Lymphoma: Understanding the Cancer of the Lymphatic System

Lymphoma: Overview

General Information

Lymphoma is a general term for cancers that originate in the lymphatic system, which forms a crucial part of the body's immune system. The lymphatic system is responsible for carrying disease-fighting white blood cells throughout the body and is composed of several key structures:

Lymph: A fluid that carries lymphocytes (a type of white blood cell) through a network of tiny lymph vessels. The lymph is essential for fighting against infection and cancer.

Lymph Nodes: Small, bean-shaped masses found in areas like the neck, underarm, groin, pelvis, and abdomen. They filter lymph fluid and store white blood cells to aid in disease combat.

Spleen: An organ situated on the left side of the abdomen that helps lymphocytes to develop, stores blood cells, and eliminates old blood cells.

Thymus: A small organ located in the chest that assists in the making and development of lymphocytes.

Tonsils: Nodes at the back of the throat that store white blood cells.

Bone Marrow: The material inside bones that produces all types of blood cells, including white blood cells.

Types of Lymphoma

The two primary categories of lymphoma are Hodgkin lymphoma and Non-Hodgkin lymphoma. They develop from different types of lymphocytes:

Hodgkin Lymphoma

This type typically begins in B lymphocytes and is nearly always characterised by abnormal B lymphocytes known as Reed-Sternberg cells.

Non-Hodgkin Lymphoma

This can originate from various types of lymphocytes, including both B and T lymphocytes.

Waldenström's Macroglobulinemia is another form of lymphoma that is usually slow-spreading and often easy to manage when detected early.

Indolent vs. Aggressive Lymphoma

Lymphomas are also classified based on their growth rate and behaviour:

Indolent Lymphoma

This grows slowly, often presenting with few or no symptoms. Most indolent lymphomas start in B-cell lymphocytes. Patients with these slow-growing tumours typically have a favourable outlook, and in some cases, doctors may recommend monitoring the disease (active surveillance) instead of immediate treatment.

Aggressive Lymphoma

This type grows rapidly, and its symptoms are usually more obvious and severe. Patients with aggressive lymphomas require immediate treatment.

Both Hodgkin and Non-Hodgkin lymphomas can fall into either the indolent or aggressive category.

Risk Factors for Lymphoma

Factors that may increase an individual's chance of developing lymphoma include:

Biological Sex

Lymphoma is slightly more prevalent in males.

Age

It is most common in young adults (15 to 40 years old) and older adults (over 55 years old).

Weakened Immune System

Due to conditions like HIV/AIDS or immunosuppressive therapy (e.g., post-organ transplant).

Infection

Previous infection with certain viruses and bacteria, such as Epstein-Barr virus (EBV), infectious mononucleosis, Human Immunodeficiency Virus (HIV), Human T-cell lymphocytotropic virus (HTLV), and Helicobacter pylori.

Family History

Having a close relative (parent, sibling, or child) with lymphoma slightly increases the risk.

Hereditary Cancer Syndromes

Certain inherited conditions can elevate the risk.

Exposure to Chemicals

Including pesticides, herbicides, and solvents, although the link is still under investigation.

Autoimmune Diseases

Such as celiac disease or Sjögren's syndrome.

Radiation Exposure

Including previous cancer treatment involving radiation therapy.

Symptoms

Lymphoma symptoms vary significantly among individuals, and some patients may experience no noticeable symptoms for a prolonged period. However, recognising the potential signs is crucial for early diagnosis and effective treatment.

Signs and symptoms of lymphoma may include:

  • Painless swelling of lymph nodes in the neck, underarm, or groin, which is often the first symptom.
  • Fevers.
  • Heavy night sweats.
  • Fatigue that does not improve with rest.
  • Loss of appetite.
  • Unexplained weight loss (often 10% or more of the body weight).
  • Dry, persistent itchy skin, sometimes without a rash.
  • A red rash, particularly in cases of skin lymphomas.
  • Nausea, vomiting, or abdominal pain.
  • Coughing or shortness of breath, typically caused by swollen lymph nodes in the chest.
  • Headaches and problems with concentration.
  • Confusion or weakness in the arms and/or legs.
  • A feeling of fullness in the abdomen, which may be caused by an enlarged liver or spleen.

