The lymphomas: an update for surgeons

Therapy of the lymphomas is predominantly nonoperative, relying on chemotherapy and radiation therapy. In Hodgkin's lymphoma, the role of the surgeon was once large, involving staging laparotomy. At present, chemotherapy is the predominant mode of therapy in patients of all ages, and the therapeutic distinctions centered on the histology of laparotomy specimens no longer exist. The surgeon most often will encounter the patient with lymphoma for biopsy for tissue diagnosis and for institution of long-term venous access. Non-Hodgkin's lymphoma presents with three cellular subtypes in children, and frequently is first seen in the abdomen and mediastinum as a fast-growing diffuse tumor. As a systemic disease, these lymphomas also are nearly always treated systemically by chemotherapy, yet a small number of patients with localized disease may benefit from attempts at tumor extirpation.