Indolent non-Hodgkin's lymphoma and its subtypes fall into a class of their own. They are different from other lymphomas in that they are slow-growing. Because physicians do not view the indolent lymphomas as "curable" in the complete sense, the goal of treatment is often "palliative". This means is that the goal is to extend life for as long as possible and improve the person's quality of life during that time. In contrast to the more fast-growing (aggressive) lymphomas, indolent lymphoma usually gives the patient and the doctor plenty of time to fully assess the best possible treatment of this disease if one becomes necessary. Also, because of the nature of this disease, there is very much an art to the care of these patients. Each patient is approached individually, even though there are basic principles in the management of all cancer patients. The first step is to determine what type of indolent lymphoma the patient has.
Staging of Low-Grade Lymphoma
There are several types of low-grade, or indolent lymphomas, (based on the appearance and size of cells found in each group). The initial approach to all of these types of lymphoma, however, is to determine the extent of the disease, what is referred to as "staging." 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.
Because of the chronic, indolent nature of the disease, most people are unaware that they have cancer and as a result, patients are usually first diagnosed with an indolent lymphoma in the advanced stages—usually stage III or IV. Many patients also have bone marrow involvement (cancer that has spread to their bone marrow). Occasionally, some patients with indolent lymphoma will be diagnosed with lymphoma that has not spread (localized) and is in Stage I. While this is relatively rare, many of these patients can be effectively treated with radiation therapy alone.
