The Grades of Non-Hodgkin Lymphoma

Low-Grade Lymphoma
Low-grade, or indolent lymphoma grows very slowly, and isn't likely to change dramatically. Under the microscope, these cells look a lot like normal cells. "You wouldn't expect to wake up one morning and suddenly find the disease has changed dramatically and is now really troubling you," says Dr. Piro.

People diagnosed with low grade lymphoma may have few symptoms, and rather than beginning immediate and aggressive treatment, they may be advised to have frequent visits with their doctor so their disease can be monitored.

"Some lymphomas are so low-grade that you don't even have to treat them; you can just observe them," says Dr. Piro. "It might be every several months, where the doctor examines you, palpates your lymph node, checks your weight, makes sure you're eating well, and checks to make sure the lymphoma isn't having any adverse effects on your body.” As long as it isn't and things stay the same, you can continue to be monitored and observed, and may not need any treatment.

With low-grade lymphoma, explains Dr. Piro, doctors aren't really looking for a remission. "We're not really caring so much about whether every last lymphoma cell in your body is gone," he says. "Instead, we’re looking to manage your survival." With low-grade lymphoma patients, doctors are more focused on making sure that the disease doesn't progress and that patients remain healthy.

At some point, low-grade lymphoma may change character and start growing more quickly, even morphing into a higher-grade lymphoma. For instance, lymph nodes may become larger and start looking more obvious or causing problems. "Or it might be you're losing weight, because the lymph nodes are so large in your abdomen that they're pressing on your stomach. Or you're having fevers and feeling ill. It can be many reasons," says Dr. Piro. At that point, patients may be re-categorized as having a higher grade lymphoma, and may need to begin treatment.

High-Grade Lymphoma
The cells of high-grade, or aggressive lymphoma look less like normal cells under the microscope. These faster-growing lymphomas often spread to lymph nodes and organs throughout the body, and they're more likely to cause symptoms and require immediate, intensive treatment. Fortunately many types of high-grade lymphoma respond very well to treatment.

Just as there are dozens of different kinds of non-Hodgkin lymphoma, there are also many types of treatment: chemotherapy, radiation, immunotherapy, stem cell transplants, etc. The specific type of therapy recommended for each patient depends on what type of lymphoma they have, what areas of their body are affected, and how quickly the lymphoma is growing and/or spreading.

"You may get an initial therapy that may work for many years," says Dr. Piro. "You may go into remission but then have a relapse years later. So then you start on another therapy." The idea is to create a therapeutic plan that extends survival for as long as possible. And, says Dr. Piro, “Often even high-grade lymphoma is curable."

One thing that can be confusing is the difference between grade and stage. Grade is a measure of the way a cancer grows and is obtained from the pathology report. Stage is where all the cancer has spread in the body and is determined from tests such as CT scans and PET scans. It is always helpful to ask your doctor to tell you the grade and the stage of your cancer to better understand what treatment options are right for you.

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