How To Determine The Stage Of Lymphoma
Lymphoma is a type of cancer involving cells of the immune system, called lymphocytes. Just as cancer represents many different diseases, lymphoma represents many different cancers of lymphocytes-about 35 different subtypes, in fact. Therefore, lymphoma is a group of cancers that affect the cells that play a role in the immune system, and primarily represents cells involved in the lymphatic system of the body.
The lymphatic system is part of the immune system. It consists of a network of vessels that carry a fluid called lymph, similar to the way that the network of blood vessels carry blood throughout the body. Lymph contains white blood cells called lymphocytes. Lymphocytes attack a variety of infectious agents as well as many cells in the precancerous stages of development.
Lymphoma is a malignant transformation of either lymphocytes B or T cells or their subtypes. As the abnormal cells multiply, they may collect in one or more lymph nodes or in other lymph tissues such as the spleen. As the cells continue to multiply, they form a mass often referred to as a tumor. Tumors often overwhelm surrounding tissues by invading their space, thereby depriving them of the necessary oxygen and nutrients needed to survive and function normally. Because of their uncontrolled growth, lymphomas can encroach on and/or invade neighboring tissues or distant organs.
Lymphomas fall into 1 of 2 major categories. Hodgkin lymphoma (HL, previously called Hodgkin’s disease) and all other lymphomas (non-Hodgkin lymphomas or NHLs). These two types occur in the same places, may be associated with the same symptoms, and often have similar gross physical characteristics. However, they are readily distinguishable via microscopic examination.
Hodgkin disease develops from a specific abnormal B lymphocyte lineage. NHL may derive from either abnormal B or T cells and are distinguished by unique genetic markers. There are five subtypes of Hodgkin disease and about 30 subtypes of non-Hodgkin lymphoma. Because there are so many different subtypes of lymphoma, the classification of lymphomas is complicated and includes both the microscopic appearance and well-defined genetic and molecular rearrangements.
Many of the NHL subtypes look similar, but they are functionally quite different and respond to different therapies with different probabilities of cure. Therefore, NHL lymphoma diagnosis is a necessary step for patients. Meanwhile, HL subtypes are microscopically distinct, and typing is based upon the microscopic differences as well as extent of disease.
Once lymphoma is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. Your doctor needs to know the stage of your disease to plan treatment. Your doctor may determine the stage of your disease by examining you and doing the testing mentioned above. This type of staging is called clinical staging. In some cases, your doctor may need to do an operation called a laparotomy to determine the stage of your cancer. During this operation, your doctor makes a small surgical incision into your abdomen and carefully looks at the organs to see if they contain cancer. The doctor will remove (biopsy) small pieces of tissue during the operation and look at them under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done when it is needed to help your doctor plan treatment.
The following stages are used for non-Hodgkin’s lymphoma:
- Stage I – Cancer is found in only one lymph node area or in only one area or organ outside the lymph nodes.
- Stage II – Either of the following means that the disease is stage II.
- Cancer is found in two or more lymph node areas on the same side of the diaphragm (the thin muscle under the lungs that helps you breathe).
- Cancer is found in only one area or organ outside the lymph nodes and in the lymph nodes around it. Other lymph node areas on the same side of the diaphragm may also have cancer.
- Stage III – Cancer is found in lymph node areas on both sides of the diaphragm. The cancer may also have spread to an area or organ near the lymph node areas and/or to the spleen.
- Stage IV – Either of the following means that the disease is stage IV
- Cancer has spread in more than one spot to an organ or organs outside the lymph system. Cancer cells may or may not be found in the lymph nodes near these organs.
- Cancer has spread to only one organ outside the lymph system, but lymph nodes far away from that organ are involved.
- Recurrent – Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.
As a result of refinements in and more aggressive approaches to therapy, the outlook for NHL has improved significantly in the last few decades. The five-year survival rate after treatment is 55% for adults and about 80% for children. The addition of immunotherapy to standard treatment for NHLs may further improve survival rates.
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