Introduction

Primary malignancies of the lymph nodes.

The major types of lymphoma--Hodgkin's disease and non-Hodgkin's lymphoma--are distinct entities characterized by different cells of origin, patterns of spread, and clinical manifestations. Hodgkin's disease usually has a predictable pattern of spread to contiguous lymph node areas; non-Hodgkin's lymphoma is usually widespread at diagnosis and is more likely to involve extranodal areas. Both can be subdivided into types based on the histologic appearance of the lymph nodes.

Patient and End-of-Life Issues

Some lymphomas are curable with radiation and/or intensive combination chemotherapy. Age alone is not a consideration for whether or not to recommend therapy; however, comorbidity is often a consideration. Patients and their families should be informed that treatment is usually long and uncomfortable and should weigh potential benefits against risks. To ease care, elderly patients who live alone usually need help at home as they undergo therapy. Therapy often weakens the patient for at least 6 months, and some degree of independence must be suspended.

If treatment is unsuccessful or if the disease relapses, the prognosis is poor and the hope for a cure dwindles. A continuing dialogue with the physician and a support system of family and friends are helpful. Supportive and palliative measures are often the goals of treatment.