Low-grade lymphoma

Specialty of Haematology

What is low-grade lymphoma?

Lymphoma is the most common type of blood cancer and occurs when the white blood cells (lymphocytes) change and grow excessively out of control. These cells are in the lymph nodes, spleen, thymus, bone marrow and other parts of the body.

There are two main types of lymphoma; non-Hodgkin and Hodgkin lymphoma, which both involve different types of lymphocyte cells, proteins present on the surface of their cells and the genetic mutation that occurs in the cells. Two grades of non-Hodgkin exist, high-grade lymphoma (grows quickly) and low-grade lymphoma (grows slowly).
 

What are the symptoms of low-grade lymphoma?

As low-grade lymphoma is slow growing and slow to spread, the symptoms may not be as noticeable. Possible symptoms are also common to all non-Hodgkin’s lymphomas. One of the commonest symptoms is swollen lymph nodes that cause a lump, which is also known as swollen glands. Other symptoms may include:

  • fever
  • weight loss
  • loss of appetite
  • severe night sweats
  • chest or abdominal pain
  • fatigue
  • itchy skin
  • skin rash

How is it diagnosed?

Low-grade lymphoma is found during a routine medical examination as it is not common to have many obvious symptoms. Thorough diagnostic testing is required to determine the type and stage of the disease. The only way to confirm a diagnosis is through a lymph node biopsy.

This is a minor surgical procedure that takes a sample of the affected lymph node, which is examined under a microscope in a laboratory.

Following a lymph node biopsy, the patient will have more tests such as a blood test for a full blood count. There will be a liver function test to check if the liver is working normally. The urea and electrolytes are also tested to check whether there has been any damage to the kidneys.
 

What’s the staging of low-grade non-Hodgkin lymphoma?

The stage of the lymphoma describes how far that it has spread and will help to determine which treatment option is right for the patient. Most people have advanced stage low grade non-Hodgkin lymphoma when they are diagnosed. Early stage – stage one and rarely stage two – can be successfully treated and the patient stays in remission for a long time.

The advanced stages – three and four - are difficult to cure. As these stages are chronic and need regular treatment the lymphoma has periods of being in remission and relapsing, meaning it keeps coming back and needs more treatment.
 

How is low-grade non-Hodgkin lymphoma treated?

There are different phases of treatment for low-grade lymphoma. These are:

  • watch and wait – the doctor may decide not to give treatment if there are no symptoms during diagnosis but they will keep a close eye on the patient.
  • first line treatment – for those with very enlarged lymph nodes, it may be recommended to have a combination of chemotherapy and immunotherapy called a monoclonal antibody.
  • maintenance treatment – once in remission, there may be maintenance treatment for some types of low-grade lymphoma, which may help to delay the lymphoma from returning.
  • second line treatment – there are lots of different options in case the low-grade lymphoma comes back after a period of time. It may be recommended to have a combination of chemotherapy with other drugs.
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