What It Means and What to Expect

Stage 4 lymphoma is a cancer of white blood cells called lymphocytes that has spread outside the lymph nodes to other parts of the body. While this is an advanced stage, treatment options are available.

Jump to Key Takeaways.

What Does Stage 4 Lymphoma Mean?

Lymphoma is a cancer of the lymphocytes in the lymphatic system, which is part of your body’s immune system. Stage 4 is the most advanced stage:

• Types: The two main types of lymphoma are Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). NHL is the most common type.
• Spread: Stage 4 HL and NHL mean that lymphoma has spread to at least one organ outside of the lymph nodes, such as the liver or bones.
• Substages: For HL, the stage may also be labeled with an A or B, with B signifying additional symptoms, such as fever, extreme night sweats, and weight loss of greater than 10% of weight over the past six months. 

What Symptoms Can You Have With Stage 4 Lymphoma?

Some people have no symptoms when they are diagnosed with stage 4 lymphoma, while others may experience significant discomfort. Symptoms often relate to where the lymphoma has spread.

Common signs include:

• Enlarged lymph nodes: Swelling in the neck, armpits, or groin that isn’t painful
• Unexplained fever: Fever without presence of infection
• Persistent fatigue: Extreme tiredness that doesn’t improve with rest
• Drenching night sweats: Can require changing bedclothes or sheets
• Unexplained weight loss: Losing 10% or more of your body weight in six months without trying
• Shortness of breath or cough: If lymphoma has spread to the lungs or lymph nodes in the chest
• Abdominal pain or bloating: Due to lymph node involvement in the abdomen or spleen/liver enlargement

How Is Stage 4 Lymphoma Diagnosed?

Diagnosing stage 4 lymphoma requires a physical exam, imaging, and laboratory tests to determine the stage.

Tests typically include:

What Are the Treatment Options?

The treatment plan depends on the type of lymphoma, overall health, and whether treatment had been given before. 

Main treatments include:

• Chemotherapy: Typically the main treatment for both HL and NHL
• Immunotherapy: Medications that target specific proteins on cancer cells that help the immune system fight the cancer.
• Chimeric antigen receptor-modified T-cell therapy (CAR-T): Genetic modification of your own T cells (a type of lymphocyte) to attack the lymphoma (used when other treatments haven’t worked)
• Radiation therapy: Beams of high energy targeted to specific areas (may be used if lymph node is enlarged and causing significant symptoms)
• Stem cell transplant: Replaces cancerous bone marrow with healthy cells, often used for relapsed or aggressive cases
• Clinical trials: Offer access to the newest treatments and combinations not yet widely available.

What’s the Outlook for Someone With Stage 4 Lymphoma?

Prognosis varies and is based on the following:

• Lymphoma type
• Age and overall health
• Response to treatment (complete remission after initial therapy is a positive sign)

Survival Statistics

Survival rates are averages that do not account for individual factors or recent advances in treatment. Discuss your prognosis with your healthcare provider to understand your most likely outcome.

Statistics include:

• Hodgkin’s lymphoma: The five-year relative survival rate (a comparison of survival over a period of time) for stage 4 is 83%.
• Non-Hodgkin’s lymphoma: The five-year relative survival rate for stage 4 varies by subtype. For example, the five-year relative survival rate for stage 4 follicular lymphoma is 87%. For diffuse large B-cell lymphoma, the five-year survival rate for stage 4 disease is 65%.

How Can You Live Well With Stage 4 Lymphoma?

Quality of life while living with stage 4 lymphoma is important. The cancer and the treatments used to fight it may cause symptoms. Be sure to talk to your cancer care team about how best to manage any side effects you’re experiencing.

Ways to improve quality of life include:

• Stay active: Activity can improve fatigue and mental health.
• Eat well: Eating a well-balanced diet can help you feel your best and provide nutrition to support you through lymphoma treatment
• Consider mental health resources: Depression and anxiety are common with a lymphoma diagnosis. Check with your healthcare team for referrals to support groups or other interventions to improve mental health.

Key Takeaways

• Stage 4 lymphoma means the cancer has spread outside the lymphatic system.
• Treatments include chemotherapy, immunotherapy, and newer options like CAR-T cell therapy.
• Supportive care for side effects, open communication, and healthy lifestyle choices can help improve quality of life with stage 4 lymphoma.