What to know about stage 4 lymphoma

By Shannon Johnson  

Reviewed by Christina Chun, MPH

Types | Symptoms | Treatment | Outlook | Survival | Summary

Stage 4 lymphoma occurs when cancer has spread to a distant part of the body outside of the lymphatic system, such as the spinal cord, lungs, or liver.

Lymphoma is cancer that originates in a type of white blood cell called lymphocytes. These cells travel through the lymphatic system, which is part of the body's immune system. As with many cancers, there are four stages of lymphoma.

Stage 4 (IV) lymphoma is often treatable. A person's prognosis depends on many factors, which include the type of lymphoma and the age of the individual.

In this article, we discuss the different types of lymphoma, including their symptoms, treatment, and survival rates.

Types of stage 4 lymphoma

Lymphoma is the term that people use to describe cancer that develops in the lymphatic system. There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma.

Hodgkin lymphoma

The hallmark of Hodgkin lymphoma is the presence of Reed-Sternberg cells, which are mature B-type immune cells that have become cancerous.

An estimated 95 percent of Hodgkin lymphomas are classic Hodgkin lymphoma, of which there are four subtypes:

• nodular sclerosis
• mixed cellularity
• lymphocyte-rich
• lymphocyte-depleted

Around 5 percent of people with Hodgkin lymphoma have nodular lymphocyte-predominant Hodgkin lymphoma.

Each different subtype of Hodgkin lymphoma has unique characteristics that will determine its treatment options.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma, in contrast to Hodgkin lymphoma, can come from B-type or T-type immune cells. It can also form in the lymph nodes and other organs, such as the stomach, intestines, and skin.

There are more than 90 types of non-Hodgkin lymphoma, and it is possible to classify them in different ways.

For example, doctors may classify non-Hodgkin lymphoma as either T-cell or B-cell, according to the type of lymphocyte that it affects. Alternatively, they may describe the lymphoma as indolent or aggressive to reflect how fast it grows and spreads.

As with Hodgkin lymphoma, the type of non-Hodgkin lymphoma will determine the treatment.

Symptoms

Hodgkin lymphoma and non-Hodgkin lymphoma share many of the same symptoms. Some symptoms occur when the disease affects organs outside of the lymphatic system, such as the stomach or lungs.

Symptoms of stage 4 lymphoma can include:

• enlarged lymph nodes under the skin
• fatigue
• chills
• loss of appetite
• itching
• a persistent cough
• shortness of breath
• chest pain
• abdominal bloating
• early satiety
• easy bruising or bleeding
• frequent infections
• nausea or vomiting

A group of symptoms called "B symptoms" contributes to the staging of both Hodgkin and non-Hodgkin lymphoma. The presence of these symptoms occurs with more advanced disease, and they include:

• unintentional loss of more than 10 percent of body weight within 6 months
• fever that comes and goes without infection
• drenching night sweats

Treatment

The treatment for stage 4 lymphoma will be dependent on the type of lymphoma that a person has, their medical history, and which organs it affects.

Hodgkin lymphoma

Treatment for stage 4 Hodgkin lymphoma typically involves multiple cycles of chemotherapy drugs.

Chemotherapy combination drugs can include:

• ABVD, which is the preferred regimen and comprises doxorubicin, bleomycin, vinblastine, and dacarbazine.
• BEACOPP, which includes bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone. Doctors reserve this regimen for people with specific characteristics. It is effective but is a less common option due to the risks it carries of secondary leukemia and infertility.
• Stanford V, which includes mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone. Doctors do not commonly use this regimen.

A doctor may recommend radiation therapy for people who have large masses or evidence of residual disease on follow-up scans.

They might also suggest other methods of treatment, including a stem cell transplant or alternative drugs or drug combinations.

Non-Hodgkin lymphoma

A standard chemotherapy combination regimen that doctors often use to treat non-Hodgkin lymphoma is known as CHOP. This regimen includes the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone.

For aggressive types of non-Hodgkin lymphoma, the doctor might add an immunotherapy drug called rituximab to the CHOP regimen. This combination increases the effectiveness of the treatment and can potentially cure non-Hodgkin lymphoma.

An oncologist may also recommend other drugs that attack cancer cells in different ways or alternative treatments, such as radiation or stem cell transplant.

Outlook

The continual improvement of available treatment options means that doctors may sometimes be able to cure stage 4 lymphoma, depending on the type and a person's risk factors. If a cure is not possible, treatment aims to manage a person's symptoms and maintain their quality of life.

Survival rates

Survival rates provide people with a better understanding of how likely it is that treatment will be successful for their type and stage of cancer.

Survival rates are estimates that vary depending on the stage of cancer. It is important to note that everyone is different, and many people can live much longer than these estimates suggest.

Overall, the 5-year survival rate for stage 4 Hodgkin lymphoma is 65 percent. The following risk factors affect a person's prognosis and can make lymphoma more severe:

• presence of B symptoms
• being over the age of 45 years
• being male
• having specific white and red blood cell counts

The overall 5-year relative survival rate for all people with a non-Hodgkin lymphoma diagnosis is 71 percent.

Relative survival rates compare people with this disease to those without it, and they vary widely for different types and stages. Many factors can affect survival rates. A person should discuss their specific risk factors with their doctor.

Summary

Lymphoma is a cancer of the lymphatic system. Stage 4 lymphoma means that cancer has spread to an organ external to the lymphatic system.

The survival rates vary widely depending on an individual's risk factors and type of cancer. The survival rate of stage 4 lymphoma is lower than that of the other stages, but doctors can cure the condition in some cases.

People with a diagnosis of stage 4 lymphoma should discuss their treatment options and outlook with their doctor. Treating this disease requires a collaborative approach from doctors, nurses, social workers, mental health counselors, and social support.

SOURCE: MEDICAL NEWS TODAY