Lymphoma

Breast Cancer | Lung Cancer | Lymphoma | Prostate Cancer

Lymphoma is a tumor of the immune system, a system which in turn communicates with all other systems of the body. The lymphatic system is a network of nodes, vessels and organs that provide the major defenses against microbial and viral invasion and atypical cells that if unchecked may progress to cancer. Lymphomas usually arise in the lymph nodes, but also in the spleen and in the intestinal lining.

Lymphoma cancer is classified as Hodgkin’s and Non-Hodgkin’s lymphoma. Hodgkin’s lymphoma accounts for around 40% of the lymphomas, and is identified by cell patterns (histology). Treatment of early stage Hodgkin’s lymphoma can result in complete remission in 90% of the cases, with only a 10% relapse rate, and even later stages may show a 80% remission rate with a 20% relapse rate.

Hodgkin lymphoma is a type of lymphoma distinguished by the presence of a particular kind of cancer cell called a Reed-Sternberg cell.

• The cause is unknown
• Lymph nodes enlarge but are not painful
• Other symptoms, such as muscle weakness, fever, and shortness of breath, develop depending on where the cancer cells are growing
• A lymph node biopsy is needed for diagnosis.

In the United States, about 8,000 new cases of Hodgkin lymphoma occur every year. The disease is more common in males than in females—about three men are affected for every two women. Hodgkin lymphoma rarely occurs before age 10. It is most common in people between the ages of 15 and 40 and in people older than 50.

The cause of Hodgkins lymphoma is unknown. There is strong evidence that, in some people, Epstein-Barr virus infection causes B lymphocytes to become cancerous and transform into Reed-Sternberg cells. Although there are some families in which more than one person has Hodgkin lymphoma, it is not contagious.

Symptoms

People with Hodgkin's lymphoma symptoms usually become aware of one or more enlarged lymph nodes, most often in the neck but sometimes in the armpit or groin. Although usually painless, sometimes the enlarged lymph nodes may be painful for a few hours after a person drinks alcoholic beverages.

People with Hodgkin lymphoma sometimes experience fever, night sweats, and weight loss. They can also have itching and fatigue. Some people have Pel-Ebstein fever, an unusual pattern of high temperature for several days alternating with normal or below-normal temperature for days or weeks. Other symptoms of lymphoma may develop, depending on where the cancerous cells are growing. For example, enlargement of lymph nodes in the chest may partially narrow and irritate airways, resulting in a cough, chest discomfort, or shortness of breath. Enlargement of the spleen or lymph nodes in the abdomen may cause discomfort in the abdomen.

Diagnosis

Doctors suspect Hodgkin lymphoma when a person with no apparent infection develops persistent and painless enlargement of lymph nodes that lasts for several weeks. The suspicion is stronger when lymph node enlargement is accompanied by fever, night sweats, and weight loss. Rapid and painful enlargement of lymph nodes—which may occur when a person has a cold or infection—is not typical of Hodgkin lymphoma. Sometimes enlarged lymph nodes deep within the chest or abdomen are found unexpectedly on a chest x-ray or computed tomography (CT) scan done for another reason.

Abnormalities in blood cell counts and other blood tests may provide supportive evidence. However, to make the diagnosis, doctors must perform a biopsy of an affected lymph node to see if it is abnormal and if Reed-Sternberg cells are present. Reed-Sternberg cells are large cancerous cells that have more than one nucleus. Their distinctive appearance can be seen when a biopsy specimen of lymph node tissue is examined under a microscope.

The type of biopsy depends on which node is enlarged and how much tissue is needed. Doctors must remove enough tissue to be able to distinguish Hodgkin lymphoma from other disorders that can cause lymph node enlargement, including non-Hodgkin lymphomas, infections, or other cancers.

Non Hodgkin’s lymphoma arises in a subset of the immune cells, the B cells, and has a good therapeutic prognosis in the early stages. In general, conventional therapy has a good record in lymphomas and should be the primary therapeutic choice in early stage disease.

Non Hodgkin lymphomas are a diverse group of cancers that develop in B or T lymphocytes.

