Lymphoma

Lymphoma is a type of cancer that begins in the lymphatic system, which is part of the body’s immune system. The lymphatic system includes the lymph nodes (small glands), spleen, thymus gland, and bone marrow. It can affect all these areas as well as other organs throughout the body. There are many types of lymphoma, but the two main categories are Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Each type differs in terms of how it spreads, the symptoms it causes, and how it is treated.

What is Lymphoma?

It occurs when a type of white blood cell called a lymphocyte, which normally helps protect the body from infection, begins to grow uncontrollably. These abnormal lymphocytes can crowd out healthy cells and form tumors in the lymph nodes, spleen, or other parts of the body.

Hodgkin Lymphoma (HL):

It is characterized by the presence of a specific type of abnormal cell called the Reed-Sternberg cell. HL is relatively rare but is considered one of the most treatable forms of cancer, especially when detected early. It typically spreads in a predictable manner from one group of lymph nodes to another.

Non-Hodgkin Lymphoma (NHL):

It is a more common type of lymphoma, accounting for about 85% of all lymphoma cases. It includes a diverse group of cancers that differ in the way they behave, grow, and respond to treatment. NHL can develop in either B lymphocytes or T lymphocytes, with B-cell lymphomas being the most common. Unlike HL, NHL can spread to lymph nodes, blood, and organs throughout the body in a less predictable pattern.

Lymphoma types:

Lymphoma is not a single disease but rather a group of related cancers that affect the lymphatic system. The two main types, HL and NHL, are further divided into several subtypes.

Subtypes of HL:

1. Classical HL: This is the most common type of Hodgkin lymphoma and includes subtypes such as nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted.
2. Nodular Lymphocyte-Predominant HL (NLPHL): This rare subtype is characterized by the presence of large, abnormal cells known as popcorn cells. NLPHL tends to grow more slowly than classical HL.

Subtypes of NHL:

1. Diffuse Large B-Cell (DLBCL): The most common subtype of NHL, DLBCL is an aggressive cancer that grows quickly but is often curable with chemotherapy.
2. Follicular: A slow-growing type of NHL, follicular lymphoma often presents as painless swelling in the lymph nodes and can transform into a more aggressive form over time.
3. Mantle Cell: This subtype is considered aggressive and challenging to treat. It often requires a combination of chemotherapy, immunotherapy, and stem cell transplant.
4. Burkitt: One of the fastest-growing types of NHL, Burkitt lymphoma is a rare but highly aggressive form that typically affects children and young adults.
5. T-Cell: This diverse group of NHL subtypes originates in T lymphocytes and includes conditions like anaplastic large cell lymphoma, peripheral T-cell lymphoma, and cutaneous T-cell lymphoma.

Lymphoma symptoms:

The symptoms can vary depending on the type and location of the cancer. Some people may not experience any symptoms until the disease has progressed, while others may notice signs early on.

Common Symptoms Include:

1. Swollen Lymph Nodes: Painless swelling of the lymph nodes, often in the neck, armpit, or groin, is the most common symptom of the disease. These swollen nodes can become larger over time but may not be painful.
2. Fever: Persistent or recurring fevers without an obvious cause, such as an infection, can be a sign of the disease.
3. Night Sweats: Excessive sweating, particularly at night, is another common symptom. This symptom can be severe enough to soak clothing and sheets.
4. Weight Loss: Unexplained weight loss of more than 10% of body weight over six months can be a sign.
5. Fatigue: Persistent tiredness or lack of energy that doesn’t improve with rest is a common symptom.
6. Itchy Skin: Some people with lymphoma experience itching all over their body, which can be severe and is often worse at night.
7. Chest Pain or Cough: If lymphoma affects the lymph nodes in the chest, it can cause chest pain, shortness of breath, or a persistent cough.
8. Abdominal Pain or Swelling: The disease can cause the abdomen to swell or become painful if it spreads to lymph nodes or organs in the abdominal cavity.

Causes and Risk Factors:

The exact cause of lymphoma is not fully understood, but several risk factors have been identified. These factors can increase the likelihood of developing the disease, though many people with these risk factors never develop the disease.

Risk Factors Include:

1. Age: While it can occur at any age, certain types are more common in specific age groups. HL is more common in young adults, while NHL is more frequently diagnosed in older adults.
2. Gender: Men are slightly more likely to develop lymphoma than women.
3. Weakened Immune System: People with weakened immune systems, such as those with HIV/AIDS, those who have had an organ transplant, or those with autoimmune diseases, are at higher risk for lymphoma.
4. Infections: Certain infections, such as the Epstein-Barr virus (EBV), Helicobacter pylori, and hepatitis C, have been linked to an increased risk of the disease.
5. Family History: A family history of the disease may increase the risk of developing the disease.
6. Exposure to Chemicals: Long-term exposure to certain chemicals, such as pesticides, solvents, and herbicides, has been associated with an increased risk of lymphoma.

