It is an abnormal cell growth that cannot be controlled by the body’s natural defenses.
Lymphoma is the most common type of blood cancer. Cancer cells can grow and eventually form tumors.
Specifically, lymphoma is a cancer that affects lymphocytes , a type of white blood cell .
Lymphocytes, carried by lymphatic fluid, are part of the immune system and fight infection.
Lymphocytes travel through the blood and lymphatic system, to tissues and organs.
Lymphomas generally develop when a change, or mutation, occurs within a lymphocyte, causing the abnormal cell to duplicate faster than a normal lymphocyte and live longer than it.
Like normal lymphocytes, cancerous lymphocytes can travel through the blood and lymphatic system, spread, and grow in many parts of the body, including the lymph nodes.
Lymph nodes are small bean-shaped glands located in the small vessels of the lymphatic system.
There are thousands of lymph nodes located throughout the body, with clusters of them in the neck, under the arms, chest, abdomen, and groin.
Lymph nodes filter lymphatic fluid, trapping and destroying potentially harmful bacteria and viruses.
Bone marrow is a spongy material found within bones that contains stem cells that develop into three types of cells:
- Red blood cells that deliver oxygen to the body and remove carbon dioxide.
- White blood cells
- Platelets, which protect the body from infection.
Types of lymphomas
Lymphoma is a cancer that begins in the lymphatic system.
Three main categories of cancers that affect lymphocytes are:
Chronic lymphocytic leukemia and lymphocytic lymphoma are the same disease with slightly different manifestations.
Where cancer cells form determines whether it is called small lymphocytic lymphoma or chronic lymphocytic leukemia.
Leukemic cells develop due to a change that takes place in the cell’s DNA information for deoxyribonucleic acid, an essential component of genes.
There are six types of Hodgkin lymphoma, a rare form of lymphoma that involves Reed-Sternberg cells.
Linfoma no Hodgkin
There are more than 90 types of non-Hodgkin lymphoma, some of which are more common than others.
Any lymphoma that does not involve Reed-Sternberg cells is classified as non-Hodgkin lymphoma.
Non-Hodgkin lymphoma is one of the most common cancers, it can occur in children, but it is more common in adults.
Hodgkin lymphoma cells look unique under a microscope.
Lymphoma cells that don’t look like this are non-Hodgkin’s lymphoma.
It is important for doctors to be able to differentiate between Hodgkin and non-Hodgkin cells, because they are two different diseases.
The lymphatic system and lymphoma
The lymphatic system is part of the immune system, which helps protect our body against infection.
It consists of lymph nodes connected by lymphatic vessels, which branch into all parts of the body except the brain and spinal cord.
The lymphatic system also includes the bone marrow, spleen, thymus, and tonsils. Its main functions are:
- Drain fluids back into the bloodstream from the body’s tissues.
- Filter blood and lymph.
- Fight infection.
The lymphatic system carries a clear fluid called lymph, which contains many white blood cells called lymphocytes.
Lymphocytes mature within the blood and bone marrow and are stored in the lymph nodes.
Lymph nodes are found in various areas of the body, such as the neck, armpits, chest, abdomen, and groin.
Lymphatic fluid leaks through the lymph nodes, and foreign organisms (such as bacteria) get trapped and attacked by lymphocytes.
In a person with lymphoma, large numbers of abnormal lymphocytes are produced, replacing some of the normal lymphocytes.
This can affect the immune system and the way the body fights infection. The lymph nodes also swell, forming painless clumps.
The lymphatic system travels most of the body. This means that you can get lymphoma almost anywhere.
It is usually first seen in the lymph nodes in the neck, but it is also quite common to find it in the liver or spleen.
You can also find lymphoma in the intestine, stomach, brain, skin, testicles, and eyes.
Causes of lymphoma
It is not known why most people get lymphoma.
There are many different types of lymphoma, and it is unlikely that there is a single cause of all lymphomas.
There are a few known risk factors, including:
- Exposure to radiation.
- Exposure to certain chemicals.