• Often, lymph nodes in the neck, under the arms, or in the groin enlarge rapidly and painlessly
• People may have pain or shortness of breath or other symptoms when enlarged lymph nodes press on organs
• A lymph node biopsy is needed for diagnosis
• Treatment may involve radiation therapy, chemotherapy, monoclonal antibodies, or a combination
• Most people are cured or survive for many years.

This group of cancers is actually more than 20 different diseases, which have distinct appearances under the microscope, different cell patterns, and different clinical courses. Most non-Hodgkin lymphomas (85%) are from B cells. Less than 15% develop from T cells. Non-Hodgkin lymphoma is more common than Hodgkin lymphoma. In the United States, about 65,000 new cases are diagnosed every year, and the number of new cases is increasing, especially among older people and people whose immune system is not functioning normally. People who have had organ transplants and some people who have been infected with the human immunodeficiency virus (HIV) are at risk of developing non-Hodgkin lymphoma.

Although the cause of non-Hodgkin lymphomas is not known, evidence strongly supports a role for viruses in some of the less common types. A rare type of rapidly progressive non-Hodgkin lymphoma, which occurs in southern Japan and the Caribbean, may result from infection with human T-cell lymphotropic virus 1 (HTLV-1), a retrovirus similar to HIV. The Epstein-Barr virus is associated with many cases of Burkitt's lymphoma, another type of non-Hodgkin lymphoma.

Symptoms

The first symptom is often rapid and usually painless enlargement of lymph nodes in the neck, under the arms, or in the groin. Enlarged lymph nodes within the chest may press against airways, causing cough and difficulty in breathing. Deep lymph nodes within the abdomen may press against various organs, causing loss of appetite, constipation, abdominal pain, or progressive swelling of the legs.

Since some lymphomas can appear in the bloodstream and bone marrow, people can develop symptoms related to too few red blood cells, white blood cells, or platelets. Too few red blood cells can cause anemia, leading to fatigue, shortness of breath, and pale skin. Too few white blood cells can lead to infections. Too few platelets may lead to increased bruising or bleeding. Non-Hodgkin lymphomas also commonly invade the bone marrow, digestive tract, skin, and occasionally the nervous system, causing various symptoms. Some people have persistent fever without an evident cause, the so-called fever of unknown origin. This type of fever commonly reflects an advanced stage of disease.

In children, the first lymphoma symptoms—anemia, rashes, and neurologic symptoms, such as weakness and abnormal sensation—are likely to be caused by infiltration of lymphoma cells into the bone marrow, blood, skin, intestine, brain, and spinal cord. Lymph nodes that become enlarged are usually deep ones, leading to:

• Accumulation of fluid around the lungs, which causes difficulty in breathing
• Pressure on the intestine, which causes loss of appetite or vomiting
• Blocked lymph vessels, which causes fluid retention, most noticeably in the arms and legs.

Diagnosis and Classification

Doctors do a biopsy of an enlarged lymph node to diagnose non-Hodgkin lymphomas and to distinguish them from Hodgkin lymphoma and other disorders that cause enlarged lymph nodes.

Although more than 20 different disorders can be called non-Hodgkin lymphomas, doctors sometimes group them into two broad categories.

Indolent lymphomas are characterized by:

• A long survival period (many years)
• Rapid response to many treatments
• Lack of cure when standard therapies are used

Aggressive lymphomas are characterized by:

• Rapid progression without therapy
• High rates of cure with standard chemotherapy

Although non-Hodgkin lymphomas are usually diseases of middle-aged and older people, children and young adults may develop lymphomas, and lymphomas that develop in children and young adults are commonly aggressive subtypes.

Treatment

Individual lymphoma treatment may vary depending upon the cancer patient and their desire to receive tradition treatment, alternative cancer treatment or integrative treatment for the disease.  It is vital that persons diagnosed with, or suspected of having hodgkin's lymphoma or non hodgkin's lymphoma consult with their health care provider to assure proper evaluation, treatment and interpretation of information contained on this site.

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