Non-Hodgkin's lymphomas, also known as malignant lymphomas and lymphosarcomas, are a heterogeneous group of malignant diseases originating in lymph glands and other lymphoid tissue. Nodular lymphomas have a better prognosis than the diffuse form of the disease, but in both, the prognosis is worse than in Hodgkin's disease.
The cause of non-Hodgkin's lymphoma is unknown, although some theories suggest a viral source. Since the early 1970s, the incidence of these lymphomas has increased more than 80%, with about 53,000 new cases appearing annually in the United States. The reason for the increase is unknown, although it has been partly attributed to acquired immunodeficiency syndrome. Non-Hodgkin's lymphomas are two to three times more common in males than in females and occur in all age-groups. Compared to Hodgkin's disease, they occur about one to three times more often and cause twice as many deaths in children younger than age 15. Incidence rises with age (median age is 50). These lymphomas seem linked to certain races and ethnic groups, with increased incidence in whites and people of Jewish ancestry.
Usually, the first indication of non-Hodgkin's lymphoma is swelling of the lymph glands, enlarged tonsils and adenoids, and painless, rubbery nodes in the cervical supraclavicular areas. In children, these nodes are usually in the cervical region, and the disease causes dyspnea and coughing. As the lymphoma progresses, the patient develops symptoms specific to the area involved and systemic complaints of fatigue, malaise, weight loss, fever, and night sweats.
Diagnosis requires histologic evaluation of biopsied lymph nodes; of tonsils, bone marrow, liver, bowel, or skin; or of tissue removed during exploratory laparotomy. (Biopsy differentiates non-Hodgkin's lymphoma from Hodgkin's disease.) (See Classifying non-Hodgkin's lymphomas, page 142.)
Other tests include bone and chest X-rays, lymphangiography, liver and spleen scan, computed tomography scan of the abdomen and chest, positron emission tomography, and excretory urography. Laboratory tests include complete blood count (may show anemia), uric acid (elevated or normal), serum calcium (elevated if bone lesions are present), serum protein (normal), and liver function studies.
Radiation therapy is used mainly in the early localized stage of the disease. Total nodal irradiation is generally effective for both nodular and diffuse histologies.
Chemotherapy is most effective with multiple combinations of antineoplastic agents. For example, cyclophosphamide, vincristine, Adriamycin, and prednisone can induce a complete remission in 70% to 80% of patients with nodular histology and in 20% to 55% of patients with diffuse histology. Other combinations — such as methotrexate, bleomycin, Adriamycin, Cytoxan, Oncovin, and prednisone (M-BACOP) — induce prolonged remission and sometimes cure the diffuse form.
In recent years, the development of monoclonal antibodies, specifically rituximab, has provided additional options for the treatment of non-Hodgkin's lymphomas either alone or in combination with traditional chemotherapy regimens. Additionally, radioimmunotherapy for the treatment of these lymphomas has shown promise. Monoclonal antibodies are labeled with beta-emitting isotopes. Currently, ibritumomab tiuxetan is being used alone and in combination with rituximab.
❑Observe the patient who's receiving radiation or chemotherapy for anorexia, nausea, vomiting, or diarrhea. Plan small, frequent meals scheduled around treatment.
❑If the patient can't tolerate oral feedings, administer I.V. fluids and, as ordered, give antiemetics and sedatives.
❑Instruct the patient to keep irradiated skin dry.
❑Provide emotional support by informing the patient and family about the diagnosis and prognosis and by listening to their concerns. If needed, refer them to the local chapter of the American Cancer Society for information and counseling. Stress the need for continued treatment and follow-up care.
Review other book chapters online related to B-cell lymphomas:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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