Lymphoma

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Overview

Lymphoma is a type of blood malignancy that begins in the lymphocytes present in the lymphatic system. As this cancer type starts in the lymphocytes, it affects the body’s ability to fight infections and other functions associated with the body’s immune system.

Lymphomas commonly form in lymph nodes, spleen, thymus, bone marrow and other organs, and they become a tumour eventually. Some lymphomas progress quickly, while some are slow-growing and do not have any symptoms until later stages. Lymphoma can happen at any age; however, it is more common in young adults and adults aged above 60.

In most cases, lymphomas are successfully treatable.

Types

Mainly, there are two types of lymphomas:

1. Hodgkin’s Lymphoma: Hodgkin’s lymphoma is a rare form of lymphoma. It usually forms in the B-lymphocytes present in the bone marrow. Hodgkin’s lymphoma is characterised by the presence of RS cells. The RS cells, or Reed-Sternberg cells, are abnormal, enormous cells found in the blood samples of patients with Hodgkin’s lymphoma.
2. Non-Hodgkin’s Lymphoma: Non-Hodgkin’s lymphoma is the most common type of lymphoma. The non-Hodgkin’s lymphoma is characterised by the absence of RS cells. Non-Hodgkin’s lymphoma is more common among older adults.

Symptoms

Lymphoma may not cause any symptoms in the early stages, and even if they do, they are not specific and are easily associated with other less severe health conditions: Following are the lymphoma symptoms that should not be ignored:

Swollen lymph nodes that cause no pain – especially in the regions of neck, armpit, chest, stomach and groin
Cough
Tiredness
Night sweats
Fever
Shortness of breath
Itchy skin and rashes
Pain in the bone and joints
Unintentional weight loss
Abdominal pain
Anaemia

A large number of these symptoms can be caused due to other illnesses too. Therefore, for a definitive diagnosis, please consult a doctor.

Courses

Researchers have identified the following as the risk factors for lymphoma:

Age: Non-Hodgkin’s lymphoma is more common among older adults (60 and above). Hodgkin’s lymphoma, on the other hand, is more common among young adults and older adults aged above 55.
Gender: Lymphomas are reported in higher numbers among men than women. Nevertheless, a few subtypes are more common among women.
Weaker Immune System: Compromised immunity caused due to immunodeficiency disorders, such as HIV, organ transplants or any other immune disorders are at a higher risk of getting lymphoma.
Autoimmune Disorders: Those with certain autoimmune disorders, namely rheumatoid arthritis, lupus, celiac disease or Sjögren’s syndrome have higher risk of developing lymphoma.
Certain Infections: Specific viral infections, namely Epstein-Barr, hepatitis C and human T-cell leukaemia/lymphoma (HTLV-1) are reported to increase the risk of lymphoma.
Family History: Having a close relative with lymphoma can increase one’s risk of getting lymphoma.
Personal History of Lymphoma: Those who have received treatment for lymphoma in the past have a higher risk of getting lymphoma again.
Exposure to Harmful Chemicals: Individuals who are often exposed to harmful chemicals, such as benzene, pesticides, weedicides, etc., are at a higher risk of getting lymphoma.
Exposure to Radiation: Those who have received radiation treatment for other cancers also have an increased risk of developing lymphoma.

Diagnosis

a. Medical History Assessment and Physical Exam: One of the first things recommended by the doctor if an individual is experiencing lymphoma symptoms is the medical history assessment and physical examination. During this, the doctor tries to get information about the patient’s past and present medical condition, surgery history, allergy-related information in order to understand the cause of the symptoms. Also, he/she may physically examine the patient for the lymphoma signs, such as swollen nodes, anaemia, skin rashes, etc.

b. Blood Tests: Blood tests are recommended to determine the number of various blood cells. A low level of red blood cells, white blood cells, or platelets could indicate lymphoma. However, blood tests alone are not used to diagnose lymphoma.

c. Lymph Node Biopsy: During the lymph node biopsy, the doctor removes a lymph node or a part of it, and this sample is examined under a microscope for the presence of lymphoma cells. If lymphoma cells are found, additional tests are recommended by the doctor.

d. Bone Marrow Aspiration and Biopsy: During the bone marrow aspiration and biopsy, the liquid portion (aspiration) or the solid portion (biopsy) of the bone marrow is collected by inserting a needle into the patient’s hip bone. Later, these samples are examined under the microscope for the presence of lymphoma cells.

e. Imaging Tests: There are various imaging tests recommended by the doctor in order to receive additional information related to the condition. Common imaging tests recommended include PET/CT scan, MRI scan, etc.