It is important to remember that these signs can also signal other health problems. You should consult a healthcare provider if you experience persistent or unexplained swelling of lymph nodes, fever, night sweats, or weight loss that does not improve, or any combination of these symptoms lasting more than two weeks. Early evaluation can help determine the cause and guide appropriate care.

Diagnosis

An accurate and precise diagnosis is essential for doctors to select the most effective course of treatment. SSCHRC maintains a highly experienced team, including specialised doctors known as hematopathologists who focus on diagnosing lymphoma and other blood cancers, to ensure the highest degree of diagnostic accuracy.

If lymphoma is suspected, your doctor will perform a physical examination and take a detailed medical history. One or more of the following diagnostic tests may be used to confirm a cancer diagnosis, determine its spread, or monitor treatment effectiveness:

Lymph Node Biopsy

A small tissue sample, or sometimes the entire lymph node, is removed and examined under a microscope.

Imaging Tests

These provide detailed images of the inside of the body and may include:

  • X-rays
  • CT (computed tomography) or CAT (computed axial tomography) scans
  • PET (positron emission tomography) scans
  • MRI (magnetic resonance imaging) scans

Blood Tests

These are conducted to assess the number and appearance of blood cells and check for normal blood chemistry. Specific blood tests can also help doctors determine the patient's outlook once lymphoma is diagnosed.

Bone Marrow Aspiration and Biopsy

A long needle is used to collect a sample of bone marrow from a large bone, usually the pelvic bone, for analysis.

Liver and Kidney Function Tests

These tests help diagnose the disease and support the prognosis.

Echocardiogram and Pulmonary Function Tests

These assess the health of the heart and lungs, respectively, before treatment begins, which informs doctors about the intensity of treatment a patient can safely undergo.

Immunophenotyping

Cells from a lymph node, blood, or bone marrow are examined to determine the specific subtype of lymphoma, which is vital for planning the best possible treatment.

Treatment

At SSCHRC is committed to providing world-class care, with physicians, nurses, and advanced practice providers specialising exclusively in lymphoma and myeloma. This focused expertise is used to design a treatment plan specifically tailored to each patient and their disease.

Treatment options include advanced therapies and access to clinical trials for cutting-edge treatments not available elsewhere.

Chemotherapy

Drugs used to kill cancer cells, control their growth, or alleviate disease-related symptoms. It may involve a single drug or a combination, depending on the type and growth rate of the cancer.

Radiation Therapy

Uses powerful, focused beams of energy to destroy cancer cells. It is often used for early-stage lymphoma or to help with symptoms like pain, though it is rarely the sole treatment.

Immunotherapy

A treatment that improves the immune system's natural ability to find and eliminate cancer cells. Types used for lymphoma include:

Immune Checkpoint Inhibitors

These prevent the immune system from prematurely shutting down, allowing cancer-fighting T cells to mount a longer-lasting response against the disease.

CAR T Cell Therapy (Chimeric Antigen Receptor T-cell therapy)

The patient's T cells are genetically modified in a laboratory to specifically recognise and attack cancer cells. This is used to treat various types of lymphoma, including certain kinds of B-cell non-Hodgkin lymphoma.

Immune Modulators

These drugs modify the tumour cell environment, making it easier for the immune system to kill the cancer.

Targeted Therapy

Drugs designed to interfere with or target specific molecules or the cancer-causing genes they are based on. This stops or slows the growth and spread of cancer at a cellular level.

Stem Cell Transplantation (Bone Marrow Transplant)

A procedure that replaces cancerous bone marrow with new, healthy bone marrow stem cells, which may come from a donor or the patient. It is typically administered after intense chemotherapy to treat some types of lymphoma.

Clinical Trials

These are an integral part of SSCHRC's mission, used to discover better ways to prevent, diagnose, and treat cancer. A doctor may offer a clinical trial as a treatment option.

Active Surveillance

This involves closely monitoring certain types of indolent or low-grade lymphomas without immediate active treatment, which may be suitable for some patients.

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