Adults and children with suspected non-Hodgkin's lymphoma first have an extensive physical examination. Swollen but painless lymph nodes in the neck, armpit or groin area are often the only symptom of non-Hodgkin's lymphoma in its early stages. Other symptoms may include fever, night sweats, fatigue, weight loss, abdominal pain or swelling, extremely itchy skin, and chest pain, coughing or trouble breathing.

Both swollen and normal lymph nodes are examined to determine their size and consistency. The patient's blood and urine are tested to help rule out infection or some other disease as a cause of swollen lymph nodes. Patients also may have X-rays and PET, CT or MRI scans to detect the presence and size of tumors.

Lymph node tissue may be removed during a biopsy procedure for study in the laboratory to determine if non-Hodgkin's lymphoma is present and, if so, what type. The biopsy may show whether a lymphoma is growing slowly (low grade), moderately (intermediate grade) or rapidly (high grade). A bone marrow biopsy also may be done to determine if the disease has spread.

Non-Hodgkin's lymphoma is classified into about 30 types. Classification is based on several factors, including whether the cancer originates in B-cell or T-cell lymphocytes, the cells' size and genetic changes, how the cancer cells group together and how fast they are growing. Doctors also assign a stage (I through IV) to non-Hodgkin's lymphoma based on the number of tumors and how widely they have spread.

Oncologists, hematologists, and other specialists work together at DHRC to treat patients with non-Hodgkin's lymphoma. Oncologists at DHRC have extensive experience in treating the disease with state-of-the-art chemotherapy, radiation therapy and bone marrow or stem cell transplantation, as well as innovative treatments such as biotherapy and radioimmunotherapy. Treatment choices depend on the type and stage of non-Hodgkin's lymphoma, the patient's age and overall medical condition.

DHRC conducts many clinical trials of experimental therapies that may be appropriate for patients who do not respond to standard treatments.

Early-stage disease

Patients whose disease is discovered at a very early stage and who have no outward symptoms may not need treatment for a year or more. These patients are examined periodically and closely monitored for disease progression. Patients with early-stage, low-grade lymphomas generally have radiation therapy, using high doses of radiation to kill cancer cells. Radiation therapy may be external (radiation directed toward specific points in the body) or internal (injection of a radioactive substance in or near the cancer via a needle, catheter or other device).

Later stage disease

Patients with intermediate- and high-grade lymphomas or advanced stages of low-grade lymphomas usually have chemotherapy. Doctors use a combination of drugs, given orally or by injection, against fast-growing cancer cells. Intermediate- or high-grade lymphoma, or cancer in a specific site such as the brain, may require radiation in addition to chemotherapy.

Recurrent disease

For patients whose intermediate- or high-grade disease recurs, DHRC offers additional high-dose chemotherapy with the option of stem cell transplantation. Chemotherapy damages bone marrow, limiting the amount of therapy a patient can receive. To avoid this complication, oncologists at DHRC remove and freeze healthy stem cells - those capable of producing new cells - from patients' blood or bone marrow.

Biotherapy

DHRC is a pioneering center for biologic therapy, the use of antibodies to help the immune system target and destroy cancer cells.

Radioimmunotherapy

When other treatments have failed, DHRC Oncologists may offer radioimmunotherapy drugs to patients. These drugs, which are combined with radioactive isotopes, attach to cancer cells, and the added radiation helps destroy these cells. Radioimmunotherapy is generally well tolerated, but serious side effects, including reduced blood cell counts, hemorrhage and life-threatening infection, are possible. The Food and Drug Administration has approved the use of these drugs only after other treatments have failed.