Non-Hodgkin’s Lymphoma.

In some ways, it is strange to have a diagnosis with such an odd name as Non-Hodgkin’s Lymphoma, because, in many ways, it is similar to Hodgkin’s disease. Yet, in the minds of the medical profession, they are effectively different entities, and carry a different prognosis. Yet they both involve the bone marrow, lymph glands and lymphocytes.

Non-Hodgkin’s Lymphoma is basically divided into three groups, low-grade and intermediate and high-grade. There is also a system with four grades, depending upon how many lymph glands are involved and how widely the condition is spread. While the condition can occur in all age groups from childhood to old age, it tends to occur slightly more often in the third third of life, i.e. over the age of 50 years, although the low-grade type is rare under the age of 40. It seems to occur just as often in males as in females. There are about 3500 new cases each year in the United Kingdom, the majority being in the more severe groups on diagnosis.

Symptoms and Signs.

As with Hodgkin’s disease, single, or more likely multiple lymph nodes, become swollen, sometimes alarmingly quickly. There is often a significant degree of fatigue, sweating and lethargy, and the immune system may not be working as efficiently as it should, so there are episodes of infections. If lymph nodes are particularly enlarged in the chest, there may be difficulty breathing or a dry cough, or, if in the abdomen, pain there or in the lower back, or constipation. Because of the effect upon the bone marrow, there may be anaemia, or spontaneous bruising (i.e. without an obvious injury) because of the low number of circulating platelets (which are responsible for normal clotting mechanisms). In advanced cases, there is often a pale complexion and weight loss, and the kidneys may start to fail. The spleen is likely to be enlarged.

The main differences between Non-Hodgkin’s Lymphoma and Hodgkin’s disease are the rapid onset and potential to spread to the bone marrow, liver and lungs of the former, for which reason, about 65% of patients already have fairly widespread disease by the time they are diagnosed. Usually Non-Hodgkin’s Lymphoma starts in a particular lymph gland area and rapidly spreads throughout the lymphatic system, which is why it can soon involve most organs of the body.

Investigations.

As with Hodgkin’s disease, a full range of blood tests will be done and a sample will be taken from the bone marrow. A chest X-ray and appropriate CT scans will be done, and a lymph node will be biopsied. This will still show fairly normal architecture of a lymph node in low-grade types of Non-Hodgkin’s Lymphoma, whereas, in the worse grades, that normal structure is lost.

Conventional Treatment.

In the low-grade form of Non-Hodgkin’s Lymphoma, the usual approach is to remove surgically the lymph glands that first appeared, if they remain the only ones. This is followed by radiotherapy to that area. If there is already spread to other organs, chemotherapy is likely to be given, but not always, as sometimes a wait-and-see approach is followed if there are very few in the way of symptoms. If certain groups of lymph glands have not responded to chemotherapy, they are likely to be irradiated.

In the higher, more aggressive, grades of the disease, chemotherapy with a combination of different drugs is the most likely treatment, with radiotherapy being used on groups of lymph glands that are either rather large, are causing unnecessary symptoms, or have failed to respond to chemotherapy. Radiotherapy may be the only treatment in an old or frail patient, or one who is likely to be made badly ill by chemotherapy. Bone marrow transplant may be considered in severely affected patients.

An Explanation by Dr Kingsley Before Your Consultation

about your Non-Hodgkin’s Lymphoma

“Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having Non-Hodgkin’s Lymphoma.  You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want.  There is no time limit.  We will take as long as you want.

Often when I see some people for the first time, they are in a state of panic.  They haven’t a clue what it is all about.  No one has explained anything to them.  Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. 

Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your Lymphoma, but, by then, you were already captive and didn’t really have much choice in the matter.

To be fair to doctors, they assume that their advice is the best on offer.  After all, they are the experts.  Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. 

In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them.  Most people put their faith in their doctor, assuming he knows what he is doing.

There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not.  That is a decision you have to make.  No one can make it for you, but I will help you make up your mind.

The Consultation

The virtual consultation with me has been planned as though you are with me in my consulting room.  I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. 

The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you.

The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information.  Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. 

All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. 

So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do.  Be positive and forget the doom and gloom merchants.  If someone has given you a poor prognosis, forget it.  You no longer fit into their statistics.  You are going to do something for yourself.  You are now in charge.

----------------------------------------

What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer.

CLICK HERE to see an overall view of The Centre