Intermediate-Grade NHL
In contrast to the low-grade, indolent lymphoma patients (see related article), patients with intermediate-grade lymphoma have more aggressive disease and all require therapy; nevertheless, intermediate-grade lymphoma is far more curable than indolent lymphoma, and the major goal of treating patients with intermediate-grade lymphoma is cure.
There are four recognized types of intermediate-grade non-Hodgkin's lymphoma (NHL), each of which differ in such factors as the kinds of cells involved and how they grow and spread (aggressiveness). By far, the most common subtype is diffuse large cell lymphoma, meaning larger cells spread evenly through the lymph node. Another example would be "follicular large cell", meaning large cells clustered in groups.
At present, physicians generally treat all subtypes of intermediate-grade lymphoma the same; therefore, a major area of lymphoma research has concentrated on determining which types should require more intensive therapy than others.
Staging
The oncologist's first task in the evaluation of patients with intermediate-grade lymphoma is to determine the extent of their disease, or "stage" of the lymphoma. In non-Hodgkin's lymphoma, staging is usually described according to the "Ann Arbor" system. In this system, there are four stages.
- Stage I (early disease): The cancer is found only in a single lymph node, or in the area immediately surrounding that node, or in a single organ.
- Stage II (locally advanced disease): The disease involves more than one lymph node area on one side of the diaphragm (the breathing muscle separating the abdomen from the chest).
- Stage III (advanced disease): The disease involves lymph node regions above and below the diaphragm. For example, there may be swollen lymph nodes under the arm and in the abdomen.
- Stage IV (widespread disease): The disease involves one or more organs.
The staging evaluation will typically include a physical exam, blood tests, chest x-ray, computer-assisted views (CT scans) of the chest/abdomen/pelvis, and bone marrow examination. Other tests that an oncologist might use to look for tumors or cancerous cells include such specialized tests as gallium scanning, positron-emission test (PET), and magnetic-resonance imaging (MRI). If a patient has central nervous system (CNS) symptoms (like headaches dizziness, or visual abnormalities), a spinal tap will be performed.