- Infections and viruses, including human immunodeficiency virus and Epstein-Barr virus in people whose immune systems are suppressed.
The main symptom of lymphoma is swollen lymph nodes, causing a lump.
This is called ‘swollen glands’. The glands will grow fairly quickly, but they won’t necessarily be painful.
The most common places to notice this swelling are in the neck, armpits, or groin.
In these areas, the lymph nodes are just under the skin, so they are more likely to be noticeable if they are swollen.
Sometimes the affected lymph nodes can be deeper in the body.
You may not be able to see the swelling, but you may have other symptoms caused by this.
The symptoms that occur will depend on where the swollen lymph nodes are in the body and which organs they are pressing on.
These swellings are generally painless.
Other general symptoms include:
- Unexplained weight loss in the last six months (more than one-tenth of the total weight).
- Fever (greater than 38 ° C) that comes and goes without any obvious cause.
- Intense sweating, especially at night, that soaks up the sheets and pajamas.
Doctors call this group of symptoms the ‘B symptoms’.
Some people with lymphoma can get them, but others don’t.
Sometimes lymphoma enters the bone marrow and causes problems with low blood counts.
Although these are not classified as B symptoms (so they will not be used to guide treatment decisions), there are other symptoms that you may experience with lymphoma. These include:
- Fatigue, a feeling of extreme tiredness that does not go away after resting or sleeping
- Itching, either generalized or in one place.
- A cold.
- Lack of energy.
- Chest or abdominal (stomach area) pain.
- Cough or shortness of breath
Most people who have any of these symptoms will not have lymphoma.
They may have a much less serious problem, such as a throat infection. However, it is always important to see your doctor if these symptoms occur.
Certain symptoms are not specific to lymphoma and, in fact, are similar to those of many other diseases.
People often go to the doctor first because they think they have a cold, the flu, or some other respiratory infection that won’t go away.
Because lymphoma is rare and symptoms like these are common, it can sometimes take time to diagnose.
Once doctors suspect lymphoma, they will act quickly to make sure that the tests are done and the treatment that is needed is given.
Tests and Diagnosis
If the doctor suspects that the patient may have lymphoma, he will refer him to the hospital for tests and scans to confirm whether he has lymphoma or not.
You may need to have some tests fairly often, and blood tests.
These are some of the common tests that people have to have to diagnose lymphoma.
Many tests may be done to help doctors learn more about the type of lymphoma the patient has.
Lymph node biopsy
A lymph node biopsy is a minor surgical procedure that takes a sample of the lymph node affected by cancer.
This sample is then examined under a microscope in a laboratory. This test can be done under general anesthesia.
Often an entire lymph node will be removed, this is called an excisional biopsy.
Bone marrow and trephine aspirate
In some cases, the doctor will take a bone marrow sample to see how the blood is working within the bone marrow.
Bone marrow tests provide information about the structure of the marrow and the number and distribution of different types of blood cells, and cancer cells, if present.
Doctors can use body scans to help with their diagnosis and staging.
These often use a form of radiation to help take the scan.
Your doctor will make sure you are not exposed to more radiation than is absolutely necessary.
X-rays, particularly chest X-rays, can be used during diagnosis to help stage the cancer.
They provide good images of the densest tissues in your body, such as bones.
Many X-rays may be done during treatment to see how your body is responding and to check for infections.
Some people may also have a CT scan to help diagnose lymphoma; this is usually done if you have symptoms other than lumps.
A CT scan is a type of X-ray that produces a detailed image of internal organs.
It can check for other affected lymph nodes and for lymphatic organs such as a swollen spleen.
Positron emission tomography
It is becoming more and more common to have a positron emission tomography scan, or sometimes a combination scan.
For this scan, you will receive an injection that contains a radioactive solution.
As cancer cells absorb more radioactive solution than non-cancer cells, doctors will be able to see more clearly where the lymphoma is in the body.
This test may be done to see if the central nervous system (brain and spinal cord) has been affected by lymphoma.
