What is Lymphoma?

Lymphoma is a type of cancer that affects cells in the human body that are called lymphocytes. These cells are a type of white blood cell, which means that when they cannot function as they are intended within the body, the immune system tends to suffer. These cells can be found in your lymph nodes, bone marrow, spleen, and other parts of the body. This cancer can occur in a person of any age, but if it is treated properly and quickly, patients who get lymphoma have a high survival rate. There are two types of lymphoma that patients can be diagnosed with; Hodgkin and non-Hodgkin. Non-Hodgkin lymphoma is much more common, with about 90 percent of the cases of lymphoma in the United States being diagnosed with this type.

The other 10 percent have Hodgkin; making it the rarer type of lymphoma. An individual who is diagnosed with Hodgkin’s lymphoma will have a rare type of cancer cells in their body that are called Reed-Sternberg cells. When these cells are seen, the cells are further looked at under the microscope to find the subtle differences that determine the actual subtype of Hodgkin’s that the patient has.

In most situations, Classic Hodgkin’s is the found diagnosis. This illness only affects the B cells, which is why it tends to be more of a rare diagnosis. If every 100,000 individuals in the United States were tested for Hodgkin’s lymphoma, only three individuals would have a result that diagnosed them with this cancer. Someone who is diagnosed with non-Hodgkin’s lymphoma will fall into the category of every other type of lymphoma. This means that there are a larger amount of subcategories that fall under the diagnosis of non-Hodgkin lymphoma, which makes it a more common diagnosis to receive.

Non-Hodgkin affects your B cells, just like Hodgkin lymphoma, but it can also affect your T cells as well. About 80 percent of all of the cases of non-Hodgkin begin in the B cells. Regardless of which cells are affected, both of them are white blood cells that are designed to keep you healthy, so if they are not functioning properly, then your immune system will be compromised.

If you take the same 100,000 individuals and tested their blood for non-Hodgkin’s lymphoma, about 20 people would find out that they have this type of cancer.

Since the lymphocyte cells travel around the body through the bloodstream, once an individual has affected cells in their body, it is easy for them to move to another location to grow within the lymphatic system or elsewhere in the body. Often, the liver, lungs, and bone marrow are the first areas where additional cancerous growth is found.

Each type of lymphoma will spread and grow differently, which is why it is important to catch it early so that your doctor can find a treatment that responds well.

History

The first notation of Hodgkin lymphoma was described in the year 1666, but it wasn’t until much later that it was seen as a medical problem. Hodgkin’s lymphoma was named after a man named Thomas Hodgkin.

He first described the symptoms and the irregularities of the disease in the year 1832 while he was working on seven patients who were experiencing larger than normal lymph nodes.

Hodgkin’s report of the patients affected was published in the “Medical Chirurgical Medical Transactions” in London, but not much more was discovered about the disease for the next two decades.

In the year 1856, a man by the name of Samuel Wilks discovered the same set of symptoms and irregularities in the lymphatic system in another group of patients. He published a paper about the disease and within the text of the paper, he gave the disease a name; “Hodgkin’s Disease.”

A few decades later, Hodgkin lymphoma was researched even more closely.

In fact, in the years 1898 and 1902, the cytogenic characteristics of the disease were discovered at a microscopic level, and the cancerous cells that were found in the body took on the name of the individuals who discovered them; Dorothy Reed and Carl Sternberg.

The first treatment for Hodgkin lymphoma dates back to 1894; it was a medicine that contained arsenic, but it seemed to destroy the cancer cells. In 1932, radiation therapy made its introduction, but it was not until nearly a decade later that it began to look like a promising form of treatment. Every few decades, new treatments were introduced.

These treatments included MOMP in the 1960s, which combined four chemotherapy agents: cyclophosphamide, methotrexate, vincristine, and prednisone.

In 1987, EVBP (epirubicin, bleomycin, vinblastine, and prednisone) was introduced as another regiment for treatment. The form of treatment that is currently used is one that was developed in 1992.

It utilizes seven different chemotherapy agents and has been a highly effective treatment for the disease. The classification of Hodgkin lymphoma was quickly decided upon, but there were a number of other types of lymphoma that had similar characteristics.

The first classification, known as the Rappaport classification, became widely accepted. In 1975, the Lukes-Collins classification came into play when the immune system functionality was attached to cell morphology.

It was not until the year 1982 that the current system of classifying non-Hodgkin lymphoma became a way of categorizing cancer into the low, intermediate, and high grade.

