Lymphoma: Types, Stages, Symptoms, Causes, Risk factors, Diagnosis, Treatment and Outlook


Lymphoma is a cancer of the lymphatic system. The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow.

May 10, 2018

Lymphoma is a cancer of the lymphatic system. The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphocytes are a type of white blood cells which play an important role in the immune system and help fight disease in the body. These cells get affected in Lymphoma.
As it is present in the bloodstream, it can spread or metastasize, to different parts of the body. Lymphoma can occur at any age, but it is one of the most common causes of cancer in children and young adults between the age of 15 to 24 years.
The disease is often treatable, and the outlook can vary depending on the type of lymphoma and its stage. Your doctor can help you find the right treatment for your type and stage of the disease.
Lymphoma treatment may involve chemotherapy, immunotherapy medications, radiation therapy, a bone marrow transplant or some combination of these. Prevention of lymphoma is not possible, but survival rates after treatment are good.
Lymphoma is different from leukemia. Each of these cancers starts in a different type of cell. Lymphoma affects the infection fighting lymphocytes where as Leukemia affects the blood forming cells inside bone marrow.

Types of Lymphoma:

Lymphatic cancers are classified by the type of immune cells affected. here are two main types of lymphoma:

  • Non-Hodgkin Lymphoma
  • Hodgkin Lymphoma

Different types of lymphocyte cells are involved in both Non-Hodgkin and Hodgkin lymphoma. There are many sub types within these two type of lymphoma.
Non-Hodgkin is the most common type which affects B and T cells. The presence of Reed-Sternberg cells is a marker for Classic Hodgkin lymphoma. Several different types of cells affects other sub types. The rate of growth and respond to different treatment vary for each type of lymphoma.

Staging of Lymphoma:

Based on the type, growth rate, and cellular characteristics of the cells involved, staging of lymphoma is done. The cancer is confined to a small area in stage 0 and 1. It will then start spreading in stage 2 and 3. Finally it has spread to more distant organs in stage 4.
Lymphoma can also be described as indolent, which is limited to one place, or aggressive, that will spread to other parts of the body.

Symptoms of Lymphoma:

Signs and symptoms of lymphoma may include:

  • Painless swelling of lymph nodes in your neck, armpits or groin
  • Persistent fatigue
  • Cough
  • Unusual itching
  • Fever and chills
  • Night sweats
  • Shortness of breath
  • Unexplained weight loss and loss of appetite

The signs and symptoms of lymphoma are similar to those of other illnesses such as viral diseases and the common cold. But they continue for longer than as expected normally. Some people does not experience any symptoms, but some may notice a swelling of the lymph nodes which are located all around the body, often in the neck, groin, abdomen, or armpits.The swellings are normally painless. But if the enlarged glands press on organs, bones, and other structures pain may occur which can be confused with back pain. Lymph nodes can swell during common infections, such as a cold causing pain due to an infection. But in lymphoma the swelling does not go away.
Anyone who has ongoing swelling of the glands requires a proper diagnosis as overlap of symptoms can lead to misdiagnosis.
If an enlarged lymph node presses against spinal nerves or the spinal cord, symptoms like pain, weakness, paralysis, or otherwise altered sensation can occur. Lymphoma can spread rapidly from the lymph nodes to other parts of the body through the lymphatic system. Overtime the body's ability to fight infection weakens as cancerous lymphocytes spread into other tissues.

Causes of Lymphoma:

The exact causes of lymphoma is unknown. But it begins when lymphocyte develops a genetic mutation. The mutation allows the cell to multiply rapidly causing uncontrolled growth of abnormal cells. This will develop many diseased lymphocytes that continue multiplying.The mutation also allows the cells to go on living instead of dying as they would in the life cycle of a normal cell. This causes too many diseased and ineffective lymphocytes in your lymph nodes which causes the lymph nodes to swell.
Lymphatic tissue is connected throughout the body. If cancer cells develop in the lymphatic system, they can spread easily from their original location to other tissues and organs, including those outside the system.
Lymphoma most often spreads to the liver, bone marrow, or lungs. In Hodgkin lymphoma, the cancer usually affects one lymph node after another in a sequence, where as tumors does not follow a sequence and may arise in disparate lymph nodes, skipping some nodes in non-Hodgkin lymphoma.

Risk factors:

Risk factors are different for two different types of lymphoma .
Non-Hodgkin lymphoma

Risk factors for non-Hodgkin lymphoma include:

Age:

Most lymphomas occur in people aged 60 years and older, but some types are more likely to affect children and young adults.

Gender:

Some types are more likely in women, others are more likely in men.

Ethnicity and location:

In the U.S., African-Americans and Asian-Americans are at lower risk of non-Hodgkin lymphoma than white Americans, and it is more common in developed nations.

Chemicals and radiation:

Nuclear radiation and some chemicals such as exposed to benzene or chemicals that kill bugs and weeds used in agriculture are the risk factor for non-Hodgkin lymphoma.

Immunodeficiency:

A person with a weak immune system such as with HIV or AIDS, medications taken after an organ transplant.is at greater risk.

