Non Hodgkin's Lymphoma

NON-HODGKINS LYMPHOMA
Non-Hodgkin's lymphoma is cancer of the
Lymphoid tissue, which includes the lymph nodes,
spleen, and other organs of the immune system.

INCIDENCE
• 60 % of lymphomas in children is NHL
• Mostly affects adults.
• Is slightly more common in males than

in females.3:1
CAUSES
 The cause is unknown.

 With weakened immune systems.
 Virus: EBV, HCV
 Triggering factors: chemicals,
radiation etc
PATHOPHYSIOLOGY
 Non-Hodgkin lymphoma begins when a
lymphocyte (usually a B cell) becomes abnormal.
 The abnormal cell divides to make copies of itself
 The new cells divide again and again, making more
and more abnormal cells.
 The abnormal cells don’t die when they should.
 They don’t protect the body from infections or
other diseases.
 The build up of extra cells often forms a mass of
tissue called a growth or tumor.
CLASSIFICATION OF NON-
HODGKINS LYMPHOMA
 According to how fast the cancer spreads
 How the cells look under the microscope-Histologic
presentation
According to how fast the cancer spreads
The cancer may be

 Low grade (slow growing),
e.g. Follicular lymphoma

High grade (fast growing)
e.g. Burkitt's tumor

How the cells look under the microscope
1. Lymphoblastic NHL: Involves T cells and usually
present with a mass on chest and swollen lymph
node with or without bone marrow or CNS
involvement
 accounts for about 30 percent of the cases

2.Burkitt or Non Burkitt :Are fast-growing lymphomas that
affects the B-cells in which the cells are undifferentiated and
diffuse, usually characterized by large abdominal tumor and
may have bone marrow and CNS involvement
 This has also been referred to as small noncleaved cells.
 Burkitt's and non-Burkitt's lymphoma accounts for about
40 to 50 percent of the cases

3.Large Cell or Diffuse Histiocytic NHL: Involves the B-cells
or T-cells accounts for about 25 percent of the cases.
 Children with this type of non-Hodgkin lymphoma usually have
lymphatic system involvement, as well as a non lymph
structure (such as lung, jaw, skin, and bone) involvement.
 Large cell lymphomas usually do not grow as quickly as other
lymphomas in children.
STAGING
STAGE DESCRIPTION
I Single tumor at single site either nodal or elsewhere in
the body
II Involve tumor at two or more sites on same side of body
III Tumour in any number that occur on both side but does
not involve BM or CNS
IV Any number of tumour with involvement of BM and CNS

CLINICAL MANIFESTATION
• In many cases, non-Hodgkin lymphoma in
children may not cause symptoms until it has
grown or spread.
• Usually symptoms starts to appear by stage III

Symptoms
• Night sweats
• Fever and chills on and off

• Itching
• Swollen lymph nodes in the

neck, underarms, groin,
or other areas
• Weight loss
• Coughing or shortness of breath

• May have abdominal pain or swelling
• May have a headache, concentration

problems, personality changes, or seizures.
DIAGNOSTIC MEASURES
 History
 Physical examination
 Biopsy of suspected
tissue, usually a lymph node biopsy: to determine histological

classification
 Lumbar puncture- to determine the presence of
malignant cells
 Bone marrow biopsy: to determine histological
classification
 Blood test to check protein levels, liver function,
kidney function, and uric acid level, Complete blood
count (CBC), EBV titers, reticulocyte count, blood
chemistries.
CT scans of the chest, abdomen and pelvis
Gallium scan
PET (Positron Emission Tomography)
Chest X-ray
USG
TREATMENT
Treatment depends on:
 The type of lymphoma
 The stage of the cancer when first
diagnosed
 Age and overall health Symptoms
• Surgery - Biopsy or removal of tumors
• Radiation therapy may be used for disease that is confined to one body
area.
• Chemotherapy is the main type of treatment. Most often, multiple
different drugs are used in combination together.
 Common Drugs: Vincristine, Prednisone, L Aspargese,
Methotrexate, Cytarabine, Cyclophosphamide, Antracyclines and
etoposide
TREATMENT : 3 PHASES
₰ Induction Phase
₰ Consolidation Phase
₰ Maintenance Phase
1. Induction: complete remission of cancerous cells
Administration of a number of drugs through infusion and
tablets over a few weeks
Methotrexate or Cytosine arabinoside: 4-6 wks.
Goal: to reduce bulky disease quickly and to induce a remission.
2. Consolidation: drugs are administered in infusion periodically
2-8 weeks to remove any remaining cancer cells
3. Maintenance: stage I, II and III- 2 years; Stage IV- 3 years. Use of

