Small lymphocytic lymphoma is a slow-growing (indolent) cancer involving immature white blood cells (lymphocytes) found in bone marrow, lymph nodes, and blood. The disease is a form of non-Hodgkin lymphoma and often treated the same as CLL (chronic lymphocytic lymphoma).
The disease develops as too many abnormal lymphocytes thrive and multiply in the body, especially in the lymph nodes, which are tiny organs found in the armpits, groin, neck, and other areas of the body. Lymph nodes are an essential part of the body’s immune system that helps fight off infection.
Small lymphocytic lymphoma usually develops and progresses slowly where symptoms are not obvious when the condition is first diagnosed. Usually, the patient is told that have the disease after it is identified in a blood test taken for other reasons.
- Who Is at Risk for Small Lymphocytic Lymphoma?
- Common Symptoms
- Diagnosing Small Lymphocytic Lymphoma
- Small Lymphocytic Lymphoma Treatments
Who Is at Risk for Small Lymphocytic Lymphoma?
Doctors have yet to determine the exact cause of small lymphocytic lymphoma. However, there are notable risk factors associated with the disease.
- Viral Infections including Epstein-Barr virus and hepatitis C virus likely increase the potential risk of developing small lymphocytic lymphoma
- Workplace exposures to toxic chemicals including pesticides and herbicides likely increase the risk of developing the disease. In farming communities across Midwest America, the incident rate of lymphoma cancers is high.
- Family history of a father, mother, or siblings who have acquired small lymphocytic lymphoma likely increases the risk of developing the disease. However, inheriting the disease is considered to be rare.
- Weakened Immune Systems affected by HIV/AIDS or other serious diseases likely place people at risk for developing small lymphocytic lymphoma
- Exposure to Chemicals when receiving chemotherapy to treat cancer and other conditions is thought to be a risk factor for the disease
- Age is thought to be a factor associated with small lymphocytic lymphoma because the disease tends to affect adults who have reached their 60 th year.
Many of the symptoms associated with small lymphocytic lymphoma are not obvious. Usually, the individual is told they have the disease from a diagnosis derived from blood test results during routine examinations. Approximately one-third of all people with the condition live years without ever displaying symptoms. However, the most common small lymphocytic lymphoma symptoms involve:
- Unexpected weight loss
- Loss of appetite
- Painful swelling in the groin, armpits, or neck
- Night sweats
- Pale appearance
- Easy bruising or bleeding
Even during the initial development of small lymphocytic lymphoma, the individual may develop the symptoms associated with anemia. This is because abnormal white blood cells are likely accumulating in bone marrow where the body produces blood cells. Anemia results in pale looking skin associated with fatigue because the body lacks sufficient numbers of red blood cells.
If the skin bruises or bleeds easily, it is likely the result of bone marrow making insufficient numbers of platelets (blood clotting cells).
Diagnosing Small Lymphocytic Lymphoma
There is no one simple diagnostic test to validate a diagnosis of small lymphocytic lymphoma. Instead, the doctor will conduct a thorough physical examination and take a medical/personal history asking questions that include:
- Have you noticed any swollen areas on the body including in the groin, armpits, or neck?
- Do you often feel fatigued, overworked, or tired?
- Have you experienced unexpected weight gain or lost your appetite recently?
Likely, the doctor will recommend a lymph node biopsy if an enlarged lymph node is detected. Removal of the note allows it to be examined under a microscope to determine if small lymphocytic lymphoma is present. The procedures performed under local anesthesia, numbing the area to be excised, or under general anesthesia while the patient is asleep.
Once a diagnosis of small lymphocytic lymphoma has been verified, the doctor will assess (stage) the extent of the disease including its progression and whether it has metastasized (spread) to other areas of the body.
The doctor will stage the disease using a strict system that identifies the affected group of lymph nodes, the location in the body, and whether the disease has spread to other organs including the liver or bone marrow. These stages include:
- Stage I – At this stage, only a single group of lymph nodes in a localized area is affected. This is usually in the groin, one side of the neck, or armpit.
- Stage II – As the disease progresses, at least two groups of lymph nodes have now become affected in a localized area just above or just below the diaphragm (the muscle under the lungs separating the abdomen from the chest).
- Stage III – As the disease advances, the lymphoma has spread to lymph nodes low and above the diaphragm.
- Stage IV – In its final stages, the lymphoma has spread (metastasized) beyond the lymph nodes and has invaded other organs including the lungs, liver, or bones.
In addition to identifying the stage of the disease, the doctor will also reference its progression by the letter “A” or “B” to categorize specific symptoms. If the patient is suffering weight loss, fevers, or night sweats, the doctor will classify the stage as “B”.
However, the doctor may be using an alternative staging system recognize as the “Binet” system that refers to the number of enlarged lymph nodes and the associated platelets, red blood cells, and white blood cells in the bloodstream. This system involves:
- Stage A – It this initial stage, there are only one or two enlarged lymph nodes detected.
- Stage B – Three or more enlarged lymph nodes have been detected.
- Stage C – The numbers of platelets, red blood cells, or both are lower than normal.
The doctor uses the staging method as an effective tool for formulating the best treatment of small lymphocytic lymphoma.
Small Lymphocytic Lymphoma Treatments
If the patient does not display any symptoms associated with small lymphocytic lymphoma, the doctor will likely recommend “watchful waiting" to see if the condition is stabilized. In its initial stage, treatment has not been effective at extending the patient’s lifespan or known to cause side effects. The doctor instead will likely recommend that the patient regularly visits a cancer specialist once symptoms have developed. In many cases, it is years before the disease progresses to the point where any treatment is required.
However, treating advanced cases of small lymphocytic lymphoma have been highly effective where the disease goes into remission (no active signs of the condition is detected). Recurrence of the disease requires additional treatment that could be followed by remission. The most common treatments for small lymphocytic lymphoma include:
- Chemotherapy – The doctor will recommend the use of cytotoxic (anti-cancer) medications that destroy cancer cells. This form of chemotherapy is usually administered intravenously (through a vein), by tablets, or both. The oncologist might prescribe a combination of medications that include bendamustine, cyclophosphamide, fludarabine, or chlorambucil.
- Monoclonal Antibody Therapy – Medications known as monoclonal antibodies are formulated to recognize specific proteins that are found on the surface of affected cells. Injecting antibiotics into the bloodstream can destroy abnormal lymphocytes (T cells and B cells).
If the above therapies are ineffective, the doctor might recommend a stem cell transplant where healthy stem cells from the patient or a donor are given through an IV drip to allow blood cells to recover from the serious side effects associated with chemotherapy.