Lymphoma

There are two main types of lymphoma:

1. Chronic lymphocytic leukemia
2. Cutaneous B-cell lymphoma
3. Cutaneous T-cell lymphoma
4. Hodgkin’s lymphoma (Hodgkin’s disease)
5. Non-Hodgkin’s lymphoma
6. Waldenstrom macroglobulinemia

Symptoms

The symptoms of lymphoma are similar to those of some viral diseases, such as the common cold. However, they typically continue for a more extended period.

Some people will not experience any symptoms. Others may notice a swelling of the lymph nodes. There are lymph nodes all around the body. Swelling often occurs in the neck, groin, abdomen, or armpits.

The swellings are often painless. They may become painful if the enlarged glands press on organs, bones, and other structures. Some people confuse lymphoma with back pain.

Lymph nodes can also swell during common infections, such as a cold. In lymphoma, the swelling does not resolve. Pain is also more likely to accompany the swelling if it has occurred due to an infection.

The overlap of symptoms can lead to misdiagnosis. Anyone who has persistently swollen glands should see their doctor for a consultation.

Other symptoms of both types of lymphoma may include:

• ongoing fever without infection
• night sweats, fever, and chills
• weight loss and reduced appetite
• unusual itching
• persistent fatigue or a lack of energy
• pain in lymph nodes after drinking alcohol

Some additional symptoms of non-Hodgkin lymphoma include:

• persistent coughing
• shortness of breath
• pain or swelling in the abdomen

Pain, weakness, paralysis, or altered sensation may occur if an enlarged lymph node presses against spinal nerves or the spinal cord.

Lymphoma can spread rapidly from the lymph nodes to other parts of the body through the lymphatic system. As cancerous lymphocytes spread into other tissues, the immune system cannot defend against infections as effectively.

What are the causes of lymphoma?

Doctors aren’t sure what causes lymphoma. But it begins when a disease-fighting white blood cell called a lymphocyte develops a genetic mutation. The mutation tells the cell to multiply rapidly, causing many diseased lymphocytes that continue multiplying.

The mutation also allows the cells to go on living when other normal cells would die. This causes too many diseased and ineffective lymphocytes in your lymph nodes and causes the lymph nodes, spleen and liver to swell.

What are risk factors for lymphoma?

Most diagnosed lymphoma cases have no known cause. However, some people are considered higher risk.

Non-Hodgkin’s lymphoma risk factors

Risk factors for non-Hodgkin’s lymphoma (NHL) include:

• Immunodeficiency. This could be due to a weak immune system from human immunodeficiency virus (HIV) or AIDs, or taking an immune system-suppressing drug after an organ transplant.
• Autoimmune disease. People with certain autoimmune disease, such as rheumatoid arthritis and celiac disease, have an increased risk for lymphoma.
• Age. Lymphoma is most common in people over 60. However, some types are more common in children and infants.
• Sex. Women are more likely to develop some particular types of lymphoma, and men are more likely to develop other types.
• Ethnicity. White Americans in the United States are more likely to develop some types of lymphoma than African-Americans or Asian-Americans.
• Infection. People who have had infections such as the human T-cell leukemia/lymphotropic virus (HTLV-1), Heliobacter pylori, hepatitis C, or the Epstein-Barr virus (EBV) are associated with an increased risk.
• Chemical and radiation exposure. Those exposed to chemicals in pesticides, fertilizers, and herbicides are also at increased risk. Nuclear radiation can also increase risks for developing NHL.
• Body size. Obesity has been connected to lymphoma as a possible risk factor, but more research is needed to understand this possible risk factor.

Hodgkin’s lymphoma risk factors

Risk factors for Hodgkin’s lymphoma include:

• Age. More cases are diagnosed in people between the ages of 20 and 30, and in people over 55.
• Sex. Men are more likely than women to develop this type of lymphoma.
• Family history. If asibling is diagnosed with this type of cancer, your risk for also developing it is higher.
• Infectious mononucleosis. An EBV infection can cause mononucleosis. This infection can increase the risk for lymphoma.
• Affluence. Individuals that come from a background with a higher socioeconomic status have a greater risk for this type of cancer.
• Immunodeficiency. Individuals with HIV have a greater risk for developing lymphoma.

How is lymphoma diagnosed?

A biopsy typically is taken if a doctor suspects lymphoma. This involves removing cells from an enlarged lymph node. A doctor known as a hematopathologist will examine the cells to determine if lymphoma cells are present and what cell type they are.

If the hematopathologist detects lymphoma cells, further testing can identify how far the cancer has spread. These tests can include a chest X-ray, blood testing, or testing nearby lymph nodes or tissues.

Imaging scans, such as a computed tomography (CT) or magnetic resonance imaging (MRI) scans may also identify additional tumors or enlarged lymph nodes.

Risk factors

Factors that can increase the risk of lymphoma include:

• Your age. Some types of lymphoma are more common in young adults, while others are most often diagnosed in people over 55.
• Being male. Males are slightly more likely to develop lymphoma than are females.
• Having an impaired immune system. Lymphoma is more common in people with immune system diseases or in people who take drugs that suppress their immune system.
• Developing certain infections. Some infections are associated with an increased risk of lymphoma, including the Epstein-Barr virus and Helicobacter pylori infection.

