Lymphoma

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Lymphoma
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Specialty scores for Lymphoma

Overview

Overview

Lymphoma is defined as cancer that involves the lymphatic system, which is the part of the body’s immune system, and this cancer develops from abnormal duplications of lymphocytes (white blood cells).

This lymphatic system is a network that consists of the spleen, lymph nodes throughout the body, the thymus and the bone marrow. Lymphoma can therefore affect any organ or tissue that makes up the lymphatic network.

There are many types of lymphoma but the main groups are referred to as Hodgkin’s and non-Hodgkin’s lymphoma.

Epidemiology

Lymphoma is the most common blood cancer in developed countries making up nearly 56 percent of all total blood cancers. Altogether, lymphoma makes up more than 5 percent of all cancers.

In the United States, lymphoma makes up around 5 percent of all the cancers in the country.

Etiology

Lymphomas arise from the lymphocytes of the immune system, but the exact cause of lymphoma is still unclear at this stage. There are risk factors associated with the development of this cancer and they include the following for the specific lymphomas:

Hodgkin’s lymphoma – previous infection with Epstein-Barr virus (EBV), people in their 20s and over 50 years of age, men, being from North America and northern Europe, family history of siblings with the disease, and being diagnosed with HIV.

Non-Hodgkin’s lymphoma – being over 60 years of age, being white from a developed country, exposure to toxins and radiation, immune deficiency due to chronic illnesses or HIV infection, having autoimmune diseases such as rheumatoid arthritis or diabetes, and being diagnosed with certain bacterial and viral infections such as EBV.

Signs and Symptoms

Lymphoma can present with non-specific symptoms since it involves the immune system. Patients may be misdiagnosed with acute or chronic infections due to the similarity of the clinical presentation.

The following signs and symptoms in combination with each other should alert one to the possibility of lymphoma:

  • Lymph node enlargement – lymph nodes are found throughout the body, and swelling of these glands is the primary presentation of lymphoma.
  • Systemic symptoms include fever, weight loss and night sweats. If an acute infection can’t be found for these symptoms, then further investigations are warranted.
  • Other symptoms may include fatigue, loss of appetite, itchy skin and shortness of breath.

Diagnosis

Lymphoma is confirmed by the presence of malignant cells in lymph nodes. These glands are biopsied, through partial or complete removal, and are investigated further.

Once the confirmation is made, further tests are performed to look for specific features of different lymphoma in order to classify the cancer. These investigations include flow cytometry, immunophenotyping and fluorescence in situ hybridization (FISH) testing.

These tests will then help classify the lymphoma into; whether it’s Hodgkin’s or non-Hodgkin’s; whether the cell that is being replicated is a B or T cell; and will determine the organ or tissue site where the cell is being duplicated.

Management

The management of the different lymphomas will depend on what type of white blood cell cancer it is and on the grade of the malignancy.

High-grade lymphoma tumours, which replicate faster, tend to react better to treatment better than their lower-grade counterparts. However, if these cancers don’t respond to treatment then they tend to have a worse prognosis. High-grade lymphomas are managed with aggressive chemotherapy, and a good amount of patients are cured with first-line treatment.

Low-grade lymphomas remain dormant for many years, so they best way to manage these patients when they don’t show any symptoms is by watchful waiting. When a low-grade lymphoma does become symptomatic, then patient is managed with radiation and chemotherapy. These cancers are incurable, but the treatment will help to alleviate symptoms.

Hodgkin’s lymphoma reacts well to radiation therapy, as long as the malignancy is localized. If the condition is advanced, then patients will be administered chemotherapy which will sometimes be combined with radiation therapy.