Lymphomas are cancers that originate in the lymphatic system. The lymphatic system operates throughout the body as the backbone of your immune system. It works to help your body fight infections. The lymphatic system is made up of: lymphoid tissue, lymphatic vessels, and lymphatic fluid. Lymphoid tissue is mostly composed of lymphocytes, a type of white blood cell. The two most common lymphocytes involved in lymphoma are T cells and B cells. Both can develop into cancerous lymphoma cells, but B cells cause most lymphomas in the United States.
Lymph nodes are small organs about the size of a bean. Most of the cells in lymph nodes are lymphocytes. Lymphocytes are white blood cells that are active in fighting infection. There are two types of lymphocytes: T-cells and B-cells. B-cells produce antibodies that help the body to destroy viruses and bacteria. T-cells help to fight off diseases like fungal infections and tuberculosis. Lymph nodes are found in your chest, abdomen, pelvis, arm pit, neck and other areas of the body. Your lymph nodes swell if an infection is present.
White cells and red cells are made in bone marrow. There are two types of white cells in the marrow: granulocytes and lymphocytes. The majority of the lymphocytes in bone marrow are B-cells. Some lymphomas begin from bone marrow B-cells.
The spleen is a small organ located on the left side of the abdomen near the ribs. The spleen makes immune system cells, including lymphocytes. It also filters out and destroys damaged blood cells, bacteria, and cellular wastes.
The thymus plays an important role in the development of T lymphocytes in an infant. Although it gradually decreases in size, the thymus continues to play an important role in immunity throughout your life.
Tonsils and Adenoids
Tonsils and adenoids are collections of lymphoid tissue located at the back of the throat. They help the body to fight off infection from bacteria and viruses that pass through the nose and throat.
The stomach and intestines contain lymphoid tissue.
There are two types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. These two kinds of lymphoma have different clinical profiles.
Although uncommon, Hodgkin’s lymphoma (also known as Hodgkin’s disease) is the most curable form of cancer. It starts in the lymph nodes, usually in the chest, neck, or under the arms. As it spreads from lymph node to lymph node, the nodes become enlarged. Eventually, the cancer cells enter the blood stream and spread to other parts of the body.
The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma.
The National Cancer Institute (NCI) reports that there will be over 9,300 new cases of Hodgkin Lymphoma in the United States in 2013. Of these, nearly 2,000 will die. Lymphomas are the third major cause of cancer for children and adolescents under the age of 20. Hodgkin lymphoma occurs less frequently than Non-Hodgkin’s lymphoma (NCI).
Risk Factors of Hodgkin Lymphoma
There are several risk factors for Hodgkin lymphoma.
- Age: Hodgkin lymphoma is most likely to occur between the ages of 15 and 35, and then in those older than 55.
- Sex: Hodgkin lymphoma occurs most often in men.
- Family history: risk increases if you have a sibling with Hodgkin lymphoma.
- Past history of Epstein-Barr virus infection (EBV): EBV causes mononucleosis. People who have had infectious mononucleosis have increased risk of developing Hodgkin lymphoma.
- Weakened immune system: an immune system weakened by HIV/AIDS, other cancers, or medications that suppress the immune system can increase your risk of developing Hodgkin lymphoma.
Symptoms of Hodgkin Lymphoma
- increased sensitivity to the effects of alcohol or pain in the lymph nodes after drinking alcohol
- fever and chills
- night sweats
- painless swelling of lymph nodes in the neck, armpits, or groin
- persistent fatigue
- unexplained weight loss
- coughing, trouble breathing, or chest pain
- loss of appetite
Hodgkin Lymphoma Diagnosis
Diagnosis of Hodgkin lymphoma begins with an assessment of the overall health history and a physical exam. Lymph node biopsies are performed to determine the type of lymphoma. Doctors use a system called staging to determine the extent of the disease. Stages are numbered from I to IV and increase as the cancer spreads from the lymph nodes to other organs. The staging process begins with health history assessment and a physical. Tests used in the staging process include imaging tests, blood tests, and bone marrow aspiration and biopsy.
- Chest X-ray: helps doctors know if lymphoma has spread to the lungs and lymph nodes in the chest.
- CT scan of the chest, abdomen, or pelvis: an X-ray that gives great detail about the size of lymph nodes and organs in the chest, abdomen, and pelvis. This tells doctors whether or not lymphoma has spread and which organs are affected.
- PET scan: a nuclear medicine study that evaluates the rate at which cells use energy (metabolic rate). This information tells doctors how active tumors are. PET scans are done by injecting a small amount of radiotracer (radioactive chemical) into an arm vein. The PET scanner makes 3D color images of organs and tissues. The colored images measure blood flow, and the use of oxygen and glucose by the organs.