What to Expect

Treatments have improved a lot, and many people do very well after treatment. Your doctor will talk to you about a survivorship care plan.  Your outlook depends on:

Outlook

With treatment, more than 72% of people with a diagnosis of non-Hodgkin lymphoma will survive for at least 5 years.

With Hodgkin lymphoma, 86.6% of people who receive treatment will survive for at least 5 years.

The chances of a good outcome decrease as lymphoma progresses. It is essential to seek medical attention for any symptoms of cold or infection that continue for an extended period. Early diagnosis can improve a person’s chances of successful treatment.

Frequently Asked Questions

What is Hodgkin lymphoma?

Hodgkin lymphoma is a rare cancer that develops in the lymphatic system, which circulates through the spleen, lymph nodes and other organs, filtering out impurities and infections. Hodgkin lymphoma develops in lymphocytes, immune cells that are found in blood and lymph fluid. When these cells mutate, they grow out of control and may overtake the lymph system and spread to other parts of the body. The disease is named for Dr. Thomas Hodgkin, a British physician who first recognized its symptoms in 1832. It was formerly called Hodgkin’s disease.

What’s the difference between Hodgkin lymphoma and non-Hodgkin lymphoma?

The primary difference between Hodgkin and non-Hodgkin lymphoma is whether Reed-Sternberg cells are found in a lymph node biopsy. Reed-Sternberg cells are found in patients diagnosed with Hodgkin lymphoma. These mutated B lymphocytes are very large compared to other cells. The various shapes of Reed-Sternberg cells often help pathologists determine the specific type of Hodgkin lymphoma. A common variety of these cells has at least two nuclei, giving them the appearance of owls’ eyes. Reed-Sternberg cells are named for the two scientists who first identified them under a microscope. Non-Hodgkin lymphoma is the seventh most common cancer, with almost 75,000 cases diagnosed each year. Hodgkin lymphoma is rare by comparison, with about 8,500 cases diagnosed annually.

What are the signs and symptoms of Hodgkin lymphoma?

A common symptom of Hodgkin lymphoma is a lump in the neck, groin or armpit. The lump may be painful, especially after drinking alcohol. Over time, the lump may grow, or more lumps may appear.

Some symptoms of Hodgkin lymphoma, such as fever and swollen lymph nodes, may be mistaken for symptoms of the flu or an infection. But in lymphoma patients, these symptoms may not go away. If these symptoms persist for more than two weeks, see your doctor.

Other common symptoms of Hodgkin lymphoma are known as B symptoms. They include:

• Fever
• Drenching night sweats
• Dramatic and unexplained weight loss
• Fatigue
• Persistent cough
• Shortness of breath
• Loss of appetite
• Abdominal bloating
• Rash or itching

Some of these symptoms may also affect patients with non-Hodgkin lymphoma or leukemia.

What are the different types of Hodgkin lymphoma?

There are two types of Hodgkin lymphoma. About 95 percent of all cases are classical (or classic) Hodgkin lymphoma. This form of the disease is divided into four subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted. A less common type is nodular lymphocyte-predominant Hodgkin lymphoma.

What is the difference between an excisional and incisional biopsy?

An excisional biopsy is when a surgeon takes out a whole lymph node to be checked for cancer. An incisional biopsy is when the surgeon takes out only part of the lymph node. These are the most common biopsies for Hodgkin lymphoma.

What is a needle biopsy?

Needle biopsies are less invasive than excisional or incisional biopsies. There are two main types of needle biopsies: a fine needle aspiration and a core needle biopsy. With a fine needle aspiration (FNA), the healthcare provider uses a very thin, hollow needle to take a small sample of tissue from the tumor. A core needle biopsy uses a larger needle to take slightly more tissue. FNA and core needle biopsy are often not the best way to get cells to check for Hodgkin lymphoma. Sometimes they can’t take enough tissue for the provider to see cancerous cells. Then the doctor may need to use an incisional or excisional biopsy.

How is Hodgkin disease treated?

The treatment for Hodgkin disease depends on the type and stage of the disease, among other factors. The main treatment for Hodgkin disease is chemotherapy. Sometimes, both radiation and chemotherapy are used. Stem cell transplantation or monoclonal antibodies may be used if these treatments don’t work.

Should everyone get a second opinion for Hodgkin lymphoma?

Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. They include:

• You are not comfortable with the treatment decision.

• Your type of cancer is rare.

• There are different ways to treat the cancer.

• You are not able to see a cancer expert.

Many people have a hard time deciding which treatment to have. It may help to have a second doctor review your diagnosis and treatment options before starting treatment. In most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many other companies will pay for a second opinion if asked.

How can I get a second opinion for Hodgkin lymphoma?

These are some of the ways to get a second opinion:

• Ask a primary care doctor. Your doctor may be able to suggest a specialist. This may be a hematologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs. Never be afraid to ask for a second opinion.

• Call the National Cancer Institute’s Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Seek other options. Check with a local medical society, hospital, medical school, or cancer advocacy group. They can provide names of doctors who can give you a second opinion. Or ask other people who have had Hodgkin lymphoma to refer you to someone.

Can Hodgkin disease be cured?

Many people with Hodgkin lymphoma can be cured. If the disease is found in the early stages, it can almost always be cured. In later stages, most cases of Hodgkin lymphoma can still be cured.