In 1994, the classification began taking immunology and genetics into consideration when looking at the clinical characteristics of the cancer cells. It became widely known as the REAL classification or the Revised European-American Classification of Lymphoid Neoplasms. Though this method had its drawbacks, it soon became adopted by the World Health Organization as the best means for classification.

Since the method was adopted, it has had a number of improvements that have helped biologists to recognize new subgroups of the disease and help move research closer to a cure.

Risk Factors

Cancer is a disease that is relatively new to the medical world. It is known that it exists, but the exact cause is not always easy to pinpoint.

Throughout the years, there have been a few factors that seemed to put a patient more at risk for the disease, but experts are still unsure of the exact risk factors that make lymphoma more likely to occur in one individual over another.

Risk factors for Hodgkin Lymphoma:

  • Mononucleosis and HIV – Individuals who have experienced a mononucleosis (mono) infection in their lives have a higher risk of getting Hodgkin lymphoma. Evidence of the virus was found in about one-third of the individuals who were diagnosed with this type of cancer, but not all of the patients have had contact with mononucleosis, so though there is a higher risk factor, the connection is not clear. Anyone that is infected with HIV also has an increased risk of Hodgkin disease.
  • Age – Teenagers and young adults who are between the ages of 15 to 40 are at a higher risk for this disease, but they’re also tends to be a trend in adults over the age of 55 as well. Even though these age groups seem to be at a higher risk, individuals of all ages can be vulnerable.
  • Gender – Males tend to be slightly more susceptible to Hodgkin lymphoma. Females can also get this type of cancer, but it is a less common occurrence.
  • Geographical Location – According to statistics, individuals in North America and Northern Europe tend to have a higher risk, while Asian countries have a much lower one.
  • Family History – Anyone who has a sibling with this type of cancer is at a higher risk. If that sibling is an identical twin, the chances of getting Hodgkin lymphoma increases drastically. If cancer becomes evident later in life, a family history of the disease is not common.
  • Social Status – The risk seems to be more prevalent in more affluent families. The reason for this is unclear, but it may have to do with the infections that the children may be exposed to growing up.

Risk factors for Non-Hodgkin Lymphoma:

  • Age – Being over the age of 60 puts you at a higher risk of non-Hodgkin lymphoma.
  • Gender – For most of the types of non-Hodgkin lymphoma, men are at a higher risk, but there are a few that mainly attack women, putting them at an increased risk.
  • Race – Whites are at a higher risk than both Blacks and Asians for being diagnosed with this type of cancer.
  • Geographic Location – Those living in the United States and Europe have a higher risk than those in less other countries of the world.
  • Chemotherapy and Radiation – exposure to certain chemicals in the treatment increase the risk of non-Hodgkin lymphoma. Radiation can also increase the risk of this type of cancer as well as a few others. A patient who has had both types of treatments may have an even higher risk factor.
  • Immune System Deficiency – Those with weakened immune systems are often at a higher risk as well. This includes those who have HIV, someone who recently had surgery or a transplant of some kind, or an individual with an autoimmune disease. In fact, an autoimmune disease can encourage the growth and division of the infected lymphocytes.
  • Infections – Any infection that weakens the immune system makes an individual more vulnerable, but contracting mononucleosis, human herpesvirus eight, and Hepatitis C can increase the risk even more.

Screening

Going for an annual checkup at a doctor’s office is not going to result in screening for lymphoma. There is actually not a screening process in place, so bring any concerns to a doctor’s attention. Most likely a patient will be treated for a simple infection, but if the symptoms keep coming back, a deeper look should be taken.

The first step in the screening process for lymphoma is to find out the history of the patient. This can help the doctor decide if they have a high-risk factor for lymphoma by looking at the family history as well as other conditions that may be of import. This history will help the doctor narrow down and rule out illnesses that have similar symptoms.

Next, the doctor will most likely perform a physical examination on the patient who has voiced their concerns. They will feel the lymph nodes to see if they are swollen, but other areas of the body may be examined as well to make sure that there is no obvious swelling in the liver, the spleen, or the abdomen. To make sure that there is no infection or swelling in the lymph nodes, a thorough examination will be done around the chin, the neck, the underarms, the shoulders, the elbows, and the groin.

If excessive swelling is located in these areas, then the doctor will attempt to classify and grade the lymphoma. This is only done once infection and other illnesses have been ruled out. To help confirm the presence of lymphoma, the doctor will do a biopsy to confirm the diagnosis.

There are three types of biopsies that the doctor may decide to take:

  • Excisional – This is when a surgeon cuts through the skin of the patient to remove the entire lymph node.
  • Incisional – This is a smaller procedure where only part of the lymph node is removed.
  • Fine Needle – This is a less common method of taking a biopsy, but it is also a less invasive way to get a sample for analysis.

