Written by Dr.Md.Redwanul Huq (Masum)
Sunday, 15 January 2012 16:35


It is the solid tumor of the immune system which is produced due to malignancies of lymphoid cells.

Classification of lymphoma:

Lymphoma is of 2 types:

i) Hodgkin’s disease (HD)
ii) Non Hodgkin’s lymphoma(NHL).

i) Hodgkin’s disease:

It is of 4 types:

a) Lymphocyte predominance
b) Lymphocyte depletion
c) Mixed cellularity
d) Nodular sclerosis

ii) Non Hodgkin’s lymphoma:

It is of 3 types

a) High grade NHL
b) Intermediate grade NHL
c) Low grade NHL.

Symptoms of Lymphoma:

Symptoms of lymphoma are-

  • May be asymptamatic only with lymphadenopathy
  • B symptoms-
  1. Drenching night sweat
  2. Weight loss
  3. Pruritus
  • If mediastinal compression occurs –
  1. Dyspnoea
  2. Dysphagia
  3. Superior venacaval obstraction (SVO)
  • If lung is affected-
  1. Cough
  2. Shortness of breath
  3. Symptoms of Pleural effusion
  • If GIT is affected-
  1. Symptoms of Intestinal obstruction
  2. Symptoms of Ascites
  3. Yellow coloration of skin and sclera
  • If vertebra is affected-there is cord compression resulting to paraplegia

Signs of Lymphoma:

1. Lymphadenopathy- may be regional(e.g. cervical, axillary or inguinal) or generalized. Characteristics of lymph nodes-large, multiple, discrete, rubbery, non tender, not fixed with underlyingstructure or overlying skin, no discharging sinus.
2. Hepatosplenomegaly
3. Other signs of lymphoma – due to obstruction (if any).


  1. CBC with ESR-TC, DC – Eosinophilia,Hb%- normal or decreased, ESR- normal or increased.
  2. PBF-done to exclude leukemia where there is presence of blast cells.
  3. Tuberculin test – to exclude disseminated TB
  4. CXR-
    • Widening of mediastinum
    • Bilateral hilar lymphadenopathy
    • Pleural effusion
  5. USG of whole abdomen – to see involvement of para aortic lymph nodes, liver and spleen.
  6. Lymph node FNAC or biopsy
  7. CT scan of chest and/or abdomen for diagnosis and/or staging of lymphoma.

Difference between HD and NHL:

1. Presentation- Usually in extreme ages In any age
2. Axial group of lymph nodes are involved Peripheral group of lymph nodes are involved
3. Mesenteric and Waldeyer’s group of lymph nodes are not involved Mostly involved
4. Extranodal involvement i.e. involvement of Liver, Bone marrow, Spleen, skin is less Extranodal involvement is more
5. B symptoms, i.e.-Dranching night sweat-Weight loss-Pruritusare more B symptoms are less
6. Clinical presentation usually occurs in early stage Usually in advanced stage
7. Reed-Sternberg cells are present.  Absent.
8. Contiguous spread of lymph node occurs  Non-contiguous spread occurs.

Treatment of Hodgkin’s lymphoma:

General treatment:

1. Adequate hydration
2. Use of antibiotics for infection control
3. Management of anemia, blood transfusion if needed.

Specific treatment:

1. Stage IA, IIA (with involvement of 3 or less areas) – radiotherapy is the choice, if relapse- chemotherapy should be given.
2. Stage IIIA (with involvement of spleen), IV, all stages with B symptoms, stage II with involvement of 3 or more areas – chemotherapy is the choice.

Chemotherapy is given as one of the following:

* ABVD (Adriamycin, Bleomycin, Vincristine, Dacarbazine)
* MOPP (Mustine hydrochloride/ mechlor-ethamine, Vincristine, Procarbazine, Prednisolone)
* COPP (Cyclophosphamide, Vincristine, Procarbazine, Prednisolone)
* ChlVPP (Chlorambucil, Vincristine, Procarbazine, Prednisolone)

Treatment of Non-Hodgkin’s lymphoma:

General treatment:

1. Adequate hydration
2. Use of antibiotics for infection control
3. Management of anemia, blood transfusion if needed

Specific treatment:

a) Stage –  I(A)- radiotherapy or surgery
b) Stage – I(B),II ,III, IV – chemotherapy.

Chemotherapy is given as following:

a) In low grade NHL: Single drug regimen with Cyclophosphamide or Chlorambucil (oral)
b) In intermediate or high grade NHL:
CHOP (C – cyclophosphamide, H – adriamycin, O – vincristine, P – prednisolone).

Leave a Reply