- Gallium scan: a nuclear medicine examination. Gallium, (a radioactive material) is injected into a vein. The bones, liver, lymph nodes, or other organs then take up gallium. This tells the doctors if cancer or other problems like infection are present.
- Bone scan: a scan that reveals whether lymphoma cells have infiltrated the bones.
- CBC (complete blood count): lab test that reveals how many red blood cells, white blood cells, and platelets are circulating in the blood.
- ESR (erythrocyte sedimentation rate): a general index of health, measuring how rapidly red blood cells sediment in an hour. It can be elevated if infection, inflammation, autoimmune diseases or cancer are present.
- HIV screening: a test to rule out the presence of HIV/AIDS. HIV infection is a risk factor for lymphoma.
Bone Marrow Aspiration and Biopsy
Bone marrow aspiration is performed by inserting a special needle attached to a syringe into the bone marrow. Generally, the back of the hip bone (called the posterior iliac crest) is used. When the needle is inside the marrow the doctor pulls back the syringe. This causes some of the marrow to enter the syringe. The sample is looked at under the microscope and sent for cultures. A bone marrow biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow).The bone marrow biopsy tells doctors how well the marrow is functioning.
Hodgkin Lymphoma Treatment
Treatment depends on the stage of the disease. Treatment options for Hodgkin lymphoma include chemotherapy, radiation, and stem cell transplant.
Hodgkin Lymphoma Outlook
If caught early, Hodgkin lymphoma is highly curable. Some 85 percent of patients diagnosed with Hodgkin lymphoma are alive and well five years later. Of that group, 80 percent will be completely cured.
Non-Hodgkin lymphoma also originates in lymphocytes and is characterized as being fast or slow growing. Prognosis depends upon the type and stage of the disease at the time of diagnosis. Many people with fast-growing NHL can be cured and those with slow-growing NHL can manage the disease. The Leukemia and Lymphoma Society of America reports that in 2011 nearly 663,000 people were living with or in remission from lymphoma. More than 500,000 of these had NHL (LLS).
Different Types of NHL
Non-Hodgkin lymphoma can arise in T or B-cells, though the majority of cases arise in B-cells. The National Cancer Institute estimates that there will be more than 70,000 new cases of NHL in the U.S. in 2012. Of these, close to 20,000 deaths can be expected (NCI).
Types of B-cell NHL include:
- Burkitt lymphoma
- chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)
- diffuse large B-cell lymphoma
- follicular lymphoma
- immunoblastic large cell lymphoma
- mantle cell lymphoma.
- precursor B-lymphoblastic lymphoma
Types of T-cell NHL include:
- anaplastic large cell lymphoma
- mycosis fungoides
- precursor T-lymphoblastic lymphoma
Risk Factors for NHL
There are several risk factors for Non-Hodgkin lymphoma.
- Age: NHL can occur at any age, but is more common in people over the age of 60.
- Viral infections: Infections from Epstein-Barr virus, HIV, and helicobacter pylori (a type of bacteria that causes peptic stomach ulcers) increase the risk of getting NHL.
- Suppressed immune system: Medications that suppress the immune system increase the risk of developing NHL.
- Exposure to certain chemicals: Certain pesticides and chemicals used to kill weeds can increase the risk of developing NHL.
Symptoms of NHL
Many of the symptoms of lymphoma occur in other diseases. Symptoms of lymphoma include:
- night sweats
- weight loss
- swollen lymph nodes in your neck, armpits or groin
- abdominal pain or swelling
- chest pain, coughing or trouble breathing
Diagnosis of NHL begins with health history assessment and a physical examination. Blood tests and imaging studies are the same as those used for Hodgkin lymphoma.
Treatments for NHL
The approach to treatment of NHL differs from that of Hodgkin lymphoma. Slow-growing or inactive tumors may not be treated until symptoms occur. This period of watchful waiting can last for several years. During this time, your doctor will schedule follow-up appointments to see if the disease is spreading. Treatment options include:
- radiation therapy
- stem cell transplant
- use of biological drugs to help your immune system kill the cancer cells. Rituximab (Rituxan) is a drug that has been approved by the FDA for the treatment of B-cell lymphoma
- medications that deliver radiation directly to the cancer cells
Outlook for NHL
The outlook for NHL can be difficult to determine as there are so many diverse factors to consider. However, the American Cancer Society claims that 63 percent of patients diagnosed with NHL will still be alive five years later, and 51 percent at 10 years after diagnosis (ACS). As treatments continue to improve, so do the long-term survival rates for NHL.
Medically Reviewed by: Brenda B. Spriggs, MD, MPH, FACP
Published By: Healthline Networks, Inc.