Non-Hodgkin's Lymphoma Diagnosis in a Female Patient: How Chemotherapy Helped Control Disease Progression

When a 55-year-old woman began experiencing persistent fatigue and noticed a growing lump on the right side of her neck, she sought medical attention to uncover the cause. After undergoing a comprehensive diagnostic workup at Sun Yat-sen University Cancer Center, she was diagnosed with diffuse large B-cell lymphoma—a common subtype of Non-Hodgkin's Lymphoma (NHL). With timely intervention using the CHOP chemotherapy regimen, her symptoms improved significantly, and disease progression was successfully halted. This case highlights the importance of early diagnosis and standardized treatment in managing aggressive blood cancers.

Patient Overview & Clinical Background

Age & Gender: 55-year-old femaleDiagnosis: Diffuse Large B-Cell Non-Hodgkin's LymphomaHospital: Sun Yat-sen University Cancer CenterDate of Initial Consultation: March 2017Treatment Plan: Six cycles of CHOP chemotherapy (cyclophosphamide, vincristine sulfate, epirubicin hydrochloride, prednisolone) combined with supportive care including nutritional support and vascular protectionTreatment Duration: Approximately six months, followed by regular monitoringOutcome: Significant reduction in lymph node size, resolution of systemic symptoms, and stable disease confirmed through imaging follow-ups

Initial Evaluation: Recognizing the Warning Signs

The patient first presented with a gradually enlarging mass on the right side of her neck, measuring up to the size of a broad bean. She also reported generalized fatigue that had been worsening over recent weeks. Despite being otherwise alert and hemodynamically stable, physical examination revealed multiple palpable lymph nodes on the right cervical region. No obvious abnormalities were detected upon cardiac or pulmonary auscultation.

Laboratory tests, including complete blood count and basic metabolic panel, returned within normal limits. However, a contrast-enhanced CT scan of the neck showed multiple enlarged lymph nodes, raising strong suspicion for lymphoma. Given the radiological findings and clinical presentation, a provisional diagnosis of lymphoma was made, prompting hospital admission for definitive diagnosis and treatment planning.

Confirming the Diagnosis Through Biopsy

To confirm the suspected diagnosis, a fine-needle aspiration biopsy of the affected cervical lymph node was performed. Histopathological analysis revealed features consistent with diffuse large B-cell lymphoma (DLBCL), an aggressive but potentially treatable form of Non-Hodgkin's Lymphoma. Immunohistochemistry further supported this classification, confirming the clonal proliferation of malignant B-cells.

Why Accurate Diagnosis Matters

Precise histologic identification is critical because treatment strategies vary widely among different subtypes of NHL. DLBCL accounts for approximately 30–40% of all NHL cases globally and typically requires prompt initiation of combination chemotherapy. Delayed or inaccurate diagnosis can lead to rapid disease progression, making early biopsy-driven confirmation essential for optimal outcomes.

Implementing the CHOP Chemotherapy Regimen

Based on international guidelines and the patient's overall health status, the oncology team recommended a standard six-cycle CHOP protocol:

• Cyclophosphamide – An alkylating agent that damages DNA in rapidly dividing cancer cells
• Vincristine (Oncovin) – A vinca alkaloid that disrupts microtubule formation during cell division
• Epirubicin – An anthracycline antibiotic that inhibits topoisomerase II, leading to cell death
• Prednisolone – A corticosteroid that enhances chemotherapy efficacy and reduces inflammation

The patient received intravenous infusions every 21 days, totaling six cycles. Throughout treatment, she was closely monitored for infusion-related complications, particularly extravasation risks due to repeated venous access. Nurses emphasized limb care and proper hydration to minimize vascular injury and support drug delivery efficiency.

Treatment Response and Follow-Up Results

After completing the full course of therapy, the patient experienced marked clinical improvement:

• Neck lymphadenopathy reduced significantly in size
• Subjective fatigue diminished, with increased energy levels reported
• Mood and appetite improved, indicating better quality of life

Follow-up imaging—including repeat CT scans of the neck and chest, as well as bone scintigraphy—showed no evidence of disease progression. PET-CT, though not mentioned initially, is often used in modern practice to assess metabolic response; in similar cases, it helps differentiate residual masses from active tumor tissue.

Long-Term Monitoring Is Key

Even with successful initial remission, ongoing surveillance remains crucial. Patients are typically advised to undergo periodic imaging and blood tests every 3–6 months during the first two years post-treatment—the period when relapse risk is highest.

Post-Treatment Lifestyle Guidance for Recovery

To sustain remission and promote long-term wellness, the patient was given personalized lifestyle recommendations:

1. Prioritize Rest and Moderate Physical Activity

Adequate sleep and light exercise such as walking, tai chi, or gentle stretching help restore immune function and reduce treatment-related fatigue. Outdoor activities also improve mental health and circadian rhythm regulation.

2. Maintain a Balanced, Nutrient-Dense Diet

Nutritional support plays a vital role in recovery. The patient was encouraged to consume high-protein foods like lean meats, eggs, legumes, and dairy, along with fresh fruits and vegetables rich in antioxidants and vitamins. Processed, greasy, or extremely cold foods were discouraged to prevent digestive discomfort.

3. Monitor for Potential Side Effects

While CHOP is generally well-tolerated, possible side effects include peripheral neuropathy (from vincristine), cardiotoxicity (from epirubicin), and immunosuppression. Any new or worsening symptoms—such as numbness, shortness of breath, fever, or unexplained bruising—should prompt immediate medical evaluation.

Insights into Non-Hodgkin's Lymphoma Management

Non-Hodgkin's Lymphoma encompasses a diverse group of hematologic malignancies, with DLBCL being one of the most prevalent aggressive forms. Fortunately, advances in immunochemotherapy—such as adding rituximab to CHOP (creating R-CHOP)—have dramatically improved survival rates over the past two decades.

In this case, the use of standard CHOP chemotherapy without targeted agents still yielded excellent disease control, underscoring its foundational role in treating DLBCL, especially in resource-conscious settings. However, future considerations may include molecular profiling (e.g., cell-of-origin classification via gene expression) to guide more personalized approaches.

Early detection, accurate diagnosis, and adherence to evidence-based treatment protocols remain the cornerstones of successful lymphoma management. This patient's journey exemplifies how structured care can transform a life-threatening diagnosis into a story of resilience and recovery.