Screening

There are no routine screening tests for lymphoma. Surveillance is recommended for individuals at risk of immunodeficiency-associated lymphoma and people with a family history of lymphoma.


Symptoms and diagnosis

Common symptoms include:

  • swelling of one or more lymph glands
  • symptoms caused by lymph node enlargement, such as superior vena cava syndrome
  • weakness, loss of appetite, weight loss and abnormal sweating, particularly at night.

Tests usually used to diagnose lymphoma are:

  • gland biopsy
  • laparotomy or thoracotomy (may be necessary to obtain a gland for diagnosis).

Staging

The extent of the cancer is determined by a CT scan of the abdomen and bone marrow biopsy. A PET scan, where available, provides extra information about distant spread, including to bones.


Causes

The causes of lymphoma are not yet known. Exposure to radiation and certain chemicals puts some people at higher risk. For people whose immune system is suppressed, exposure to viruses such as the Epstein-Barr virus or HIV increases the risk of developing lymphoma.


Prevention

There are no proven measures to prevent lymphoma, except potentially avoidance of causes such as HIV infection.


Treatment

Treatment depends on the type of lymphoma, stage of disease and how fast it is likely to grow.

Treatment options include chemotherapy, radiotherapy and monoclonal antibodies. In some cases, a stem cell transplant is required if the lymphoma has recurred or where there is a high likelihood of recurrence in the future.

Early Hodgkin disease is treated with combination chemotherapy plus local field radiation. Chemotherapy is usually ABVD – adriamycin, bleomycin, vinblastine and dacarbazine.  Advanced disease (stages IIB, III, IV) is treated with chemotherapy using ABVD or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone). Radiotherapy may be required for bulky or non-responding sites.

For patients with non-Hodgkin lymphoma, some can be controlled with localised radiotherapy alone, or radiotherapy plus combination chemotherapy (CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone or FCM – fludarabine, cyclophosphamide and mitoxantrone).

If the non-Hodgkin lymphoma is aggressive, successful treatment requires starting chemotherapy immediately – usually rituximab plus combination chemotherapy (eg. CHOP). For early stage disease and advanced stages with bulky sites, involved field radiotherapy is usually required.