Lymphoma diagnosis:

Diagnosing the disease involves a combination of physical examination, medical history, imaging tests, and laboratory tests. If lymphoma is suspected, a biopsy is typically required to confirm the diagnosis.

Diagnostic Procedures Include:

1. Physical Examination: The doctor will examine the patient for swollen lymph nodes and signs of infection or other conditions that could cause similar symptoms.
2. Blood Tests: Blood tests can help assess overall health, detect signs of infection or organ dysfunction, and measure levels of certain proteins that may be elevated in lymphoma.
3. Imaging Tests: Imaging tests such as X-rays, CT scans, PET scans, or MRI can help determine the extent of the disease and identify areas of the body affected by lymphoma.
4. Biopsy: A biopsy involves removing a sample of tissue from a swollen lymph node or other affected area for examination under a microscope. The biopsy can confirm the presence of lymphoma and determine the specific type.
5. Bone Marrow Aspiration and Biopsy: In some cases, a bone marrow aspiration and biopsy may be performed to determine if the lymphoma has spread to the bone marrow.
6. Lumbar Puncture (Spinal Tap): If there is concern that lymphoma has spread to the brain or spinal cord, a lumbar puncture may be performed to collect and analyze cerebrospinal fluid.

Lymphoma staging

Once lymphoma is diagnosed, the next step is to determine the stage of the disease. Staging describes the extent of the cancer and helps guide treatment decisions.

The Stages of Lymphoma Are:

1. Stage I: Lymphoma is found in one lymph node region or one area outside the lymphatic system.
2. Stage II: Lymphoma is in two or more lymph node regions on the same side of the diaphragm or one lymph node region and a nearby organ.
3. Stage III: Lymphoma is found in lymph node regions on both sides of the diaphragm.
4. Stage IV: Lymphoma has spread to one or more organs outside the lymphatic system, such as the liver, bone marrow, or lungs.

Lymphoma treatment:

The treatment of lymphoma depends on the type, stage, and specific characteristics of the disease, as well as the patient’s overall health and preferences. Treatment options may include chemotherapy, radiation therapy, targeted therapy, immunotherapy, stem cell transplant, or a combination of these approaches.

Chemotherapy:

Chemotherapy uses powerful drugs to kill cancer cells throughout the body. It is often the primary treatment for lymphoma, particularly for aggressive types. Chemotherapy may be administered orally or intravenously, and it is typically given in cycles over several months.

Radiation Therapy:

Radiation therapy uses high-energy beams to target and kill cancer cells in specific areas of the body. It is often used to treat early-stage Hodgkin lymphoma or as part of a combined treatment approach with chemotherapy.

Targeted Therapy:

Targeted therapy involves the use of drugs that specifically target certain proteins or pathways that are involved in the growth and survival of cancer cells. Rituximab, a monoclonal antibody, is a common targeted therapy used in the treatment of B-cell lymphomas.

Immunotherapy:

Immunotherapy boosts the body’s immune system to help it fight cancer. Checkpoint inhibitors, CAR T-cell therapy, and other forms of immunotherapy are being increasingly used to treat lymphoma, particularly in cases where other treatments have failed.

Stem Cell Transplant:

Stem cell transplant, also known as bone marrow transplant, is a procedure that replaces damaged or destroyed bone marrow with healthy stem cells. It is often used in patients with relapsed or refractory lymphoma or those undergoing high-dose chemotherapy.

Living with Lymphoma:

Living with lymphoma can be challenging, both physically and emotionally. However, many people with lymphoma live long, healthy lives after treatment. Here are some tips for managing life with lymphoma:

1. Follow-Up Care: Regular follow-up appointments are essential to monitor for any signs of recurrence and to manage any long-term side effects of treatment.
2. Healthy Lifestyle: Eating a balanced diet, getting regular exercise, and maintaining a healthy weight can help support your recovery and overall well-being.
3. Emotional Support: Coping with a cancer diagnosis can be overwhelming. Seek support from friends, family, support groups, or a mental health professional to help manage the emotional challenges.
4. Financial and Practical Support: Treatment for lymphoma can be costly and time-consuming. Explore resources for financial assistance, transportation, and other practical needs.
5. Stay Informed: Educate yourself about lymphoma and your treatment options. Being informed can help you feel more in control of your health and make informed decisions about your care.

Lymphoma is a complex and varied disease, but advances in diagnosis and treatment have significantly improved outcomes for many patients. Early detection and appropriate treatment are key to managing the disease and improving survival rates. Whether you are newly diagnosed, in treatment, or living in remission, it is important to stay informed, seek support, and work closely with your healthcare team to navigate the challenges of living with the disease. With the right care and support, many patients can lead full and active lives.

To consult a Doctor at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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Additional Reading:

• https://www.who.int/health-topics/cancer#tab=tab_1