About Non-Hodgkin Lymphoma Stage 4
Non-Hodgkin lymphoma (NHL) is a type of cancer that develops when lymphocytes (a type of white blood cell) start to grow abnormally, weakening the immune system and potentially forming tumors throughout the body. Stage 4 NHL is the most advanced stage of the disease. In this stage, the cancer has spread extensively throughout the body. Stage 4 NHL can be characterized by the following:
- Cancer has spread to one or more organs outside of the lymph system
- Cancer is found in two or more groups of lymph nodes, either above or below the diaphragm, and in one organ outside of the lymph system
- Cancer is found in groups of lymph nodes both above and below the diaphragm, as well as in any organ outside of the lymph system
- Cancer is found in the liver, bone marrow, more than one place in the lung, or cerebrospinal fluid (CSF)
The treatment approach for stage 4 NHL will depend on various factors including the specific type of NHL and individual patient characteristics. It is important to consult with a healthcare professional for personalized advice and guidance.
Non-Hodgkin lymphoma develops when lymphocytes continuously multiply abnormally, forming tumors. Genetic mutations (changes in DNA) in lymphocytes cause the lymphocytes to multiply out of control. While the exact cause of the mutations leading to non-Hodgkin lymphoma is unknown, there are several factors that can increase a person's risk of developing this condition.
Non-modifiable risk factors (factors that a person cannot change or control) for NHL include:
- Age: Most people diagnosed with non-Hodgkin lymphoma are 65 years or older.
- Sex Assigned at Birth: Being male is associated with a higher risk of developing non-Hodgkin lymphoma
- Autoimmune conditions: Some autoimmune conditions, like rheumatoid arthritis and lupus, are associated with a higher risk of non-Hodgkin lymphoma.
Modifiable risk factors (factors that a person potentially can change or control) for NHL include:
- Exposure to radiation: Exposure to radiation, such as during cancer treatment or from X-rays or other sources, can increase the risk.
- Having a weakened immune system: Having a weakened immune system, which can occur due to certain medical conditions or medications, can increase the risk.
- Viral and bacterial infections: Certain viral infections, such as Epstein-Barr virus (EBV), human T-cell lymphotropic virus type 1 (HTLV-1), and human herpesvirus 8, can increase the risk. Bacterial infections like Helicobacter pylori have also been linked to non-Hodgkin lymphoma.
- Obesity or overweight: While the link between obesity and non-Hodgkin lymphoma is still being researched, maintaining a moderate weight is recommended by the American Cancer Society to reduce the risk of multiple types of cancer.
It's important to note that these risk factors are for NHL in general and not specifically stage 4 NHL. Having risk factors does not guarantee the development of NHL. People may develop NHL without known risk factors. If you have concerns about your individual risk or symptoms, consult with your healthcare professional.
Common symptoms of stage 4 non-Hodgkin lymphoma include:
- Painless swelling in the lymph nodes, typically in the armpit, neck, or groin
- Fever
- Chills
- Fatigue
- Unintentional weight loss
- Enlarged lymph nodes
- Reduced appetite
Additional symptoms may occur, including:
- Persistent cough
- Chest pain
- Skin rashes
- Easy bruising or bleeding
- Frequent infections
- Shortness of breath
- Blood in the urine
- Mass on the lower back
It's important to note that having these symptoms does not necessarily mean you have stage 4 non-Hodgkin lymphoma. If you experience any of these symptoms, it is recommended to speak with a medical professional for an accurate diagnosis and appropriate treatment.
To diagnose non-Hodgkin lymphoma, doctors commonly perform the following examinations, tests, and procedures:
- Medical history: The healthcare professional will ask about symptoms, medical history, medications, and family medical history.
- Physical exam: During a physical exam, the doctor looks for swollen lymph nodes in the neck, groin, and underarms, and checks for swelling in the spleen and liver. This helps provide a baseline for your diagnosis.
- Blood tests: A complete blood count (CBC) is performed to check the number of red blood cells, white blood cells, and platelets in your blood. It also measures the amount of hemoglobin (the protein that carries oxygen) in the red blood cells. Other blood tests may check for general health of the kidneys and liver or for signs of inflammation or infection.
- Biopsy: This involves taking a sample of cells from a lymph node or tumor using a small needle. A pathologist then examines this sample under a microscope to check for signs of the lymphoma. Additional tests may be performed on the tissue sample to look for signs of cancer cells.
- Imaging tests: X-rays, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or PET scans may be used to examine areas inside the body, such as the liver, spleen, and lungs. These tests help determine if there are any abnormalities or tumors.
Additional tests or procedures may be performed based on initial findings or to determine the stage or severity of non-Hodgkin lymphoma. These may include:
- MRI with gadolinium: This procedure uses a magnet, radio waves, and a computer to create detailed pictures of areas inside the body. Gadolinium is injected into a vein, which collects around cancer cells and makes them appear brighter in the pictures. This test helps determine if the cancer has spread to specific areas like the brain and spinal cord.
- Lumbar puncture: This procedure involves collecting cerebrospinal fluid (CSF) from the spinal column by placing a needle between two bones in the spine. The CSF sample is then checked under a microscope for signs that the cancer has spread to the brain and spinal cord.
- Bone marrow biopsy: A small sample of bone marrow is taken from your hipbone or another large bone to check for cancer cells. This test helps determine if the cancer has spread to the bone marrow.
- Heart and lung function tests: These tests assess how well your heart and lungs are functioning. They provide important information about your overall health and help determine if you can tolerate certain treatments.
The goals of treatment for stage 4 NHL are to control the growth of the cancer, alleviate symptoms, and improve quality of life. Here are the recommended treatments and how they work:
- Chemotherapy: Chemotherapy is a primary treatment for NHL. It involves the use of drugs to kill cancer cells or stop them from growing. Combinations of different types of chemotherapy medications may be used, and the specific drugs and dosage depend on the individual's condition and cancer stage. Chemotherapy can be given orally or through intravenous infusion.
- Immunotherapy: Immunotherapy is a type of treatment that boosts the body's immune system to fight cancer cells. It uses substances that stimulate the immune system or antibodies that specifically target cancer cells. Immunotherapy can help enhance the body's natural defenses against NHL.
- Targeted cell therapies: Targeted cell therapies are a newer form of treatment for NHL that specifically target cancer cells while sparing healthy cells. Targeted therapies disrupt a cancer cell’s function or processes needed to divide, multiply, grow, or spread.
- Radiation therapy: Radiation therapy uses high-energy beams to target and destroy cancer cells. It is often used in combination with chemotherapy for NHL treatment. The radiation is directed at specific areas where the lymphoma is located or has spread.
- Stem cell transplantation: This procedure may be recommended for some people with NHL. It involves replacing damaged or diseased stem cells (the immature cells that normally become red blood cells, white blood cells, and platelets) with healthy stem cells.
- Supportive treatments: Additional medications or therapies may be used as part of the treatment plan. Examples include medications to help reduce nausea or vomiting or to help reduce the risk of infections.
These treatments aim to control the growth of NHL, reduce symptoms, and improve overall well-being. However, it's important to consult with a healthcare professional for personalized recommendations and to understand potential side effects. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.