Lymphoma is a type of cancer. In all cancers, cells in the body multiply uncontrollably, disrupting the body's normal function. In lymphoma, the out-of-control cells are in the lymph nodes. Since lymph nodes consist primarily of white blood cells, these cells often appear in the blood. "End stage" refers to a disease that has progressed to its worst possible state. End-stage lymphoma usually occurs when available treatments either fail to arrest the course of the disease or prove too toxic for the patient.
Types of Lymphoma
Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) differ based on certain microscopic characteristics of the cancer cells. In general, HL can be treated more effectively then NHL and is less likely to progress to end-stage disease. For NHL, the most important distinction is between indolent and non-indolent forms. Non-indolent NHL responds well to treatment and can often be cured, but is very aggressive and will spread rapidly to end-stage disease if untreated or if treatment fails. Indolent NHL does not respond as well to treatment and usually cannot be cured, but also progresses very slowly. Even without treatment, indolent NHL may take decades to reach end stage.
Characteristics of End-Stage Lymphoma
Patients reach end-stage lymphoma either through lack of treatment (usually due to a delay in diagnosis) or, more commonly, when treatments fail to control the disease. In end-stage lymphoma, cancer cells have spread to multiple lymph nodes, into the blood and to at least one other organ. Organs typically affected by lymphoma include the heart, lungs, liver, bone marrow, skin and the digestive tract.
Treatment for Lymphoma
Treatments for lymphoma include chemotherapy, radiation and bone marrow transplants. Though usually effective, they have a number of toxic side effects to organs such as the liver, kidneys, heart and brain. Treatments often fail because a patient is no longer able to tolerate the side effects from therapy that is sufficiently intense to control the disease. Survival rates vary with the type of lymphoma and the age of the patient (younger patients do better). The five-year survival rate is 55 per cent for adults with NHL and 90 per cent for children with HL.
Treatment in End-Stage Lymphoma
End-stage lymphoma is reached when conventional treatments fail. Still, much can be done to help a patient. Experimental therapies are constantly being tested, and sometimes these are an option for patients in end-stage lymphoma who are otherwise in good health. Also, there are effective methods for controlling pain. These treatments can greatly improve quality of life.
Complications of End-Stage Lymphoma
In end-stage lymphoma, the uncontrolled multiplication of abnormal white blood cells from lymph nodes prevents the immune system from effectively fighting disease, resulting in increased and more severe infections. The cancer cells that have spread to other organs frequently continue to multiply in those locations, disrupting the normal organ functions. The lymph nodes themselves may enlarge. Depending upon their location, they can impede normal functions such as breathing and swallowing. Many patients in end-stage lymphoma suffer from organ damage caused by the toxic effects of treatments previously used in attempts to control the disease.