Lymphoma is a cancer originating in lymphocytes, white blood cells that are part of the immune system. In lymphoma, these cells grow abnormally, forming tumors. Yes, lymphoma can spread to the brain and spinal cord, collectively known as the central nervous system (CNS). While serious, this complication is relatively uncommon.
Understanding Central Nervous System Lymphoma
Lymphoma affecting the brain can be primary CNS lymphoma (PCNSL) or secondary CNS lymphoma. PCNSL originates directly within the brain, spinal cord, eyes, or surrounding membranes, with no lymphoma elsewhere at diagnosis. Secondary CNS lymphoma occurs when lymphoma from another body part spreads to the CNS, often via the bloodstream.
Lymphoma cells can also spread to the CNS through direct extension or along neurovascular bundles. While any lymphoma type can spread to the CNS, aggressive non-Hodgkin lymphoma subtypes carry a higher risk. Diffuse large B-cell lymphoma (DLBCL) accounts for about 90% of CNS lymphoma cases. Other aggressive types, like Burkitt lymphoma, also have an elevated risk.
Recognizing Signs and Symptoms
When lymphoma spreads to the brain or spinal cord, it can cause neurological symptoms depending on the tumor’s location and size. Common signs include persistent headaches and seizures. Individuals might also experience vision changes, such as blurred or double vision, or “floaters” if lymphoma affects ocular structures.
Other symptoms involve motor and sensory functions, like weakness or numbness in limbs, balance difficulty, or speech problems. Cognitive and behavioral changes, including confusion, memory issues, concentration difficulty, or personality shifts, can also occur. Nausea and vomiting, particularly in the morning, may indicate increased skull pressure. These symptoms warrant immediate medical evaluation, though they are not exclusive to lymphoma spread.
Diagnosis and Evaluation
Diagnosing lymphoma spread to the brain or spinal cord involves specialized tests. Imaging techniques are often the first step, with Magnetic Resonance Imaging (MRI) of the brain and spinal cord being the preferred method due to its high resolution. A Positron Emission Tomography (PET) scan may also check for lymphoma activity elsewhere.
A lumbar puncture, or spinal tap, is a crucial diagnostic procedure. This involves collecting cerebrospinal fluid (CSF), the fluid surrounding the brain and spinal cord, to analyze for lymphoma cells. In some cases, a brain tissue biopsy confirms the diagnosis and determines the lymphoma type. This is often a stereotactic biopsy, a minimally invasive procedure for microscopic examination.
Treatment Approaches
Treating lymphoma spread to the brain or spinal cord requires a multidisciplinary approach, often using therapies that bypass the blood-brain barrier. High-dose chemotherapy is a primary treatment, frequently using drugs like methotrexate designed to penetrate the CNS. This chemotherapy may be administered intravenously or directly into the cerebrospinal fluid (intrathecally).
Radiation therapy, particularly whole-brain radiation, is another common treatment, sometimes used with chemotherapy or as consolidation. Targeted therapies and immunotherapy are also emerging. These include monoclonal antibodies like rituximab, which target specific lymphoma cell proteins, or immune checkpoint inhibitors that enhance the body’s immune response. For some patients, high-dose chemotherapy followed by an autologous stem cell transplant may reduce recurrence risk. Treatment plans are individualized, considering lymphoma type, spread, and patient health.