Non Hodgkin's lymphoma & Hodgkin's disease
The Lymphomas are a heterogeneous group of neoplasms that arise in the lympho-reticular system. The incidence of Hodgkins Disease in the UK is 3/100,000, approximately half that of NHL currently standing at 6/100,000 but rising. In Hodgkins Disease the neoplastic cell takes the form of mononuclear Hodgkins cells and the characteristic multinucleate Reed-Sternberg cell, which must be identified for histological diagnosis. The histological classification of Non Hodgkins Lymphoma is more diverse and subject to a degree of controversy. The most widely accepted classification is the Working Formulation but more recently the Revised European-American Lymphoma (REAL) Classification has been devised. It has the advantage of incorporating all nodal and extranodal lymphoid tumour, including Hodgkins disease and it incorporates newer categories of lymphoma. The aggressiveness and response to treatment vary widely within the sub types of these neoplasms.
Symptoms of a lymphoma
Isolated or generalised lymphadenopathy (glands) in the absence of local or systemic infection. Particularly if associated with weight loss, sweating excessively at night or unexplained temperatures.
What to do:
Patients should present to their GP's and unless another explanation
can be found sent for urgent biopsy to a surgeon. or if a high suspicion of
lymphoma directly to the Oncologist/Haematologist with an interest in lymphoma who may
organise an ultrasound guided biopsy in consultation with the radiologist. If the
lymphadenopathy is above the clavicles it is best to refer to an ENT or oro-maxillary
surgeon. If there are risk factors for HIV infection these are best mentioned to the
doctor at this stage.
The following investigations are often required at this time:-
1. Full history and clinical examination, with particular reference to clinically assessable disease, e.g. lymph nodes, spleen, liver, Waldeyers ring etc.
2. Baseline bloods - FBC, U+E, LFT, LDH, ESR. Consider HIV test, with appropriate counselling and consent, if patient in high risk category.
3. Baseline imaging, CXR, other imaging as indicated usually CT scan chest, abdomen & pelvis
4. Bone marrow aspirate and trephine:
All patients with NHL
Evidence of bone marrow impairment on FBC with Hodgkin's.
5. Lumbar puncture (see section - management of the CNS in lymphoma) for patients with:-
6. Histology review at Cambridge, all newly diagnosed patients - send to Dr Arno.
7. If chemotherapy is likely, offer sperm banking if required by the patient and if delay is acceptable .
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.