What Is It?
Lymphoma is a cancer of the lymphocytes, cells in the lymphatic system that help the body to fight infections. The lymphatic system is a network of vessels throughout the body that collect invading organisms, such as viruses, and abnormal cells. The invaders are moved into lymph nodes where they are destroyed by white blood cells, including cells called lymphocytes. Lymphoma usually begins in a lymph node, but it also can begin in the stomach, intestines, skin or any other organ. The two main types of lymphoma are Hodgkin disease and non-Hodgkin lymphoma.
Hodgkin disease is characterized by a specific type of abnormal cell called the Reed-Sternberg cell. This type of cancer can spread throughout the lymphatic system, affecting any organ or lymph tissue in the body. Hodgkin disease most commonly affects people in their late 20s or older than 50. Males are affected more than females, and whites are affected more often than people of other races. The disorder strikes about five in every 100,000 people.
Most lymphoma is non-Hodgkin lymphoma. In adults, non-Hodgkin lymphoma affects males more than females and frequently occurs between the ages of 60 and 70. Whites are affected more often than people of other races. The disorder affects about 16 in every 100,000 people — or about 45,000 Americans. The incidence rate of this cancer is growing for unknown reasons.
Different types of lymphoma occur in different age groups.
- In adulthood — Adult non-Hodgkin lymphoma is classified by the size, type and distribution of cancer cells in the lymph nodes. The three types are low grade (slower growing), intermediate grade, and high grade (aggressive).
- Low-grade lymphomas include small-lymphocytic lymphoma, follicular small-cleaved-cell lymphoma, and follicular mixed-cell lymphoma.
- Intermediate-grade lymphomas include follicular large-cell lymphoma, diffuse small-cleaved-cell lymphoma, diffuse mixed lymphoma, and diffuse large-cell lymphoma.
- High-grade lymphomas include immunoblastic lymphoma, lymphoblastic lymphoma, and small noncleaved (Burkitt and non-Burkitt) lymphoma.
- In childhood — Childhood non-Hodgkin lymphomas include lymphoblastic lymphoma, large-cell lymphoma, and small-noncleaved-cell lymphoma (including Burkitt and non-Burkitt lymphomas). Note that high-grade (aggressive) non-Hodgkin lymphomas usually affect children and young adults.
Several factors may contribute to the development of lymphoma:
- Environmental factors — Recent studies show a possible link between lymphoma and exposure to certain chemicals, herbicides and insecticides. Further study is needed.
- Genetic factors — Studies indicate that patients with certain genetic (inherited) immunodeficiency disorders, such as Wiskott-Aldrich syndrome, may have an increased risk of developing lymphoma.
- Viral infections — Research suggests links between lymphoma and certain viruses, such as the Epstein-Barr virus and HIV. For example, one study found that Burkitt disease was related to Epstein-Barr virus in nearly all cases in Africa and in 15 percent of U.S. cases. Patients infected with HIV, especially those with AIDS, also are more susceptible to both Hodgkin and non-Hodgkin lymphoma.
The main symptom of both Hodgkin and non-Hodgkin lymphomas is swelling of lymph nodes in the neck, under the arms, or in the groin. Other symptoms can include:
- Night sweats
- Abdominal pain
- Unexplained weight loss
- Itchy skin
Because swollen lymph nodes caused by lymphoma usually are painless, lymph nodes may enlarge slowly over a long period before the patient notices. Also, the fever commonly associated with lymphoma may appear and disappear for several weeks before the patient sees a doctor. Even the unexplained weight loss caused by certain lymphomas may progress for months before the patient seeks medical help.
If your doctor suspects lymphoma based on your medical history and the results of a physical examination, he or she will order blood tests and perform a test called a lymph node biopsy.
In lymph node biopsy, your doctor will inject a local anesthetic beneath your skin to numb the area where a swollen lymph node is located. After the area is numb, a sterile needle is used to remove a small piece of tissue. The tissue is then examined in a laboratory for evidence of lymphoma. Occasionally, a whole lymph node is removed surgically instead of a small piece of tissue because this can help the pathologist be more certain of the diagnosis.
You may also need other tests, including X-rays to evaluate the chest, bones, liver and spleen; a bone marrow biopsy; a gallium scan; and a computed tomography (CT) scan of your abdomen.
