Lymphoma is a type of blood cancer that develops in the lymphatic system. The lymphatic system is part of the body’s immune system and helps fight infections. There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. Lymphoma can develop when lymphocytes, a type of white blood cell, begin to multiply uncontrollably. This article provides an overview of the signs and symptoms of lymphoma, how it is diagnosed, and the available treatment options.
What are the signs and symptoms of lymphoma?
Some common signs and symptoms of lymphoma include:
- Swollen, painless lymph nodes in the neck, armpits or groin
- Fatigue
- Fever
- Night sweats
- Unexplained weight loss
- Itching
- Coughing or trouble breathing
- Pain, swelling or fullness in the abdomen
However, the signs and symptoms of lymphoma can vary significantly depending on the type and where it develops in the body. Many of the symptoms are vague and could potentially indicate other medical conditions.
Swollen lymph nodes
One of the most common signs of lymphoma is swollen lymph nodes, usually in the neck, armpit or groin area. Lymph nodes are small, bean-shaped glands that contain immune cells. Healthy lymph nodes are typically not visible or palpable. When lymphoma develops, it causes lymph nodes to abnormally enlarge as malignant cells multiply. The swollen nodes are usually not painful.
B symptoms
Some people with lymphoma develop what are called “B symptoms.” These include:
- Fever
- Drenching night sweats
- Unexplained weight loss
When someone has one or more of these symptoms without any apparent cause, it raises suspicion for lymphoma. However, other conditions like infections can also cause these symptoms.
Abdominal symptoms
Lymphoma that develops in the abdomen or spleen can cause swelling, pain or a feeling of fullness. Enlarged lymph nodes or the liver and spleen pressing on the stomach can lead to loss of appetite and feeling full quickly when eating. Diarrhea or constipation can also occur.
Coughing, trouble breathing
When lymphoma affects lymph nodes in the chest, it can press on the trachea and cause coughing or difficulty breathing. The accumulation of fluid around the lungs (pleural effusion) may also lead to respiratory symptoms.
Itching
Some people with lymphoma develop severe, unexplained itching (pruritus). This is thought to result from the release of cytokines, signaling proteins secreted by immune cells. Itching is most common in lymphomas that develop in the skin.
So in summary, any unexplained lymph node swelling, fevers, night sweats, weight loss, or itching should prompt suspicion for possible lymphoma. Contact your doctor if you experience these symptoms.
How is lymphoma diagnosed?
If lymphoma is suspected based on someone’s symptoms, the doctor will run tests to help confirm the diagnosis and identify the specific type. Common diagnostic tests include:
Physical exam
The doctor will carefully palpate all lymph node regions to check for any enlarged nodes. They will also examine the abdomen, feeling for an enlarged spleen or liver.
Blood tests
A complete blood count can detect abnormalities in blood cell levels that may indicate lymphoma. Tests may also assess kidney and liver function, check inflammatory markers, and look for the presence of certain proteins associated with lymphoma.
Biopsy
A lymph node biopsy is the main test used to diagnose lymphoma. The doctor numbs the area, makes a small incision, and removes an entire lymph node or a piece of a mass. A pathologist examines the lymph node tissue under a microscope to look for lymphoma cells. flow cytometry and genetic tests are often done on the tissue sample to help classify the specific type of lymphoma.
Bone marrow biopsy
A bone marrow biopsy can help determine if the lymphoma has spread to the bone marrow. Local anesthesia is given to numb the area. Then the doctor inserts a needle into the hip bone to withdraw a sample of bone marrow tissue for examination.
Imaging tests
Imaging studies like CT scans or PET scans are done to look for enlarged lymph nodes and organs throughout the body. This helps determine the extent and stage of the lymphoma. Imaging can also be used to monitor response to treatment.
Lumbar puncture
In some cases, a lumbar puncture (spinal tap) may be performed to look for lymphoma cells in the cerebrospinal fluid and see if the brain and spinal cord are affected.
So in summary, a tissue biopsy of an enlarged lymph node is essential to confirm lymphoma. Other blood tests, imaging studies, and procedures help determine the type, location, and extent of the disease.
What are the types of lymphoma?
The two main categories of lymphoma are:
Hodgkin lymphoma
About 10% of lymphomas are Hodgkin lymphoma, named after Dr. Thomas Hodgkin who first described it. It develops from a specific abnormal B lymphocyte. There are several subtypes of Hodgkin lymphoma that are classified based on the microscopic appearance of the cells:
- Classic Hodgkin lymphoma – Most common subtype accounting for over 90% of cases.
- Nodular lymphocyte-predominant Hodgkin lymphoma – Only about 5% of cases.
- Lymphocyte-rich classic Hodgkin lymphoma
- Mixed cellularity classic Hodgkin lymphoma
- Lymphocyte-depleted classic Hodgkin lymphoma
The subtype helps determine the ideal treatment approach.
