Primary lymphoma of the brain

Also known as: Brain lymphoma, Cerebral lymphoma, Primary lymphoma of the central nervous system or Lymphoma - brain

Definition

Primary lymphoma of the brain is cancer of the lymph cells that starts in the brain.

Causes, incidence, and risk factors

The cause of primary brain lymphoma is unknown. It is more common in people ages 45 - 70.

Patients who have a weakened immune system are at greater risk for primary lymphoma of the brain. Common causes of a weakened immune system include:

HIV
Organ transplants (especially heart transplants)

Primary lymphoma of the brain is also linked to Epstein-Barr Virus (EBV) infection, the virus that causes mononucleosis.

The rate of primary brain lymphoma is rising, but it is still relatively rare.

Symptoms

Changes in speech
Changes in vision
Confusion
Fever
Hallucinations
Headaches
Numbness to hot, cold, and pain
Personality changes
Seizures
Weakness in hands
Weight loss

Signs and tests

The following tests may be performed to help diagnose a primary lymphoma of the brain:

Treatment

The condition is usually first treated with corticosteroids to control any local swelling and improve symptoms. However, chemotherapy may increase survival by 3 - 4 years, or longer. The chemotherapy is usually high doses of methotrexate given through a vein (intravenously) or a spinal tap (intrathecally).

Treating patients with weakened immune systems is not as successful, but it is improving.

Radiation therapy used to be the main treatment for primary lymphoma of the brain. Now it is usually reserved for treating patients who do not respond to chemotherapy.

Treatment with multiple therapies (combination therapy) is common.

Expectations (prognosis)

The survival of untreated primary brain lymphoma is under 2 months. Treated with chemotherapy, patients often survive 3 - 4 years or more. About 40% of patients are alive at 5 years. In general, older patients have a worse outlook than younger patients.

Complications

Possible complications include:

Chemotherapy side effects, including low blood counts
Radiation side effects, including confusion, headaches, nervous system (neurologic) problems, and tissue death
Return (recurrence) of the lymphoma

References

DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 199.

National Cancer Institute. . 2009. Accessed February 25, 2009.

Review date:: March 2, 2010
Reviewed by:: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.

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