The scan will focus on the head and neck, or the spine.
Ultrasounds can be used to provide more information about the condition.
For example, it could be used to measure the size of the spleen, which is often enlarged in lymphoma patients.
Ultrasound is also used to help see the lymph nodes when a biopsy is done.
A series of blood tests will be done to give the doctor a complete picture of the patient’s general health before starting treatment.
Complete blood count
A complete blood count measures the number of each type of cell in the blood: red blood cells, white blood cells, and platelets.
The complete blood count will help doctors detect if anemia (low concentration of hemoglobin in red blood cells) develops, either due to disease or treatment.
If you have bone marrow problems, your blood count may be low.
Liver function tests
This test checks if the liver is working normally. This is important to know when you are receiving chemotherapy.
This is because many medications are broken down in the liver. If the liver is not working normally, you may need to adjust the doses of your treatment medications.
Urea and electrolyte test
This test checks how well the kidneys are working.
This can help decide the dose of drugs that will be needed in treatment.
During a lumbar puncture, the doctor will take a small sample of cerebrospinal fluid.
A lumbar puncture may be needed if the lymphoma is at high risk of spreading to the central nervous system.
It is becoming more and more common for doctors to use special research, such as cytogenetics, to find out how developed the cancer is.
Lymphoma is caused by genetic errors. Sometimes this happens on a larger scale, which is easy to see under a microscope.
Genes are arranged in structures called chromosomes.
Chromosomes can sometimes be broken or rearranged.
Stages of lymphoma
The disease is ‘staged’ according to its location and spread.
This is important in determining the type of treatment you will need. The stages are:
- Stage I: Cancer is found in a lymph node area or in an area or organ outside of the lymph nodes.
- Stage II: Cancer is found in two or more areas of the lymph nodes or in an area or organ outside the lymph nodes on the same side of the diaphragm (the sheet of muscle hanging below the lungs that allows breathing).
- Stage III: Cancer is present on both sides of the diaphragm or in the lymph node areas.
- Stage IV: Cancer has spread outside the lymphatic system to one or more organs, such as the spleen, liver, or skin.
Treatment for lymphoma depends on the location and severity of the cancer.
Treatment for Hodgkin lymphoma is usually very successful, and many people are cured.
Non-Hodgkin lymphoma is also curable, but it can be more difficult to treat.
The treatments are slightly different for Hodgkin lymphoma and non-Hodgkin lymphoma.
Some people just need one treatment. Others will need a combination of treatments.
The options include:
- Watchful waiting: Some forms of slow-growing non-Hodgkin lymphoma may not need active treatment when first diagnosed. Regular checkups will be needed.
- Chemotherapy – Anticancer drug tablets or injections are used.
- Radiation therapy: X-rays are used to attack and destroy cancer cells. This is used in adults, but is rarely used to treat children with lymphoma.
- Steroids – Tablets or injections can improve how chemotherapy works.
- Immunotherapy (biological therapy, monoclonal antibodies) with antibodies : This is a treatment that uses natural body substances or medicines made from natural body substances. It is usually combined with chemotherapy.
- Stem cell (or bone marrow) transplantation: Stem cells are the cells from which blood cells evolve. High doses of chemotherapy can damage stem cells, so during this treatment the stem cells are removed from the bone marrow before higher doses of chemotherapy are given. They are then autotransplanted again after chemotherapy has finished.
- Allogeneic transplantation: Sometimes you need to have stem cells from a relative or donor who has a matching bone marrow. This type of transplant is sometimes done if your lymphoma comes back after a transplant that uses the patient’s own stem cells, and is called an allogeneic stem cell transplant.
- Complementary and Alternative Therapies: When used in conjunction with your conventional cancer treatment, some of these therapies can make the patient feel better and improve quality of life. Others may not be as helpful and in some cases they may be harmful.
All treatments have side effects. This will vary depending on the type of treatment being administered.
Many side effects are temporary, but some can be permanent. Your doctor will explain all possible side effects before your treatment begins.