Stage 4 lymphoma is when cancer has spread to at least one organ outside the lymphatic system, such as the spinal cord, lungs, bones, or liver. It can cause a range of symptoms. It is an advanced stage of cancer but is often treatable.
Lymphoma is cancer that originates in the lymphocytes, a type of white blood cell. These cells travel through the lymphatic system, which is part of the body’s immune system. As with many cancers, there are four stages of lymphoma.
Stage 4 lymphoma is often treatable. A person’s prognosis depends on many factors, which include the type of lymphoma and the age of the individual.
This article discusses the different types of lymphoma, including their symptoms, treatment, and survival rates.
Lymphoma is cancer that develops in the lymphatic system. There are two main types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
Hodgkin lymphoma
The hallmark of Hodgkin’s lymphoma is the presence of Reed-Sternberg cells, which are mature B-type immune cells that have become cancerous.
An estimated 95% of Hodgkin’s lymphomas are classic Hodgkin’s lymphoma, of which there are four subtypes:
- nodular sclerosis
- mixed cellularity
- lymphocyte-rich
- lymphocyte-depleted
Around 5% of people with Hodgkin’s lymphoma have nodular lymphocyte-predominant Hodgkin’s lymphoma.
Each different subtype of Hodgkin’s lymphoma has unique characteristics that will determine its treatment options.
Learn more about B-cell lymphoma.
Non-Hodgkin’s lymphoma
In contrast to Hodgkin’s lymphoma, non-Hodgkin’s lymphoma can come from B-type or T-type immune cells. It can also form in the lymph nodes and other organs, such as the stomach, intestines, and skin.
There are more than 90 types of non-Hodgkin’s lymphoma, and they can be classified in different ways.
For example, doctors may classify non-Hodgkin’s lymphoma as either T-cell or B-cell, according to the type of lymphocyte that it affects. Alternatively, they may describe the lymphoma as indolent or aggressive to reflect how fast it grows and spreads.
As with Hodgkin’s lymphoma, the type of non-Hodgkin’s lymphoma will determine the treatment.
Learn about non-Hodgkin’s lymphoma and genetics.
Hodgkin’s lymphoma and non-Hodgkin’s lymphoma share many of the same symptoms. Some symptoms occur when the disease affects organs outside of the lymphatic system, such as the stomach or lungs.
Symptoms of stage 4 lymphoma can include:
- enlarged lymph nodes under the skin
- fatigue
- chills
- loss of appetite
- itching
- a persistent cough
- shortness of breath
- chest pain
- abdominal bloating
- early satiety
- easy bruising or bleeding
- frequent infections
- nausea or vomiting
A group of symptoms called “B symptoms” contributes to the staging of both Hodgkin’s and non-Hodgkin’s lymphoma. The presence of these symptoms occurs with more advanced disease, and they include:
- unintentional loss of more than
10%Trusted Source of body weight within 6 months - fever that comes and goes without infection
- drenching night sweats
Learn more about the stages of lymphoma.
The treatment for stage 4 lymphoma will depend on the type of lymphoma a person has, their medical history, and which organs it affects.
Hodgkin’s lymphoma
Treatment for stage 4 Hodgkin’s lymphoma typically involves multiple cycles of chemotherapy drugs.
Chemotherapy combination drugs can include:
- ABVD, which is the preferred regimen and comprises doxorubicin, bleomycin, vinblastine, and dacarbazine.
- BEACOPP, which includes bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone. Doctors reserve this regimen for people with specific characteristics. It is effective but is a less common option due to the risks it carries of secondary leukemia and infertility.
- Stanford V, which includes mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone. Doctors do not commonly use this regimen.
A doctor may recommend radiation therapy for people who have large masses or evidence of residual disease on follow-up scans.
They might also suggest other methods of treatment, including a stem cell transplant, alternative drugs, or drug combinations.
Learn more about chemotherapy for lymphoma.
Non-Hodgkin’s lymphoma
A standard chemotherapy combination regimen that doctors often use to treat non-Hodgkin’s lymphoma is known as CHOP. This regimen includes the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone.
For aggressive types of non-Hodgkin’s lymphoma, the doctor might add an immunotherapy drug called rituximab to the CHOP regimen. This combination increases the effectiveness of the treatment and can potentially cure non-Hodgkin lymphoma.
An oncologist may also recommend other drugs that attack cancer cells in different ways or alternative treatments, such as radiation or stem cell transplant.
Read about R-CHOP chemotherapy.
The continual improvement of available treatment options means doctors may sometimes be able to cure stage 4 lymphoma, depending on the type and a person’s risk factors. If a cure is not possible, treatment aims to manage a person’s symptoms and maintain their quality of life.
Cancer resources
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Survival rates provide people with a better understanding of how likely successful treatment will be for their type and stage of cancer.
Survival rates are estimates that vary depending on the stage of cancer. It is important to note that everyone is different, and many people can live much longer than these estimates suggest.
Overall, the 5-year survival rate for Hodgkin’s lymphoma that has spread to distant parts of the body is
- presence of B symptoms
- being over the age of 45 years
- being male
- having specific white and red blood cell counts
The overall 5-year relative survival rate for all people with a non-Hodgkin’s lymphoma diagnosis is
Relative survival rates compare people with this disease to those without it, and they vary widely for different types and stages. Many factors can affect survival rates. A person should discuss their specific risk factors with their doctor.
Learn more about the survival rates for Hodgkin’s and non-Hodgkin’s lymphoma.
Lymphoma is a cancer of the lymphatic system. Stage 4 lymphoma means that cancer has spread to an organ outside the lymphatic system.
The survival rates vary widely depending on an individual’s risk factors and type of cancer. The survival rate of stage 4 lymphoma is lower than that of the other stages, but doctors can cure the condition in some cases.
People with a diagnosis of stage 4 lymphoma should discuss their treatment options and outlook with their doctor. Treating this disease requires a collaborative approach from doctors, nurses, social workers, mental health counselors, and social support.