Autoimmune disease:

This type of disease develops when the immune system attacks the body's own cells mistakenly. Examples include rheumatoid arthritis and celiac disease.

Infection:

Certain viral and bacterial infections that transform lymphocytes increase the risk, such as the Epstein-Barr virus (EBV), which causes glandular fever.

Breast implants:

These can cause anaplastic large cell lymphoma in the breast tissue.

Body weight and diet:

Obesity is considered as one of the risk factor in the development of lymphoma, although more research is needed to confirm the link.
Hodgkin lymphoma

Risk factors for Hodgkin lymphoma include:

Infectious mononucleosis:

Infection with EBV can cause mononucleosis, which increases the risk of lymphoma.

Age:

People between the ages of 20 and 30 years and people over the age of 55 years are at a higher risk

Gender:

It is slightly more common in men.

Location:

Hodgkin lymphoma is most common in the U.S., Canada, and northern Europe. It is least common in Asia.

Family history:

If a sibling or a close relative has the condition, the risk is slightly higher, and very high if the sibling is an identical twin.

Affluence:

People of higher socioeconomic status are at greater risk

HIV infection:

This can weaken the immune system and increase the risk of lymphoma.

Diagnosis of Lymphoma:

Tests and procedures used to diagnose lymphoma include:

Physical exam:

Your doctor will check for swollen lymph nodes, including in your neck, underarm and groin. He will also look for swollen spleen or liver. Most of the time, an infection causes swollen lymph nodes. Therefore having this symptoms doesn't necessarily indicate cancer.

Lymph node biopsy:

A lymph node biopsy can be done to check for cancer cells in which your doctor will remove all or part of a lymph node, or use a needle to take a small amount of tissue from the affected node. Advanced tests can determine the presence of lymphoma cells and the type of cells involved.

Bone marrow aspiration or biopsy:

A bone marrow aspiration and biopsy procedure involves inserting a needle into your hipbone to remove a sample of bone marrow. Bone marrow is the spongy part inside bone where blood cells are made. The sample is analyzed to look for lymphoma cells.

Molecular test:

This test is done to figure out which type of lymphoma you have. It looks for changes to genes, proteins, and other substances in cancer cells to help your doctor determine.

Blood tests:

These are done to check the number of certain cells, levels of other substances, or evidence of infection in your blood.

Imaging tests:

Imaging tests may be recommended by your doctor to look for signs of lymphoma in other areas of your body. Tests may include Chest X-ray, MRI and positron emission tomography (PET).
Radiation in low doses to make images of the inside of your chest is used in Chest X-ray. A MRI scan uses powerful magnets and radio waves to make pictures of organs and structures inside your body where as a radioactive substance is used in PET scan to look for cancer cells in your body.

Treatment of Lymphoma:

Several treatment options are available for treating lymphoma which will depend on the severity and type of lymphoma. Stage of your disease, your overall health, and your preferences will be taken in to consideration while choosing an option. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission.
Slow growing lymphoma may need only watchful waiting before starting the treatment. In this case treatment can be started only after it causes signs and symptoms that interfere with your daily activities. If treatment is necessary, it can involve:

Biologic therapy:

This is a drug treatment that stimulates the immune system to attack the cancer cells by inserting living microorganisms into the body.

Antibody therapy:

Synthetic antibodies are inserted into the bloodstream to combat the cancer's antigens.

Chemotherapy:

Aggressive drug treatment is used to kills cancer cells.

Radioimmunotherapy:

This delivers high powered radioactive doses directly into the cancerous B-cells and T-cells to destroy them.

Radiation therapy:

This is used to focus on small areas of cancer.

Stem-cell transplantation:

This can restore damaged bone marrow following high dose chemotherapy or radiation therapy. As this procedure destroys stem cells in your bone marrow that make new blood cells, after chemotherapy, you will get a transplant of stem cells to replace the ones that were destroyed.
Stem cell transplants can be of two type which include an autologous transplant uses your own stem cells and an allogeneic transplant uses stem cells taken from a donor.

Steroids:

These may be injected to treat lymphoma.

Surgery:

This can be used to remove the spleen or other organs after the lymphoma has spread. Surgery is used more often for obtaining a biopsy.
As Lymphoma treatment can cause side effects, talk to your medical team to help relieve any symptoms you have. Changing your diet and doing regular exercise can help you feel better during your treatment. If you are not sure what types of food to eat consult a dietitian for help. Exercises like walking or swimming can relieve fatigue and help you feel better during treatments like chemotherapy and radiation.
Alternative therapies like relaxation, biofeedback, or guided imagery can also be tried to help relieve pain. Art therapy, meditation, music therapy, relaxation exercises, acupuncture or massage may help you cope with the stress of a cancer diagnosis and the side effects of cancer treatment.

Outlook:

Your outlook depends on:

  • The kind of lymphoma you have
  • How far the cancer has spread
  • Your age
  • The type of treatment you get
  • What other health problems you have

If you experience any unusual signs and symptoms, it is important to seek medical attention as this can lead to an early diagnosis and a good chance of successful treatment.