Lymphoma

What Is Lymphoma?

Lymphoma is a type of cancer. It starts in cells that help the body fight infections. These cells are call lymphocytes. They are a type of white blood cell. 

When lymphocytes change and do not work the right way, they can grow too fast. This can cause tumors to form. Lymphocytes move throughout the body. They travel through small glands called lymph nodes. Lymph nodes help filter fluid and fight germs.

Lymphoma can quickly spread to other parts of the body. It most often spreads to the liver, bone marrow or lungs. People of any age can develop lymphoma. It is one of the most common types of cancer in children and young adults. Non-Hodgkin lymphoma is common and makes up about 4% of all cancers, according to the American Cancer Society. 

Types of Lymphoma

There are different types of lymphocytes. Lymphoma usually starts in B lymphocytes. B lymphocytes make antibodies to protect your body from bacteria and viruses. Different forms of lymphoma are broken down into two main types:

• Hodgkin lymphoma: This type of lymphoma occurs when large cells called Reed-Sternberg cells are present. Other abnormal cells are often present. It usually starts in one lymph node and spreads to another. It can also spread to other organs. 
• Non-Hodgkin lymphoma: Lymphoma that does not have Reed-Sternberg cells is classified as NHL. About 85 percent of non-Hodgkin lymphoma develops from abnormal B lymphocytes, according to the Lymphoma Research Foundation. There are more types of non-Hodgkin lymphoma (NHL) than Hodgkin lymphoma. NHL may not affect every lymph node.

Lymphoma Risk Factors

It is not known exactly why lymphocytes change. These factors can increase your risk. 

Non-Hodgkin Lymphoma Risk Factors

• Age: People 60 and older are more likely to develop lymphoma, although some types may occur in children and young adults.
• Autoimmune conditions: Lymphoma involves the immune system, so other conditions that affect it can increase risk, such as rheumatoid arthritis and celiac disease.
• Breast implants: These can cause anaplastic large cell lymphoma in breast tissue.
• Body weight: Being overweight or obese may increase the risk of developing lymphoma. 
• Chemical or radiation exposure: Nuclear radiation and some agricultural chemicals may have a link to developing non-Hodgkin lymphoma.
• Ethnicity and location: non-Hodgkin lymphoma is more common in developed countries. In the U.S., white people are at a higher risk than African Americans or Asian Americans.
• Immunodeficiency: People with less active immune systems are at a greater risk. Immunodeficiency can be caused by medications taken after an organ transplant or HIV.
• Infection: Some viral and bacterial infections that affect the lymphocytes may increase risk, such as the Epstein-Barr virus.
• Sex: This varies by type. Women are more likely to develop certain types of lymphoma. Men are more likely to have other types.

Hodgkin lymphoma Risk Factors

• Age: People ages 20-30 and over 55 have a higher risk.
• Family history: Risk is higher if you have a sibling with Hodgkin lymphoma. If an identical twin sibling has it, the risk is much higher.
• HIV infection: HIV weakens the immune system, which can increase lymphoma risk.
• Infection: The Epstein-Barr virus can cause mononucleosis, which increases the risk of Hodgkin lymphoma.
• Sex: This type of lymphoma is slightly more common in men than women.

Lymphoma Prevention

There is no guaranteed way to prevent lymphoma. Some risk factors cannot be prevented. There are some things you can do to lower your risk. 

Avoid certain types of infections. HIV can increase the risk of non-Hodgkin lymphoma. Avoiding risk factors for HIV can also help you avoid developing NHL. Heliobacter pylori (H. pylori) is a germ that causes infections in the stomach. H. pylori infections have been linked to some stomach lymphomas. Finding and treating H. pylori infections may lower the risk.

Maintain a healthy lifestyle. Keeping a healthy weight, staying active, and eating a healthy diet can help prevent lymphoma.

Signs and Symptoms

Each type of lymphoma may have different symptoms. Some symptoms may be similar to common illnesses such as a cold or the flu. See a doctor if you experience symptoms that don’t go away.

Common symptoms of both types of lymphoma include: 

• Fatigue
• Fever without infection
• Itching
• Low appetite and weight loss
• Night sweats
• Pain in the lymph nodes after drinking alcohol
• Swelling of the lymph nodes

Diagnosis

Several tests may be necessary to confirm a diagnosis of lymphoma because symptoms may seem like other conditions. There are no screening tests, but early diagnosis is possible.

Your doctor will start with a physical exam and take your medical history. They also may perform diagnostic tests.

Imaging Tests

Computerized tomography (CT): This test combines several x-rays to create detailed images of the inside of the body.

Magnetic resonance imaging (MRI): An MRI uses a magnetic field and radio waves to make images of organs and tissues in the body. This can help doctors view tumors.

