Non-Hodgkin's Lymphoma - Staging and Treatment Guidelines

Treatment

Treatment for non-Hodgkin's lymphoma is highly specific for each patient and is determined by the tumor classification. It includes the following factors:

• Stage (the extent of the tumor)
• Grade (the growth pattern of the tumor)
• Histologic type (cellular structure)
• Location of tumor
• Other factors, such as blood levels of lactate dehydrogenase or patient's age and overall health status

Staging and Grading

Grading refers to how fast the tumor cells grow and divide, and for how fast the tumor itself spreads. In NHL, indolent lymphomas are slow growing and referred to as low grade. Aggressive lymphomas are fast growing and referred to as high grade. Aggressive lymphomas are considered more curable than indolent lymphomas. Indolent lymphomas may respond to treatment but tend to recur. (Recurrence is also called relapse.)

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Staging refers to where the tumor is contained and where it has spread. The stages of non-Hodgkin’s lymphoma are:

Stage I. In Stage I (early disease), lymphoma is found in only one lymph node area or in only one area or organ outside the lymph nodes.

Stage II. In Stage II (locally advanced disease), lymphoma is found in two or more lymph nodes on the same side of the diaphragm or the lymphoma extends from a single lymph node or single group of lymph nodes into a nearby organ.

Stage III. In Stage III (advanced disease), lymphoma is found in lymph node areas on above and below the diaphragm. Lymphoma may have also spread into areas or organs adjacent to lymph nodes, such as the spleen.

Stage IV. In Stage IV (widespread disease), the lymphoma has spread (metastasized) via the bloodstream to organs outside the lymph system, such as the bone marrow, brain, skin, or liver.

Treatment Options

The main treatments for non-Hodgkin’s lymphoma are:

• Radiation therapy
• Chemotherapy
• Biologic therapy (immunotherapy)
• Stem cell or bone marrow transplantation

In early stages of lymphoma, doctors may recommend watchful waiting where treatment is delayed until symptoms appear or worsen. Treatment for lymphomas generally uses chemotherapy (particularly intensive regimens using several drugs) or a combination of chemotherapy and radiation. Monoclonal antibody biologic drugs, (a treatment approach also called immunotherapy), are now being used more frequently in combination with chemotherapy drugs. Transplantation is mainly used to treat patients who relapse or who are in remission. Surgery is not a usual treatment option.