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Small lymphocytic lymphoma is a form of indolent (slow-growing) non-Hodgkin lymphoma (NHL).
It is a malignant condition (cancer) affecting a type of white blood cells called lymphocytes. Small lymphocytic lymphoma and chronic lymphocytic leukaemia (CLL) are different forms of the same disease. They are treated in the same way and have a similar outlook.
There are several different types of lymphocyte – SLL affects a type known as B cells, which normally produce antibodies to fight infection. Unlike leukaemia, in lymphoma, the cancer cells are found in organs and tissues of the lymphatic system. The lymphatic system is a network of fine vessels, glands and channels which occur throughout the body. It also conveys nutrients and cells, and is responsible for draining fluid and waste products away from tissues, and into the blood stream to be processed. The lymphatic system is an important part of the immune system and is made up of lymph nodes and vessels and of collections of lymphocytes in other tissues.
Small lymphocytic lymphoma is a low-grade form of NHL, this means that it develops slowly and, even if not treated, it grows slowly. Small lymphocytic describes the appearance of the affected lymphocytes under the microscope.
In most cases of SLL, there is no obvious cause. There are some things which are known to be associated with a higher than average chance of developing lymphoma, including SLL. These include:
It is important to understand that:
The most common sign of SLL is a lump in the neck, armpit or groin or stomach. These are usually, but not always, painless and are often described as feeling “rubbery”. Patients with SLL often develop frequent, persistent infections.
Other common symptoms include:
The most important test for diagnosis of SLL is a biopsy of affected tissue. This may mean removing a whole abnormal lymph node (excision biopsy) or just a sample of tissue.
Other tests which may be done include:
It is sometimes difficult for doctors to decide whether to classify a particular patient’s disease as chronic lymphocytic leukaemia or as small lymphocytic lymphoma. They may write CLL/SLL as a diagnosis and sometimes the diagnosis may be changed from SLL to CLL or vice versa. None of this is a cause for worry because the treatment is the same whether it is called SLL or CLL and the likelihood of a good outcome is the same for both.
Staging is the use of test results to show how widely the lymphoma has spread. There are four stages in the standard system used:
Stages 1-2 are known as early-stage disease and stages 3-4 are known as advanced-stage disease.
This stage description may be modified by adding the letters A, B, E or S:
Many patients who have early-stage SLL do not start treatment straight away. If patients are not being treated they have regular check-ups. This is known as “watch and wait” or “active monitoring”. This can last for many years and some patients with SLL never need treatment for their lymphoma. Some patients with SLL may start treatment as soon as they are diagnosed.
Small lymphocytic lymphoma is not usually curable with standard treatments. After treatment most patients have a period of no active disease, this is known as remission and may last for many years. SLL will nearly always come back, this is known as a relapse and it can usually be treated again, using similar treatments as were used the first time. Many patients have repeated remissions and FL may be controlled for many years in this way.
Small lymphocytic lymphoma sometimes changes into a high-grade lymphoma, usually DLBCL. This is called transformation and is treated in the same ways as DLBCL.
The main ways in which SLL is treated are:
Chemotherapy is the use of cell-killing drugs. These kill the cancer cells and/or stop them from dividing. Chemotherapy is usually given in blocks or ‘cycles’ of treatment. One cycle of treatment will consist of a series of doses of chemotherapy followed by a break for the healthy cells to recover.
Chemotherapy is normally given as a combination of drugs, which will usually include steroids. Steroids used to treat SLL are a laboratory-made version of chemicals naturally made by the body. They are very different from the type of steroids sometimes misused by body-builders or sportsmen.
The details of your treatment will vary depending on the stage of your SLL and your general fitness. You will be given a chance to discuss treatment options and detailed information on your treatment plan before it starts. The side effects of treatment vary between different types of treatment and different patients. You will be given detailed information about any likely side effects before you start treatment.
We understand going through a blood cancer through journey can be difficult. It may help to talk to a close friend or relative about how you are feeling. Here are some questions that may be useful to ask your doctor.