If a biopsy is required, an anesthetic will be used during the procedure. It could be a local anesthetic to simply numb the area or a general anesthetic to sedate the patient during the procedure. Some doctors prefer to run other tests as well to help them confirm their diagnosis.

These tests could include x-rays or ultrasounds to help the doctor see the swollen lymph nodes or they could decide to run blood tests to get an accurate count of the patient’s white blood cells to see if their immune system has been compromised.

Symptoms

The signs and symptoms of lymphoma, regardless of whether it is Hodgkin or non-Hodgkin, are hard to discern.They are very similar to the symptoms that an individual would experience with a common cold, so it can take a bit of time for the doctor to narrow down the possibilities and pinpoint a diagnosis.

One of the ways that a doctor will be able to figure out that the illness is not a typical viral infection is that the symptoms will last for a fair bit longer than that of a cold. In addition to these symptoms, there may also be a noticeable swelling of your glands or lymph nodes. This can be felt on the sides of the neck and under the armpits the most, but it can also affect other areas. This does not occur in every patient, but if an individual feels these glands are swollen, a doctor should be seen right away. Individuals who are diagnosed with lymphoma may experience other symptoms as well.

These can include:

  • Swelling in the legs, ankles, or other extremities.
  • Painful or unusual sensations; generally itchy.
  • Fatigue or a general lack of energy throughout the entire day.
  • Tonsils that are larger than normal.
  • An extreme loss of appetite.
  • Night sweats, a fever, or chills.
  • Cramping of the abdomen or an unusual bloated feeling.
  • Unexplained recent weight loss.
  • A persistent cough that will not go away.
  • Being breathless without exerting energy.
  • Consistent and severe headaches that do not seem to go away.

A patient will not experience painful symptoms during the early stages of the disease. They will be mild and easy to miss.

If painful sensations are occurring in a patient, it is possible that they have an enlarged lymph node in their body that is pressing up against their spinal cord. If that enlarged gland goes untreated, it could lead to excessive weakness and even paralysis. Drinking alcohol could also exacerbate the pain, so if a night out on the town makes you feel extremely ill, seeking medical attention may be something that could catch cancer before it is able to spread to other areas of the body.

Lymphoma is a type of cancer that can spread easily within the body. It develops in the lymphocytes, which means that cancer will be able to travel throughout the entire lymphatic system. It will have access to the entire body of the patient, including areas outside of the lymphatic system.

Any time that an individual feels off balance or they have had an infection or a common cold for an extended period of time, it is a good idea to see a doctor make sure that the illness is a cold, not something more severe like lymphoma.

Diagnosis and Stages

Once a biopsy is done to confirm the existence of lymphoma, there will be other testing done to help determine which classification of lymphoma it is and the stage that the cancer is in.

Finding this information out will help the pathologist determine the best method of treatment and whether the cancer is confined to the lymphatic system or it has spread to other areas of the body.

The staging tests that are performed on each patient are up to the doctor.

In many cases, more than one of the following tests will be conducted so that the doctor can get the best picture of cancer that needs to be dealt with and how aggressive it is in the body of the patient.

Here are some of the tests that a doctor may decide to include in the list of included staging tests:

  • Another Biopsy – With this one, a sample cell will be removed from the blood to be examined more closely. This will help the doctor determine whether the lymphoma originated in the T cells or the B cells.
  • A Bone Marrow Biopsy – This is a way that the doctor can examine individual cells within the body to see if they have been affected.
  • Blood Tests – These will be done to check the count of the white blood cells in the patient, the protein level in the body, the uric acid level in the body, and the lactate dehydrogenase level in the body. The blood tests can also make sure that the liver is functioning as it should as well as the kidneys.
  • A CT Scan – This is a way for the doctor to see an image of the patient’s chest, abdomen, and pelvic area. These tests allow the doctor to easily scan for tumors that could otherwise be difficult to detect.
  • An Ultrasound – This is another test that a doctor may use to locate tumors within the body.
  • An MRI – Gives a doctor more detailed images of the inside of the patient’s body so that they can see details of the tissue.
  • A PET Scan – This is a scan that is designed to help the doctor locate traces of cancer within a body.
  • A Spinal Tap – This is a test in which a very long, thin needle is used to remove spinal fluid from the body. A doctor can examine the fluid to see if evidence of lymphoma is evident. Typically, a local anesthetic is used on the patient during this procedure.

