About the International Prognostic Index for Lymphoma (IPI)

Until the creation of the Follicular Lymphoma International Prognostic Index (FLIPI), the standard prognostic tool for assessing all lymphomas was the International Prognostic Index (IPI). This is a points-based system that allows doctors to guess how a given person's disease is likely to progress, based on a handful of particularly significant common risk factors.


How IPI Works
The IPI was the product of a research project in the 1990s, meaning essentially that it was based on the standard regimens of the 1980s and early 1990s (alkalating agent-based regimens like CHOP). The report of the International Non-Hodgkin's Lymphoma Prognostic Factors Project, published in the New England Journal of Medicine in 1993, formed the basis for the IPI model. They evaluated data from over 3000 patients in all stages of lymphoma.

IPI established five basic factors known to equate with a worse prognosis (less response to therapy, and shorter overall survival expectancy):

About FLIPI in Follicular Lymphoma

Currently, the standard method for determining the prognosis of follicular lymphoma, and separating low-risk patients (who can delay treatment) from high-risk patients (who may require immediate treatment), is a tool called the Follicular Lymphoma International Prognostic Index (FLIPI).

How FLIPI Works


FLIPI was established in a 2004 article published in Blood, with a large list of European and American co-authors. It identified five risk factors associated with a poorer prognosis (lower survival rates) for follicular lymphoma. Patients get one "point" for each risk factor they carry; essentially, the more points a person accumulates, the more dangerous their disease is:

PET Scans in Canada

Positron Emission Tomography (PET) is a type of advanced medical scanning which takes a 3-dimensional image of the body. Most commonly, a tracer molecule such as FDG (which contains glucose, or sugar) is used. The PET scan then detects areas of substantial "pickup," or accumulation, of FDG in the body. Because tumours tend to actively take up glucose, they can be more easily spotted on the scan. Today some centres operate combined PET/CT machines, which produce a composite image using both PET technology and CT (X-ray) technology.

Availability of PET scans, unfortunately, is one of many elements of healthcare that varies between provinces in terms of public funding and availability. For instance, Quebec performs about 21,000 PET scans per year, while Ontario performs only 2000 PET scans per year. Ontario's public funding for PET scans is very limited, although coverage has recently been expanded to several new conditions, including (in certain cases) lymphoma.

The following list is under perpetual construction will be regularly updated. If you are aware of changes, please contact Northoma or leave a comment.

How Ann Arbor Staging Works for Lymphoma

The first standard action once cancer is diagnosed is "staging": an assessment of how far it has spread throughout the body. Lymphoma is traditionally staged according to what is known as the Ann Arbor system, which stages cancer between Stage I (localized disease) and Stage IV (metastasis, or spread, throughout the body). This is similar to the TNM system used in other solid cancers.

For lymphoma, the Ann Arbor stages mean:

When To Be Concerned About Lymph Nodes

Lymphoma is a disease of white blood cells called lymphocytes, usually the particular type known (as in the case of follicular lymphoma) as B-cells. It typically begins as painless, firm or hard swelling of one or more lymph nodes. The lymph nodes, popularly (and incorrectly) known as "glands," are components of the immune system. There are hundreds around the body, but the most easily felt ("palpable") nodes can be found in the neck, the armpits, and the groin. Swollen lymph nodes are extremely common, and are almost always an indication that the body is fighting off an infection. Lymphoma is only one (uncommon) explanation for swollen lymph nodes. In some cases, lymph nodes are permanently swollen after an infection and never shrink again. Frequently poking and prodding at swollen lymph nodes may prevent them from shrinking normally.

It is difficult to identify a set of characteristics which automatically indicate or rule out lymphoma as a cause of swollen lymph nodes. In general, healthy nodes are more likely soft; cancerous nodes are more likely firm, rubbery, or hard. Multiple nodes are more concerning than single nodes, especially if they are dispersed through multiple node regions (see the image below).

Chances of Getting Lymphoma – Plus, My Experience

My own sluggish path towards a diagnosis continues. I had an ultrasound yesterday which will apparently have results available within five days (although my clinic's office said 14 days, so who knows?). Judging the size and shape of the one node I did glimpse by craning my neck towards the screen (2.0 x 0.6 cm), it's not exactly great news. On the other hand, it's always possible I'll luck out.

In the meantime, I know that one of the most worrying periods in any person's life is the one in which they're not quite sure (yet) whether they're really sick. In the vast majority of cases, we actually aren't – or at least, not seriously. So, on the assumption that some such nervous readers will eventually find their way here, I thought I'd share some potentially comforting statistics.