Non-Hodgkins Lymphomas (cont.)

Medical Author:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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NHL is classified into many different types. Several classification systems exist for NHL, including the Revised European American Lymphoma Classification which is the foundation for the WHO lymphoma classification. The classifications uses cell types and defining other characteristics. Basically there are three large groups: the B cell, T cell, and natural killer cell tumors.

Newer techniques such as immunophenotyping (a way to study the proteins on a cell and identify the precise types of B or T cells that are involved) are used to diagnose and classify lymphomas. This technique is especially useful in the case of B cell lymphomas.

Testing of DNA from the lymphoma is used to detect gene defects that help determine the prognosis and response to treatment.

To plan the best treatment for NHL, your health-care provider needs to stage (know the extent of) the disease. This is an attempt to find out what part of your body is involved.

Different tests are involved in the staging process, and they can include the following:

• Bone marrow biopsy (see above)
• CT scan
• MRI
• Ultrasound
• PET scan: Radioactive material is injected, and a CT scan is performed to determine the metabolism of this material. Lymphoma cells show faster metabolism than normal cells, and areas with lymphoma look brighter on the pictures.

Doctors will also stage the lymphoma based on spread of the disease and organ involvement as well as symptoms:

• Stage I: The cells are found in only one lymph node area (such as in the neck or axilla). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).
• Stage II: The lymphoma cells are found in at least two lymph node areas on the same side of the body or only above or below the diaphragm. Or the cells are in one organ and the lymph nodes affected are near that organ
• Stage III: The lymphoma is in lymph nodes above and below the diaphragm. There might be spread into an organ near this lymph node group.
• Stage IV: In addition to lymph cell spread, lymphoma cells are found in several parts of one or more organs or tissues.
• A: No symptoms (You have not had weight loss, fever or night sweats)
• B: Presence of any of the following symptoms: weight loss (10 % or more in the last six months), fever (greater then 101.5 F) night sweats, or severe itching.

Source: MedicineNet.com
http://www.medicinenet.com/non-hodgkins_lymphomas/article.htm