaceofHodgkindiseasecells andsomeothertypesoflymphoma. Radioimmunotherapy(alsocalledradiolabeledmonoclonalantibodytherapy): Thistherapypairsamonoclonalantibodywitharadioactivematerial,suchasYttrium-90 withIbritumomabTiuxetan(Zevalin®).Theradiolabeledmonoclonalantibodytravelstoandbindstocancercells,allowingahighdoseofradiationtobedelivereddirectlytothetumor. Biologictherapy:Thistreatmentinvolvesnaturalorlaboratory-madesubstancesdesignedtoboost,directorrestorethebody'snaturaldefensesagainstcancer,ortointerferewithspecificbiologicpathwayswithinthelymphomacells.Interferon isonetypeofbiologictherapythataffectsthedivisionofcancercellsandcanslowtumorgrowth.Lenalidomideandibrutinibareexamplesofagentsthat interferewithmetabolicpathwayswithinthelymphomacells. Stemcelltransplant:Inthistreatment,diseasedbonemarrowisreplacedwiththepatient'sownhealthystemcells(calledautologous)orthestemcellsofadonor(calledallogeneic)inordertohelpnewbonemarrowgrow.Astemcelltransplantmaybeanoptioniflymphomareturnsaftertreatment.Patientsundergoingastemcelltransplantmayfirstreceivewhole-bodyexternalbeamradiationalongwithhigh-dosechemotherapytoeliminateasmanylymphomacellsaspossiblethroughoutthebody. topofpage ThispagewasreviewedonJune,01,2022 Sendusyourfeedback Didyoufindtheinformationyouwerelookingfor? Yes No Pleasetypeyourcommentorsuggestionintothetextboxbelow.Note:weareunabletoanswerspecificquestionsorofferindividualmedicaladviceoropinions. Comments: E-Mail: AreaCode: Phoneno: Images × ImageGallery Radiologistandpatientconsultation. 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