drugs usually in oral form over a few years.
One combination currently used are : 5 cycles of 6-thioguanine
and cyclophosphamide; hydroxyurea, and daunomycin;
methotrexate and carmustine; Cytostine arabinoside and
vincristine.
DIFFERENCE BETWEEN
HODGKIN’S AND NON
HODGKIN’SLYMPHOMA
Character Hodgkin Non Hodgkin
Histology Marked by the presence of special type Reed Sternberg cells are absent
of cell called a Reed-Sternberg cell
Origin Hodgkin’s Lymphoma usually starts in the Non-Hodgkin’s Lymphoma can start in
lymph nodes in the neck. a variety of locations depending on
the type of cancer and cells affected-
any where in lymphoid tissue
Age Hodgkin’s Lymphoma typically occurs in Non-Hodgkin’s Lymphoma is rare in

younger patients, age 15 to 24 young patients
Symptoms More likely to have systemic symptoms Less likely to have systemic symptoms
like night sweats, unexplained fever, (27%) at the time of diagnosis
itching, rashes, swollen lymph nodes,
fatigue and unexplained weight loss
Progression Hodgkin’s Lymphoma progresses in an Non-Hodgkin’s Lymphomas are less

orderly fashion between lymph groups, orderly, sometimes more aggressive,
and is often caught before Stage IV. and are more likely to be caught in
advanced stages.
Prognosis Hodgkin’s Lymphoma is considered one Non-Hodgkin’s Lymphoma has a lower

of the most treatable cancers. survival rate in most cases

Non Hodgkin's Lymphoma

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NON-HODGKINS LYMPHOMA

Non-Hodgkin's lymphoma is cancer of the

Lymphoid tissue, which includes the lymph nodes,

spleen, and other organs of the immune system.

• 60 % of lymphomas in children is NHL

• Mostly affects adults.

• Is slightly more common in males than

 The cause is unknown.

 According to how fast the cancer spreads

 How the cells look under the microscope-Histologic

The cancer may be

e.g. Follicular lymphoma

e.g. Burkitt's tumor

1. Lymphoblastic NHL: Involves T cells and usually

present with a mass on chest and swollen lymph

node with or without bone marrow or CNS

 accounts for about 30 percent of the cases

affects the B-cells in which the cells are undifferentiated and

diffuse, usually characterized by large abdominal tumor and

may have bone marrow and CNS involvement

 This has also been referred to as small noncleaved cells.

 Burkitt's and non-Burkitt's lymphoma accounts for about

40 to 50 percent of the cases

or T-cells accounts for about 25 percent of the cases.

 Children with this type of non-Hodgkin lymphoma usually have

lymphatic system involvement, as well as a non lymph

structure (such as lung, jaw, skin, and bone) involvement.

 Large cell lymphomas usually do not grow as quickly as other

IV Any number of tumour with involvement of BM and CNS

• In many cases, non-Hodgkin lymphoma in

children may not cause symptoms until it has

• Usually symptoms starts to appear by stage III

• Fever and chills on and off

• Swollen lymph nodes in the

• Coughing or shortness of breath

• May have a headache, concentration

tissue, usually a lymph node biopsy: to determine histological

PET (Positron Emission Tomography)

• Chemotherapy is the main type of treatment. Most often, multiple

different drugs are used in combination together.

 Common Drugs: Vincristine, Prednisone, L Aspargese,

Methotrexate, Cytarabine, Cyclophosphamide, Antracyclines and

3. Maintenance: stage I, II and III- 2 years; Stage IV- 3 years. Use of

Age Hodgkin’s Lymphoma typically occurs in Non-Hodgkin’s Lymphoma is rare in

Progression Hodgkin’s Lymphoma progresses in an Non-Hodgkin’s Lymphomas are less

Prognosis Hodgkin’s Lymphoma is considered one Non-Hodgkin’s Lymphoma has a lower

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