There are additional tests, namely immunophenotyping, flow cytometry, FISH testing, etc., recommended for lymphoma diagnosis in order to assess the levels of cancer biomarkers and look for the presence of specific genes.

Treatment

The treatment planning for lymphoma is made upon considering multiple factors, such as the type of lymphoma, its subtype, the stage, patient’s age, overall health condition and presence of any underlying medical conditions, etc.

Majorly recommended treatment plans for lymphoma include chemotherapy, radiation therapy, bone marrow transplantation, targeted therapy and immunotherapy.

a. Active Surveillance: In the case of slow-growing cancers, active surveillance may be recommended, wherein the doctor will monitor the patient for signs of disease progression. The doctor may recommend treatment once the disease starts showing symptoms and is affecting the patient’s day-to-day activities.

b. Chemotherapy: During chemotherapy, powerful anticancer drugs are given in high doses in order to destroy the lymphoma cells. Chemotherapy is a systemic therapy i.e., unlike surgery or radiation therapy, this treats cancer cells throughout the body. This is the main line of treatment for lymphoma. It may or may not be combined with other treatment options depending on the severity of the disease.

c. Radiation Therapy: During radiation therapy, high-energy radiation beams, which could be X-rays or proton beams, are used to destroy cancer cells in specific regions. In the case of lymphoma, radiation therapy is administered to destroy the lymphoma cells that are accumulated in lymph nodes or in any specific organs.

d. Stem Cell Transplantation: Although not a primary treatment, stem cell transplantation is one of the treatment options recommended for lymphoma. A stem cell transplant is especially recommended when lymphoma relapses.

This treatment is often combined with chemotherapy, which is used to destroy the aggressive cancer cells. The bone marrow cells that are damaged during this procedure have to be replaced with healthy functioning cells. During stem cell transplantation, the healthy bone marrow cells that should be transfused to the patient are either collected from the patient’s bone marrow itself (right before the chemotherapy) or from a donor. Then healthy bone marrow stem cells collected through either of the ways are infused into the patient’s bloodstream where they travel to the bones and start rebuilding the bone marrow and help in the production of healthy-functioning blood cells.

e. Immunotherapy or Biological Therapy: Immunotherapy is a novel treatment approach that is recommended for the management of lymphoma in rare cases. Immunotherapy aims at stimulating the patient’s immune system to fight against the lymphoma cells. Specific biomolecules used in immunotherapy include monoclonal antibodies, cytokines and specialised vaccines.

Other treatments recommended for lymphoma include targeted therapy, chimeric antigen receptor (CAR)-T cell therapy, etc.

Frequently Asked Questions

1. Is lymphoma treatable?

Yes, lymphoma cases are treatable. There are many treatment options, namely chemotherapy, radiation therapy, stem cell transplantation, immunotherapy and targeted therapy available for the successful management of lymphoma.

However, early-stage lymphomas are relatively easier to treat when compared to advanced-stage lymphomas. In other words, early detection plays a significant role in the success of the treatment delivered. Therefore, one should not ignore symptoms, such as swollen lymph nodes, cough, rashes, shortness of breath, pain in joints, especially if they last for more than two weeks.

2. Is lymphoma hereditary?

No, lymphoma is not found to be hereditary. However, those with a close relative who is diagnosed with lymphoma has a relatively higher risk of developing this disease.

3. Can lymphoma come back?

In a few cases, lymphoma can come back a few years after the treatment. Therefore, it is important for lymphoma patients to keep up their follow-up appointments without fail. These follow-ups play an important role in preventing recurrences and in catching them in the early stages.

4. Can I prevent lymphoma?

Although there are no known ways to prevent lymphoma completely, there are a few ways for you to reduce your lymphoma risk:

a. Quit Smoking: Smoking is reported to increase specific types of lymphoma. Therefore, quitting smoking is important in order to reduce lymphoma risk among adults.
b. Avoid Exposing Yourself to Certain Harmful Chemicals: Certain chemicals, namely formaldehyde, benzene, pesticides, weedicides, etc., can increase your lymphoma risk. Consider wearing a mask, goggles, gloves and protective clothing in order to reduce your exposure to these chemicals.