National Cancer Institute
Posted Date: Aug 9, 2004
Note: A separate summary on Adult Non-Hodgkin's Lymphoma Treatment is also available.
This summary discusses the treatment of non-Hodgkin's lymphoma during pregnancy.
Adult non-Hodgkin's lymphoma is a disease in which cancer (malignant) cells are found in the lymph system. The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.
Because lymph tissue is found in many parts of the body, non-Hodgkin's lymphoma can start in almost any part of the body. The cancer can spread to almost any organ or tissue in the body, including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), spleen, and nose.
There are many types of non-Hodgkin's lymphomas. Some types spread more quickly than others. The type is determined by how the cancer cells look under a microscope. This determination is called the histology. The histologies for adult non-Hodgkin's lymphoma are divided into 2 groups: indolent lymphomas, which are slower growing and have fewer symptoms, and aggressive lymphomas, which grow more quickly.
|Follicular small cleaved cell lymphoma||Adult diffuse mixed cell lymphoma|
|Follicular mixed cell lymphoma||Adult diffuse large cell lymphoma|
|Follicular large cell lymphoma||Adult immunoblastic large cell lymphoma|
|Adult diffuse small cleaved cell lymphoma||Adult lymphoblastic lymphoma|
|Small lymphocytic (marginal zone)||Adult small noncleaved cell lymphoma|
Other types of indolent non-Hodgkin's lymphoma are lymphoplasmacytoid lymphoma, monocytoid B-cell lymphoma, mucosa-associated lymphoid tissue (MALT) lymphoma, splenic marginal zone lymphoma, hairy cell leukemia, and cutaneous T-cell lymphoma (Mycosis fungoides/Sezary syndrome).
Other types of aggressive non-Hodgkin's lymphoma are anaplastic large-cell lymphoma, adult T-cell lymphoma/leukemia, mantle cell lymphoma, intravascular lymphomatosis, angioimmunoblastic T-cell lymphoma, angiocentric lymphoma, intestinal T-cell lymphoma, primary mediastinal B-cell lymphoma, peripheral T- cell lymphoma, lymphoblastic lymphoma, post-transplantation lymphoproliferative disorder, true histiocytic lymphoma, primary central nervous system lymphoma, and primary effusion lymphoma. Aggressive lymphomas are also seen more frequently in patients who are HIV-positive (AIDS-related lymphoma).
A doctor should be seen if any of the following symptoms persist: painless swelling in the lymph nodes in the neck, underarm, or groin; unexplained fever; drenching night sweats; tiredness; unexplained weight loss in the past 6 months; or itchy skin.
If these symptoms are present, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, a doctor may need to surgically remove a small piece of tissue and look at it under a microscope to see if there are any cancer cells. This procedure is called a biopsy.
The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), and the patient's age and overall condition.
Non-Hodgkin's lymphoma (NHL) usually affects older adults and, therefore, women are seldom found to have NHL when they are pregnant. Most non-Hodgkin's lymphomas are aggressive and delaying treatment until after the baby has been delivered appears to lead to a poor outcome. Immediate treatment is often recommended, even during pregnancy. Children who were exposed to doxorubicin (a chemotherapy drug) before they were born have been monitored for up to 11 years, and they do not appear to suffer from side effects of the drug. Long-term studies have not been conducted to determine the effects of other chemotherapy drugs on children who were exposed to them before birth. Ending the pregnancy during the first trimester of pregnancy may also be an option for women who have aggressive NHL that must be treated immediately. Early delivery may reduce or avoid the fetus' exposure to chemotherapy drugs or radiation therapy. Women who have indolent (slow-growing) non-Hodgkin's lymphoma can usually delay treatment.
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