Non-Hodgkin lymphoma
The majority of lymphomas (90%) are non-Hodgkin lymphomas. These can arise from either B lymphocytes or T lymphocytes. B-cell lymphomas are more common. There are over 60 subtypes of non-Hodgkin lymphoma, including:
- Diffuse large B-cell lymphoma – Most common type
- Follicular lymphoma
- Small lymphocytic lymphoma/chronic lymphocytic leukemia
- Mantle cell lymphoma
- Marginal zone lymphoma
- Burkitt lymphoma
- Peripheral T-cell lymphomas
Identifying the specific non-Hodgkin lymphoma subtype is important to select the best treatment. The cell origin and microscopic appearance help determine the category.
What are the stages of lymphoma?
Once lymphoma is diagnosed, doctors determine the stage of the cancer based on the results of exams, imaging tests, and biopsies. Lymphoma stages indicate how far the cancer has spread throughout the body. The stages are:
Stage I
Cancer is found in one lymph node region or lymphoid organ such as the thymus.
Stage II
Cancer is in two or more lymph node regions on the same side of the diaphragm (the muscle under the lungs).
Stage III
Lymphoma is in lymph node areas on both sides of the diaphragm. It may also have spread to nearby organs.
Stage IV
Cancer has spread more extensively to involve distant organs such as the liver, bone marrow or lungs.
For Hodgkin lymphoma, there are subclassifications of the stages – A or B – based on the presence of certain symptoms.
Knowing the stage of lymphoma helps doctors determine prognosis and the best treatment approach. Early stage cancers that have not spread widely tend to have a better outlook.
How is lymphoma treated?
Lymphoma treatment usually involves chemotherapy and radiation therapy in various combinations. The regimen selected depends on the type and stage of lymphoma along with the patient’s age and overall health.
Chemotherapy
Chemotherapy uses drugs that circulate in the blood to kill cancer cells. For lymphoma, chemo may be given alone or combined with other treatments. Often, multiple chemo medications are used in cycles over several months. Common chemo drugs for lymphoma include:
- Doxorubicin
- Cyclophosphamide
- Vincristine
- Prednisone
The side effects of chemotherapy can include fatigue, increased risk of infection, nausea, hair loss, and mouth sores. But medications are available to help manage these side effects.
Radiation
Radiation uses high-energy beams to kill cancer cells and shrink tumors. It may be used after chemotherapy or alone for early-stage lymphomas. Radiation treatment is carefully targeted to spare as much healthy tissue as possible. But side effects can include fatigue and skin reactions.
Targeted drugs
For some types of lymphoma, targeted drugs are used that specifically act on molecular abnormalities within lymphoma cells. These innovative treatments often have less severe side effects than traditional chemotherapy. Examples include rituximab and brentuximab vedotin.
Stem cell transplant
For lymphoma that recurs after initial treatment, a stem cell transplant may be an option. High-dose chemotherapy is first given to destroy remaining lymphoma cells. Then the patient receives a transplant of blood-forming stem cells to regrow their blood cells and immune system.
Surgery
Surgery is occasionally used to remove a lymphoma tumor pressing on organs or blocking the bowel. But in general, lymphoma is rarely treated with surgery alone.
So in summary, chemotherapy and radiation remain the cornerstones of lymphoma treatment. But newer targeted drugs and stem cell transplants provide additional options for certain patients. The outlook for lymphoma continues to improve with advances in therapy.
What is the prognosis and survival rates for lymphoma?
The prognosis and outlook for lymphoma depends heavily on the specific subtype, location, stage, and other factors. But in general, lymphoma is very treatable, especially when detected early.
According to American Cancer Society statistics:
- The overall 5-year relative survival rate for Hodgkin lymphoma is 86%.
- For the most common type of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, the 5-year survival rate is 71%.
Survival rates can approach 90 to 95% for lymphomas caught early at stage I or II. More advanced stage IV disease has lower survival rates of around 50 to 60%.
Young adult patients without other serious health conditions who respond well to initial therapy tend to have better long-term outlooks.
So while lymphoma can be frightening, most types today are very treatable. The prognosis keeps improving with ongoing advances in cancer therapies and supportive care.
Conclusion
Lymphoma refers to a group of blood cancers that arise from lymphocytes. The most common symptoms are swollen lymph nodes, fever, fatigue, and weight loss. Doctors diagnose lymphoma with a lymph node biopsy, bone marrow biopsy, imaging tests, and other procedures to categorize the specific type. Treatment typically involves chemotherapy combined with radiation or other therapies.
Many factors influence the prognosis for an individual patient, but overall survival rates for lymphoma continue to improve. Catching lymphoma early before it spreads leads to better outcomes. Being aware of the signs and symptoms of lymphoma allows for prompt diagnosis so that treatment can begin quickly, giving patients the greatest chance for remission and long-term survival.