The cause of malignant lymphomas is unknown.

Malignant lymphomas can lead to hypercalcemia, hyperuricemia, lymphomatosis, meningitis, and anemia from bone marrow involvement. As tumors grow, they may produce liver, kidney, and lung problems. Central nervous system involvement can lead to increased intracranial pressure.

Signs of malignant lymphomas may mimic those of Hodgkin’s disease. Most patients’ histories often reveal painless, swollen lymph glands. Swelling may appear and disappear over several months. As the lymphoma progresses, the patient may complain of fatigue, malaise, weight loss, and night sweats.

Inspection may reveal enlarged tonsils and adenoids, and palpation may disclose rubbery nodes in the cervical and supraclavicular areas.

Biopsies—of lymph nodes; of tonsils, bone marrow, liver, bowel, or skin; or, as needed, of tissue removed during exploratory laparotomy—differentiate a malignant lymphoma from Hodgkin’s disease. Chest X-rays, lymphangiography, a computed tomography scan of the abdomen, excretory urography, and liver, bone, and spleen scans indicate disease progression.

A complete blood count (CBC) may show anemia. The patient may have a normal or elevated uric acid level and an elevated serum calcium level, resulting from bone lesions.

The staging system for Hodgkin’s disease also applies to malignant lymphomas.

Radiation and chemotherapy serve as the main treatments for lymphomas. Radiation therapy is used mainly during the localized stage of the disease. Total nodal irradiation often effectively treats both nodular and diffuse lymphomas.

Chemotherapy is most effective with a combination of antineoplastic agents. For example, the CHOP protocol (cyclophosphamide, doxorubicin, vincristine [Oncovin], and prednisone) can induce a complete remission in 70% to 80% of those with nodular lymphoma and in 20% to 55% of those with diffuse lymphoma. Other combinations such as MACOPB (methotrexate, leucovorin, doxorubicin [Adriamycin], cyclophosphamide, vincristine [Oncovin], prednisone, and bleomycin) can induce a prolonged remission
and possibly a cure for diffuse lymphoma.