What to know about stage 4 lymphoma

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

Lymphoma is cancer that arises in a type of white blood cell called a lymphocyte. These cells travel through the lymphatic system, which is part of the body’s immune system. As with many cancers, lymphoma has four stages.

Stage 4 (IV) lymphoma can often be treated. The prognosis (course of the disease) of a person diagnosed with lymphoma depends on many factors, including the type of lymphoma and the individual’s age.

This article discusses different types of lymphoma, including their symptoms, treatments and survival times.

Types of lymphoma

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

1. Hodgkin lymphoma and
2. Non-Hodgkin lymphoma.

Hodgkin lymphoma

Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells. These are mature B-type immune cells that have become cancerous.

95 percent of Hodgkin lymphomas consist of the following 4 subtypes; these are called classical Hodgkin lymphoma.

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

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

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

Non-Hodgkin lymphoma

Unlike Hodgkin lymphoma, non-Hodgkin lymphoma can arise from B-type or T-type immune cells. It can also develop outside the lymph nodes in other organs, such as the stomach, intestines and skin.

There are more than 90 types of non-Hodgkin lymphoma , and they can be classified in different ways.

Non-Hodgkin lymphoma can be classified as T-cell or B-cell non-Hodgkin lymphoma according to the type of lymphocyte it affects. Alternatively, lymphoma may be described as indolent (mild / gentle) or aggressive to reflect how quickly it grows and spreads.

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

What are the symptoms of lymphoma?

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

Symptoms of stage 4 lymphoma may include:

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

B symptoms are a group of symptoms that provide information about the staging of both Hodgkin and non-Hodgkin lymphoma. These symptoms generally occur in more advanced lymphoma and include: 

• within 6 months, unintentional loss of more than 10 percent of body weight 
• fever unrelated to infection 
• drenching night sweats

- Related topic: What is lymphoma (lymph cancer)? (detailed)

Lymphoma treatment

Treatment for stage 4 lymphoma will depend on the type of lymphoma a person has, their medical history and which organs it will affect.

Treatment of Hodgkin lymphoma

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

Chemotherapy drug combinations may include: 

• ABVD: This is the most commonly preferred regimen for Hodgkin lymphoma; it contains doxorubicin, bleomycin, vinblastine and dacarbazine. 
• BEACOPP: It contains bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone. Doctors consider this regimen for people with specific characteristics. It is effective, but secondary cancer (for example, leukemia) and infertility risks make it a less common option. 
• Stanford V: It contains mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide and prednisone. Doctors do not use this regimen often.

Afterward, for people with large masses or evidence of residual disease, doctors may recommend radiation therapy .

Other options may also include a stem cell transplant or other treatments, including experimental drugs or drug combinations.

Treatment of non-Hodgkin lymphoma

To treat non-Hodgkin lymphoma, we often use a standard chemotherapy combination called CHOP . This regimen contains the drugs cyclophosphamide, doxorubicin, vincristine and prednisone.

For aggressive types of non-Hodgkin lymphoma, the CHOP regimen may include rituximab , a drug that is a form of immunotherapy . This combination increases the effectiveness of treatment and can potentially cure non-Hodgkin lymphoma.

Stem cell transplantation, radiotherapy or other drugs may also be recommended to treat non-Hodgkin lymphoma.

Summary of lymphoma treatment

Continual improvements in the available treatment options mean that, depending on the type and a person’s risk factors, lymphoma can sometimes be completely cured even at stage 4. If a cure is not possible, treatment aims to manage a person’s symptoms and maintain their quality of life.

Survival times for stage 4 lymphoma

Survival rates help provide a better understanding of how likely treatment is to succeed for a type and stage of cancer.

Survival rates are estimates that vary with the stage of cancer. It is important to know that everyone is different and that many people may live much longer than these estimates.

Overall, stage 4 Hodgkin lymphoma has a 5-year survival rate of 65 percent. The following risk factors affect a person’s prognosis and may make lymphoma more severe:

• presence of B symptoms
• being older than 45 
• being male 
• having certain specific blood test values

All stages of non-Hodgkin lymphoma have an overall 5-year relative survival rate of 71 percent.

Relative survival rates compare people with this disease with people who do not have it, and vary widely for different types and stages. Many factors can affect survival rates. A person should discuss their individual risk factors with their doctor.

Summary

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

Survival rates vary widely depending on an individual’s risk factors and the type of cancer. The survival rate for stage 4 lymphoma is lower than for other stages, but in some cases doctors can achieve a cure (complete recovery).

People diagnosed with stage 4 lymphoma should discuss treatment options and outcomes with their doctors. Treating this disease requires a collaborative approach involving doctors, nurses, social workers, mental health counselors and social support. 

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- What is the difference between leukemia and lymphoma?