Approach to lymphoma diagnosis and management in South Africa

Abstract

Lymphoma is a cancer of the lymphoid cells, with a hugely variable mode of clinical presentation, which includes constitutional symptoms, lymphadenopathy, superficial or deep-seated masses, effusions, and full blood count abnormalities such as anaemia and lymphocytosis. Lymphoma can infiltrate any organ of the body, although it typically involves lymphoid tissue or bone marrow, or both. In this article an overview is given of the diagnostic pathway and clinical diagnostic subsets that determine treatment. The treatment approach according to these subsets is best understood as: indolent lymphoma, where treatment is not urgent and the disease is not curable; aggressive lymphoma, where rapid diagnosis and treatment are of the utmost importance, with the majority of cases curable; and very aggressive lymphoma, where patients are at high risk of death at presentation, but with rapid diagnosis and treatment there is an excellent chance of long-term cure. The past decade has seen an explosion of targeted (as opposed to classic chemotherapeutic) treatments for lymphoma. These drugs target certain molecules or receptors in the tumour pathway, often with spectacularly beneficial effects that open up new horizons for cure.