There are four stages that this cancer can fall under. No matter which stage cancer falls under, the lymphoma will be categorized as either A or B as well. Being categorized as an A means that the patient has not experienced a high fever over 100 degrees, weight loss over 10 percent of their body weight from six months prior, or night sweats. Falling into the B category means that these symptoms have been experienced by the patient, which typically means that cancer may be more advanced.

Here are the four stages that lymphoma may be categorized into:

  • Stage I – This is when the cancer is localized to one lymph node. It has not spread to another area of the body.
  • Stage II – This stage means that the cancer is located in two or more areas of the body, but it is located on the same side of the diaphragm within the body.
  • Stage III – Cancer has spread to the other side of the diaphragm, but it remains within the lymphatic system in the body.
  • Stage IV – This is the most advanced stage of the disease, which means that it has spread to other parts of the body beyond the lymphatic system. This can mean that the cancer was found in organs or other tissue throughout the body.

Treatments and Drugs

Once a diagnosis of Lymphoma is confirmed, a doctor will decide which form of treatment will have the best results for defeating cancer in the patient’s body. Some of the treatments are extremely aggressive so that they can control the spread of cancer, while others are a bit milder. The treatment will be determined based on the health of the patient and the advancement of the lymphoma. Talk to the doctor to know exactly which treatment is recommended and the side effects that should be expected during the treatment.

Here are some of the more common treatments used today:

  • Chemotherapy

Chemotherapy is a good choice for nearly all of the stages of lymphoma. It is designed to stop the growth of cancerous cells, keep them from dividing in the body, and kill them off for good. The most common method of chemotherapy is given through an IV, but it can also be given to the patient in pill form. The doctor will decide the number of treatments and the length that they will continue. The chemo can be one drug or a combination of a few different ones that the doctor feels will be more effective. The most common chemotherapy drug that is used is ABVD, and it is given to a patient once every two weeks for a period of two to eight months.

BEACOPP is another common combination used to fight lymphoma; this treatment is often given to a patient every three weeks. If the lymphoma seems to be returning, another type of medication may be used. Chemotherapy can result in fatigue, nausea, vomiting, hair loss, and a loss of appetite. The symptoms that a patient experiences will vary based on the medication that is used during the treatment.

  • Radiation

This type of therapy used high doses of radiation to ultimately destroy the lymphoma cells. The doctor will decide the length of the treatment based on the severity of cancer. A patient who receives radiation may experience fatigue, nausea, bowel movements, and skin irritation.

  • Stem Cell or Bone Marrow Transplant

This is a treatment method that replaces the patient’s bone marrow with stem cells so that healthy bone marrow can grow in the body. This is not often the first option that a doctor will suggest for treatment, but when the cancer is not responding to chemotherapy or radiation, this may be a treatment option that may be suggested. The goal of this treatment is to use it in combination with chemotherapy so that cancer can be killed off and new cells can take their place.

  • Immunotherapy

This form of treatment is designed to give a boost to the body and allow it to naturally fight against cancer that is taking over the body of the patient. Sometimes called biologic, this method can help restore the weakened immune system in the body and allow the white blood cells to fight cancer without the use of chemotherapy or radiation.

The side effects experienced with this treatment are mild compared to the other options.

Coping and Support

The process of treating, and hopefully, curing lymphoma can take a toll. As a result, sometimes support is needed for the patient as he or she goes through the process. This supportive structure of care is called palliative or supportive care, and this type of care can even extend into the period when treatment fails. Palliative care is designed to provide a supportive structure for patients on a physical, emotional, and social level. The physical aspect of this care will directly focus on reducing the symptoms of lymphoma and attempt to improve the quality of life of lymphoma sufferers. This physical palliative care can include methods that help patients relax and physical therapies that are designed to ease painful symptoms. This branch of palliative care can also extend to more traditional treatments like chemotherapy or even radiation therapy; any method that can make physical symptoms more bearable.

The emotional aspect directly deals with the emotional fallout that can occur as a result of being sick and can even extend into hospice care if a patient is not responding to treatment efforts. This is a type of palliative care that is meant to make a patient’s life more comfortable physically and emotionally as he or she approaches the end. If a patient has passed on, emotional palliative can continue through services that can help a grieving family cope with this devastating loss.

Social palliative care can include group therapy that can help an entire family deal with the processes of lymphoma treatment. The social strains of suffering through this form of cancer can be difficult to cope with, which is why palliative social support is an important aspect of the recovery process. It’s imperative that this palliative treatment is started as early as possible; optimally at the beginning of the cancer treatment process.

This early start helps patients to have an overall easier time with the disruption that this form of cancer can cause. In fact, many patients often find themselves simultaneously receiving treatments for lymphoma and its side effects.

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