Definition and Overview: What is Lymphoma?

Lymphoma is a form of cancer that attacks the lymphocytes, a type of white blood cell that forms part of a person’s immune system. Abnormality in the lymphocytes causes them to grow uncontrollably, causing tumours to develop. This also inhibits them from doing their job, which is to protect the body from disease and infection.

Since lymph nodes are located in various parts of the body, lymphoma can start anywhere. Once tumours begin to develop, they can spread throughout the body and affect the organs leading to the development of other forms of cancer, such as leukemia.

The two main types of this condition are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Although they both arise from lymphoid tissues, they have a notable difference in their pathology. If a specific type of abnormal cell called Reed-Sternberg cell is detected, the lymphoma is classified as Hodgkin’s. If the said cell is not present, the lymphoma is classified as non-Hodgkin’s. Examples of this type of lymphoma include B-cell lymphoma and follicular lymphoma.

Cases of non-Hodgkin’s lymphoma are identified as either indolent/low-grade lymphomas or aggressive/high-grade lymphomas based on how fast they spread. The specific type of disease that affects a person determines the prognosis.

Causes

The main cause of lymphoma cancer is unknown. However, experts agree that it is triggered by the following factors:

  • Viral or bacterial infection

  • Weakened immune system

  • Exposure to environmental factors

  • Gene changes/mutations

Key Lymphoma Symptoms

The following symptoms are indicative of lymphoma:

  • Swollen lymph nodes, usually in the neck, groin, or underarm

  • Fatigue

  • Fever that is unrelated to other health problems

  • Weight loss

  • Night sweats

  • Back pain

  • Pain in the belly

  • Shortness of breath

  • Itchy skin

To diagnose a lymphoma, a doctor will examine the size of the lymph nodes. If swelling is suspected, a piece of tissue will be taken from the lymph node for a biopsy. If tested positive, other tests will be conducted to determine the specific type of lymphoma. Biopsy of the bone marrow is sometimes conducted to determine whether the cancerous cells have spread to the area.

Other tests used to diagnose the disease include:

  • Blood tests (CBC)

  • Chest X-ray

  • Lumbar puncture

  • MRI or CT scan of the neck, chest, and abdomen

  • PET scan

Who to See and Types of Treatment Available

Any general physician, family doctor, or a doctor of internal medicine can do the initial examination of the lymph nodes and order tests necessary to determine whether a person is suffering from lymphoma. If lymphoma is suspected, the patient is referred to an oncologist, a specialist who deals with tumours and cancers.

Lymphoma treatment typically begins with therapy. A treatment plan is often created depending on the stage of the disease, the patient’s age, and general state of health. Treatment options include:

  • Chemotherapy

  • Radiation therapy

  • A combination of radiation and chemotherapy

  • Targeted therapy (which uses monoclonal antibodies that attach to the cancerous cells and destroy them)

As with other types of cancer, the foremost treatment option is chemotherapy. Thus, doctors also have to assist patients in living with the effects of the therapy, particularly persistent nausea.

If lymphoma is diagnosed during the early stages, if it is growing slowly, or if the symptoms are very mild, health professionals may recommend going through a period of surveillance or watchful waiting. During this period, patients do not receive any form of therapy. Instead, they will have regular appointments with their doctor and undergo periodic medical examinations that will help the doctor watch the tumours closely.

The idea behind watchful waiting is that several cases of slow-growing lymphoma produce little to no symptoms at all and patients are able to live comfortably despite the disease. Exposing the body to chemo or radiation therapy is therefore not necessary. However, once the tumour changes or grows, and symptoms become more troublesome, the surveillance period ends immediately, and therapy has to begin.

In recurrent lymphoma, a stem cell transplant may also be considered.

With proper treatment, the survival rate of patients diagnosed with lymphoma is about 80% to 85%. If caught in the early stages, it increases to about 90%.

When Should You See an Oncologist?

Doctors who specialise in cancer care are called oncologists. If you experience any of the symptoms of lymphoma for a prolonged period of time, i.e., more than two weeks, you should call your doctor for an examination. Once confirmed that the tumours are cancerous, you will be referred to an oncologist.

A medical oncologist specialises in the treatment of cancer and has special expertise in coming up with the most suitable treatment plan for you. Oncologists may also have further specialisations such as radiation oncologists, who treat patients in need of radiation therapy and paediatric oncologists, who treat young patients with cancer.

References:

  • American Society of Clinical Oncology: “Treatment of Hodgkin Lymphoma: A 50-Year Perspective”

  • Oxford Journals, Annals of Oncology: “Hodgkin’s Lymphoma: ESMO Clinical Recommendations for Diagnosis, Treatment, and Follow-up”

  • National Cancer Institute: “Childhood Non-Hodgkin Lymphoma Treatment”

  • American Joint Committee on Cancer: “Hodgkin and non-Hodgkin Lymphomas Section in Lymphoid Neoplasms”

  • National Cancer Institute: “Adult Non-Hodgkin Lymphoma Treatment”

  • National Comprehensive Cancer Network: “Non-Hodgkin’s Lymphomas: Clinical Practice Guidelines in Oncology Version 4”

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