These are cancers of the lymph glands. While most cancers occurring anywhere spread into lymph glands) lymphomas primarily involve the lymph nodes. On account of their characteristics) lymphomas are divided into two categories:

1. Hodgkin's lymphoma
2. Non-Hodgkin's lymphoma.

Hodgkin's Lymphoma

The disease is characterized by progressive painless enlargement of lymph glands. It occurs in both sexes more often in males. Its incidence is low in children maximum around the age of 20 years decreases after this age but occurs in older people.

It is distinguished from non-Hodgkin's lymphoma by histological examination of the involved gland, which shows the presence of Reed-Sternberg cells) now thought to be cancer cells.

Cause(s) It is not known.

Symptoms

• Painless swelling of a group of glands, more often on one side of the neck.
• The involvement of the glands may be present in the thorax or the abdomen.
• Loss of weight
• Diminished appetite
• Feeling of ill health
• Fever which comes on and abates, leaving behind increasing weakness.

Diagnosis

Routine: Blood: Hb, RBC, TI..C may be normal. DLC may show some increase of eosinophil cells.
Speclal: Biopsy examination of the involved lymph gland shows the characteristic microscopic picture of Hodgkin's disease, thus clinching the diagnosis.
Additional: X-ray of the chest may show opacities of the Hodgkin's disease if the lung is involved.

Ultrasound examination and CT scan may show the involvement of the organ such as the liver.

Treatment

Hodgkin's disease is thought to arise in one region of the body and spread from there to others. It is, therefore, important to establish the extent of the disease at the time of diagnosis because staging largely determines the way the treatment is to be given. There are four clinical stages, based primarily on the extent of the disease.

Stage I: Only one group of glands is involved anywhere in the body.
Stage II: More than one group of glands is involved, but only on one side of the body.
Stage III: More than one group of glands are involved, but on both sides of the body.
Stage IV: Besides the glands, there is involvement of the lungs, liver, bones.
Surgery: In stage 1, surgery is resorted to, in order to remove the involved lymph nodes.
Radiation: In stage n and ill, radiation is the treatment of choice. It is given 4 to 5 days a week, for 3 to 4 weeks. The usual side-effects are nausea, vomiting, tiredness, soreness over the radiated area.
Chemotherapy: When the disease is widespread, only chemotherapy may be of help. Different group of drugs are given.
MOPP: Nitrogen Mustard, Vmaistine, aho called Oncovin, Prednisolone, Procarbazine.
MVPP: Nitrogen Mustard, Vinblastine, Prednisolone, Procarbazine.
ABVD: Adriamycin, Bleomycin, Vmblastine, DTIC.

The drugs are usually given intravenously and repeated weekly. Tablets are taken by mouth about a fortnight after the injection.

Prognosis

The results of treatment are best in those with a localized disease, discovered early.

Non-Hodgkin's Lymphoma
This comprises all lymphomas other than Hodgkin's. Most of these occur in people above 50 years of age, though some occur in children as wcl1. They differ from Hodgkin's disease because of their different histological picture. These lymphomas grow rapidly, but arc potentially curable.

Cause(s) It is not known.

Symptoms

Lymph node enlargement is the most common presenting finding and is usually painless unless it has developed very quickly. The nodes are discrete and firm. Tissues and organs other than lymph node arc involved more often than in the Hodgkin's.
The other symptoms present are:

• Tiredness and lassitude.
• Loss of weight.
• Fever with sweating.

Symptoms also depend on the site where the lymphoma is located. In the chest, there may be breathlessness and coughing; in the abdomen, there may be enlargement of the abdomen, discomfort, pain, obstruction in the intestinal tract or jaundice.

Diagnosis

Routine: Blood: TLC, DLC may be normal, Hb is decreased. ESR is raised.
Special: Biopsy examination of the involved lymph gland clinches the diagnosis.
Additional: If spread in other parts of the body is suspected, then ultrasound examination of the abdomen or CT of the abdomen or chest, or X-ray of the chest is done.

Treatment

It depends upon the type of lymphoma and its staging. The staging process is similar to that of Hodgkin's.

Swgery: Because the disease is generally widespread, surgery is not helpful.
Radiation: Majority of these lymphomas respond to radiation. The patient may live for many years after treatment, even though the disease is not eradicated.
Chemotherapy: The drugs commonly used are Cyclophosphamide or Chlorambucil. A combination of drugs called CVP (Cyclophosphamide, Vincristine and Prednisolone) is also useful. The period of treatment may be for up to 6 months. Response to chemotherapy is good. Some patients live even after ten years.

Radiation and chemotherapy are, many a time, used together, leading to remission of disease for up to even ten years. But the disease does get cured for ever.
For more rapidly progressive lymphomas, the chemotherapy combinations recommended are as follows:
1. Cyclophosphamide, Adriamycin, Vincristine, Prednisolone.
2. Cyclophosphamide, Adriamycin, Prednisolone, Procarbazine Bleomycin, Vincristine.
3. Bleomycin, Vmcristinc, MethotreXate, Cytosine rabinoside, Leucovorin.
4. Cyclophosphamide, Vincristine, Prednisolone.

Any of these regimes is given intermittently usually at. 3-weekly intervals for 6 cycles. Side-effects are nausea, vomiting, tiredness, and increased risk of infection.

Prognosis