Positron emission tomography (PET): This scan uses radiation to view activity in the body on a cellular level. It can show how organs are functioning.

Ultrasound: This test creates images of the inside of the body with high-frequency sound waves. An ultrasound may be used when doing a biopsy.

Lab Tests

Blood tests: Analyzing blood may show the presence of lymphoma.

Diagnostic Procedures

Biopsy: A biopsy can confirm non-Hodgkin lymphoma. Your doctor may remove a portion of one of the lymph nodes to test in a lab for lymphoma. A bone marrow biopsy may be done to determine the stage of lymphoma after diagnosis.

Spinal tap: A surgeon uses a long, thin needle to remove spinal fluid while the patient is under local anesthetic. The spinal fluid is then tested. This test can reveal the stage of lymphoma. 

Lymphoma Staging

After a lymphoma diagnosis, doctors will try to determine if it has spread and how far. Diagnostic testing procedures can help doctors figure out the stage of lymphoma and how to best treat it. Imaging tests, such as PET or CT scans, are the most important staging tool.

The current staging system for lymphoma is described through Roman numerals. An “E” is added to the number when lymphomas affect an organ outside of the lymph nodes.

• Stage I: Lymphoma is only found in one lymph node or organ in the lymph system such as the tonsils. Stage IE refers to lymphoma found in only one area of a single organ outside of the lymph system.
• Stage II: Lymphoma has spread to two or more groups of lymph nodes in the same area of the body. Stage IIE means lymphoma is in a group of lymph nodes and one area of an organ.
• Stage III: Lymphoma is in lymph node areas on both sides of the diaphragm, the thin band of muscle between the chest and abdomen. At this stage, lymphoma may also be in the spleen.
• Stage IV: Lymphoma has spread widely to at least one organ outside of the lymph system, such as bone marrow, liver, or lungs.

Many forms of lymphoma are highly treatable and often curable. This type of cancer has many advanced treatments. Compared to many other types of cancer, lymphoma has a relatively high five-year survival rate. However, the success of treatment depends on your individual type and stage of lymphoma. Your prognosis may depend on your age, stage of lymphoma, whether lymphoma has spread outside the lymph system, and how well you can do normal daily activities.

Treatment

Treatment will depend on what type of lymphoma you have, the stage of the cancer and other health factors. Slow-growing (also known as indolent) lymphoma may not need treatment, although it requires monitoring to make sure it doesn’t spread. 

Your treatment team may include an oncologist or hematologist. Multiple treatments may be combined.

Medications

• Biologics: A drug treatment to boosts the immune system with living microorganisms to attack cancer.

Procedures  

• Stem cell transplant: A stem cell transplant (also known as a bone marrow transplant) enables healthy new blood cells to be made. This treatment is often used with a higher dose of chemotherapy so more cancer cells can be targeted without damaging the bone marrow. Stem cell transplants may be done with the patient’s own stem cells or they may come from a donor. 
• Surgery: In rare cases, surgery may be used to treat lymphoma that starts in the spleen or other organs outside the lymph system.

Therapies

• Antibody therapy: This treatment uses synthetic antibodies to attack cancer cells.
• CAR T-cell therapy: This is a therapy that uses a patient’s own immune system cells to fight the lymphoma. Doctors collect the cells by separating them from the rest of the blood. They are then genetically engineered to produce antigen receptors.
• Chemotherapy: This is an aggressive anti-cancer drug that spreads through the entire body. It may be taken by mouth or injected by IV. Because this treatment can also harm healthy cells, it’s given in cycles to give the body time to recover.
• Immunotherapy: This is a medical treatment that supports a person’s own immune system to kill lymphoma cells or slow the growth. Immunotherapy is usually given by infusion.
• Radiation: This treatment uses concentrated doses of radiation to destroy cancer cells. It may be used for small areas of cancer or earlier stages.

• Targeted therapy: Newer drug therapies target the changes in lymphoma cells that allow them to grow. There are many different types of targeted therapy. These drugs may work when chemotherapy doesn’t.

Lifestyle Management

In addition to following your treatment plan, living with lymphoma involves managing symptoms, addressing emotional challenges and adopting a healthy lifestyle that includes eating a healthy diet, getting enough exercise and sleep and connecting with your support system. Find more resources for living with lymphoma at the Blood Cancer United website.

Clinical Trials

Clinical trials help determine new treatment options for lymphoma. Patients with lymphoma have access to clinical trials at National Jewish Health. Speak with your doctor to find out if a clinical trial may be a good fit for you.

When to See a Specialist

If you or a loved one has symptoms or a family history of lymphoma, it’s important to be evaluated by a hematologist.

At National Jewish Health in Golden and Thornton, Colorado, we have one of the area’s leading cancer programs for lymphoma patients. Learn more about our Cancer Care program or use the button below to make an appointment.