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Stage 4 Lymphoma: Facts, Types, Symptoms, and Treatment

Fight anxiety with knowledge

Key points

  1. Lymphoma is a group of blood cancers that can develop in your lymphatic system.
  2. There are two main types, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).
  3. The symptoms, treatment options, and long-term outlook vary depending on the type.

A diagnosis of “stage 4 lymphoma” might be difficult to accept. But it’s important to know that some types of stage 4 lymphoma may be curable. Your outlook depends, in part, on the type of stage 4 lymphoma that you have.

Read more to learn about different lymphoma subtypes, including the treatment options and long-term outlook for Hodgkin lymphoma and non-Hodgkin lymphoma.

Types of lymphoma

Lymphoma isn’t a single disease. The term refers to a group of blood cancers that can develop in your lymphatic system. There are two main types of lymphoma:

  • Hodgkin lymphoma
  • non-Hodgkin lymphoma (NHL)

If you’re diagnosed with lymphoma, your doctor will perform tests to learn what stage of the disease you have. Stage 4 is the most advanced stage of lymphoma. The characteristics of stage 4 lymphoma vary, depending on the subtype of lymphoma you have.

Hodgkin lymphoma

According to estimates from the American Cancer Society (ACS), about 8,500 new cases of Hodgkin lymphoma will be diagnosed in the United States in 2016.

Hodgkin lymphoma is treatable, especially in its early stages. The one-year survival rate for all patients diagnosed with Hodgkin lymphoma is about 92 percent. The five-year survival rate is about 86 percent. For people with stage 4 Hodgkin lymphoma, the survival rate is lower. But even in stage 4 you can beat the disease.

If you have Hodgkin lymphoma that’s spread through one or more organs outside of your lymphatic system, you’ll be diagnosed with stage 4 of the condition. For example, the cancer might have spread to your liver, lungs, or bone marrow.

Non-Hodgkin lymphoma (NHL)

NHL accounts for about 4 percent of all cancers in the United States, reports the ACS. An estimated 72,580 people in the country will be diagnosed with it in 2016.

The many subtypes of NHL are categorized as either B cell type or T cell type NHL. The subtypes are further categorized as aggressive or indolent.

Aggressive NHL progresses quickly. According to the Leukemia and Lymphoma Society (LLS), about 60 percent of people with NHL have aggressive subtypes of the disease. Diffuse large B cell lymphoma (DLBCL) is the most common aggressive subtype. It affects about 30 percent of people with NHL in the United States.

Indolent NHL is slow growing. It accounts for about 30 percent of NHL cases in the United States, reports the LLS. Follicular lymphoma is the most common type of indolent NHL.

If you have NHL that’s spread outside of your lymphatic system to an organ that isn’t next to an affected lymph node, you’ve reached stage 4 of the disease. You also have stage 4 NHL if it’s spread to your bone marrow, liver, lungs, brain, or spinal cord.

Symptoms of stage 4 lymphoma

Stage 4 Hodgkin lymphoma and NHL have similar symptoms. Your symptoms will depend on the type of lymphoma you have and the organs affected. Your symptoms may include:

  • fatigue
  • night sweats
  • recurrent fevers
  • weight loss
  • itching
  • bone pain, if your bone marrow is affected
  • loss of appetite
  • abdominal pain
  • abdominal swelling
  • nausea
  • vomiting
  • constipation, if your spleen, intestines, or other parts of your abdomen are affected
  • chest pain, shortness of breath, or coughing if you have tumors that press on your trachea or superior vena cava

Treatment for stage 4 lymphoma

Your recommended treatment plan will vary. It will depend on the type of lymphoma you have, the organs affected, and your health and medical history.

Hodgkin lymphoma

To treat Hodgkin lymphoma, your doctor may recommend chemotherapy. For example, they may recommend:

  • six or more cycles of ABVD, a chemotherapy regimen that includes the drugs doxorubicin, bleomycin, vinblastine, and dacarbazine
  • 12 weeks of the Stanford V protocol, a combination of the drugs mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone, followed by radiation
  • the BEACOPP regimen, which includes the drugs bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone

If your condition doesn’t respond to initial treatment, your doctor may recommend other drug combinations, higher doses of drugs, or a stem cell transplant.

NHL

To treat stage 4 DLBCL, your doctor will likely recommend chemotherapy. For example, they may recommend the R-CHOP chemotherapy regimen. This involves a combination of the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, with the addition of rituximab, a monoclonal antibody. Treatment usually lasts about six months.

To treat slow-growing follicular lymphoma, your doctor may start by prescribing rituximab and chemotherapy drugs.

Outlook for stage 4 lymphoma

Your long-term outlook for stage 4 lymphoma will vary, depending on a number of factors, including:

  • the type of lymphoma
  • the organs affected
  • your age and overall health

According to the ACS, the five-year survival rate for stage 4 Hodgkin lymphoma is about 65 percent. The five-year survival rate for people with stage 4 NHL varies depending on the subtype of NHL and other factors.

Ask your doctor for more information about your diagnosis, treatment options, and long-term outlook.

Seek support

The treatment options and survival rates for lymphoma continue to improve. Depending on the type of stage 4 lymphoma you have, you may be able to cure your cancer. Even if you can’t cure it, treatments may help prolong your life and improve its quality.

Living with stage 4 cancer of any kind requires support. To learn about local and online support services, talk to your doctor or visit the LLS.

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