If you are diagnosed with lymphoma, the next step is to determine the cancer’s stage. To do this, your doctor will take into account whether you have any of the so-called “B symptoms,” including fever, weight loss, and night sweats. The stages range from Stage I, in which the cancer is limited to one area, such as only one lymph node, to Stage IV, in which the cancer has spread extensively outside the lymph system and possibly to the bone marrow or other organs.
Occasionally, laparoscopic surgery is performed to help to determine the stage. In this procedure, a small incision is made in the abdomen, and a thin, lighted tube called a laparoscope is used to see if cancer has spread to any of the internal organs. During the procedure, small pieces of tissue also may be removed and examined under a microscope for signs of cancer.
Like other cancers, lymphoma will continue to progress unless it is treated.
There is no definitive way to prevent Hodgkin or non-Hodgkin lymphomas. You may be able to lower your risk of lymphoma by taking precautions to avoid becoming infected with HIV. It is not known whether avoiding certain chemicals will prevent lymphoma.
radiation is the traditional treatment for early stages of Hodgkin disease. Chemotherapy, possibly with radiation, is used in later stages of the illness. Whether chemotherapy may be used instead of radiation for early-stage disease is being investigated. Treatment for non-Hodgkin lymphoma depends on the grade of lymphoma (low, intermediate or high), the stage of the disease, and the age and health of the patient.
- In very early stages, low-grade (slow-growing) lymphomas sometimes can be cured with a combination of radiation and chemotherapy. Otherwise, treatment is based on when symptoms develop and their severity. Early, aggressive therapy is not thought to improve survival for most low-grade lymphomas. In some cases of early-stage, low-grade lymphoma, the disease will be monitored, but no treatment will be given unless the disease gets worse. If a patient with early-stage, low-grade (slow-growing) lymphoma has symptoms, or if the disease has spread significantly, it can be treated with radiation therapy.
- Advanced-stage, low-grade lymphoma may be treated in a variety of ways, ranging from chemotherapy with or without radiation therapy to a bone marrow transplant. In a bone marrow transplant, the patient’s bone marrow cells are killed and then cancer-free bone marrow cells are injected.
- For higher-grade lymphomas, cure is possible in 40 percent to 50 percent of cases. The main treatment is chemotherapy. Radiation also is used sometimes. Intermediate-grade lymphoma may be treated with a combination of chemotherapy drugs. More advanced stages may require higher-dose chemotherapy and possibly a bone marrow transplant or stem cell transplant. In a bone marrow transplant, the patient’s bone marrow cells are killed, and then cancer-free bone marrow cells are injected. Stem cells are immature cells that grow into blood cells. In a stem cell transplant, the patient’s stem cells are removed and treated to kill the cancer before being injected back into the patient. Burkitt lymphoma, a high-grade lymphoma, can be cured in 80 percent of cases with a combination of chemotherapy drugs.
If cancer returns in a person who has been treated for intermediate and high-grade lymphomas, he or she may be a candidate for a bone marrow or stem cell transplant.
In recent clinical trials, radioimmunotherapy has been used to treat advanced, higher-grade or lymphomas that keep returning after treatment. This therapy involves injecting antibodies with added radioactive iodine. The antibodies are proteins that are part of the immune system and attack cancer cells. The added radiation helps to kill the cells. Researchers are studying other biological therapies that use the immune system to fight cancer.
When To Call A Professional
See your doctor if you experience any symptoms of lymphoma for more than two weeks.
This is considered to be the most curable of all the blood cancers. With proper treatment, about 80 percent of patients survive five years or longer. Patients diagnosed with Stage I disease have more than a 90 percent chance of living 10 years or more. Those diagnosed in Stage IV have a 50 percent chance of living 10 years or more.
For patients with non-Hodgkin lymphoma, the chance of survival depends on the grade and stage of cancer, overall health, and response to treatment. Between 50 percent and 80 percent of patients survive five years or more. The higher-grade aggressive types of lymphoma are more likely to be cured with chemotherapy, but this form of cancer can be fatal. Lower-grade lymphoma often can have longer average survival times, however, with mean survival reaching 10 years in some cases.
Most children respond well to treatment, even though children tend to have the higher-grade, aggressive types of non-Hodgkin lymphoma. As many as 70 percent to 90 percent of children survive five years or more.
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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.