Lymphoma: Symptoms, Causes, Diagnosis & Treatment

Lymphoma is a broad word for cancer that begins in the infection-fighting cells of the lymphatic system. It occurs when lymphocytes, a type of white blood cell, undergo abnormal changes and multiply uncontrollably. These abnormal lymphocytes can accumulate and form tumours in various body parts, including lymph nodes, bone marrow, spleen, and other organs.

Researchers have grouped more than 70 forms of lymphoma into two categories: Hodgkin's lymphoma and non-Hodgkin's lymphoma. Lymphoma cancers may negatively impact any part of the body's lymphatic system, including the bone marrow, thymus, spleen, tonsils, and lymph nodes.

Lymphoma is broadly classified into two main types: Hodgkin’s and Non-Hodgkin’s lymphoma. These types of lymphoma cancer differ in terms of their characteristics, behaviour, and the specific cells involved.

1. Hodgkin’s Lymphoma (HL): Hodgkin’s lymphoma is characterised by the presence of Reed-Sternberg cells, which are large abnormal cells within the lymph nodes. It accounts for a smaller proportion of lymphomas compared to non-Hodgkin’s lymphoma. Hodgkin’s lymphoma is further divided into several subtypes, including:

1. Nodular Sclerosis Hodgkin Lymphoma (NSHL): Nodular sclerosis is the most frequent form of Hodgkin's lymphoma. It is identified by the presence of Reed-Sternberg cells enclosed by fibrous tissue in the affected lymph nodes. It commonly affects young adults and teenagers.

2. Mixed Cellularity Hodgkin Lymphoma (MCHL): It is a type of Hodgkin's lymphoma characterised by an excess of Reed-Sternberg cells mixed with other inflammatory cells. 

1. It is more common in older adults and can be linked to the Epstein-Barr virus, which spreads through saliva. 

2. MCHL is identified by the presence of popcorn-like cells called eosinophils, lymphocytes, and histiocytes.

3. Lymphocyte-Rich Hodgkin Lymphoma (LRHL): This is a less common subtype characterised by many lymphocytes and fewer Reed-Sternberg cells. It often has a positive outlook and is more commonly found in the body's lymph nodes.

4. Lymphocyte-Depleted Hodgkin Lymphoma (LDHL): LDHL is a type characterised by a significant number of Reed-Sternberg cells but fewer immune cells around them. It is more frequently observed in older individuals or those with weakened immune systems.

5. Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma: This subtype is less common and has distinct characteristics, including the presence of popcorn cells.

2. Non-Hodgkin’s Lymphoma (NHL): NHL describes a wide range of lymphomas without Reed-Sternberg cells. It is further divided into subtypes based on additional characteristics and the particular lymphocyte involved (B cells, T cells, or natural killer cells). Non-Hodgkin lymphoma has several common subtypes, including:

1. Diffuse Large B-Cell Lymphoma is the most common subtype of non-Hodgkin lymphoma, characterised by rapidly growing tumours.

2. Follicular Lymphoma: This subtype grows slowly and often remains indolent for many years.

3. Mantle Cell Lymphoma: This is a rare and aggressive subtype of non-Hodgkin lymphoma, usually diagnosed at an advanced stage.

Non-Hodgkin lymphoma tumour growth may not touch every lymph node, often skipping some and developing on others. It is responsible for 95% of lymphoma instances.

Lymphoma Stages

The lymphoma cancer stage, which is categorised using a numbering system (stages 1 through 4), shows how far the disease has spread. Depending on whether the patient exhibits particular symptoms, the stage may include the letters A, B, E, or S to describe the malignancy further.

1. A and B: The letter A denotes the absence of B symptoms in a subject. The letter B denotes the presence of at least one of the wet night sweats, unexplained fever, or abrupt weight loss symptoms.

2. E and S: The disease has spread to tissues or organs beyond the lymphatic system, as indicated by the letter E. Cancer that has progressed to the spleen is represented by the letter S.

3. Stage I: The cancer is limited to a single lymph node or lymphatic site.

4. Stage II: Cancer involves two or more lymph nodes or lymphatic sites on the same side of the diaphragm.

5. Stage III: The cancer is present in lymph nodes or lymphatic sites on both sides of the diaphragm. 

6. Stage IV: The cancer has spread to other organs or tissues beyond the lymphatic system, such as the bone marrow, liver, or lungs.

In its early stages, lymphoma may not constantly develop symptoms. Instead, a medical professional may discover swollen lymph nodes via a physical examination. Under the skin, these may feel like little, soft nodules. A person can feel lymph nodes in the following areas:

1. Upper neck and chest

2. Armpit

3. Stomach 

4. Groin

The symptoms of lymphoma vary depending on the type and stage of the disease. It's important to note that experiencing these symptoms does not necessarily mean one has lymphoma, as other conditions can also cause them. However, if one has persistent or concerning symptoms, it's advisable to consult a healthcare professional for proper evaluation. 

Early lymphoma symptoms are generally nonspecific. Thus, it is important to keep an eye on any unusual symptoms. Below mentioned are some of the most prevalent early lymphoma symptoms:

1. Chills 

2. Cough

3. Tiredness

4. Enlarged spleen 

5. Fever and night sweat

6. Uncomfortable rash

7. Shortness of breath

8. Skin irritation

9. Stomach ache and appetite loss

10. Unexpected, unexplained weight loss

The cause of lymphoma cancer is unknown. However, scientists say it all starts with a genetic mutation in a disease-fighting white blood cell called a lymphocyte. The mutation instructs the cell to multiply, resulting in the proliferation of abnormal lymphocytes.

This creates an overabundance of defective and inefficient lymphocytes in the lymph nodes, which causes swelling of the lymph nodes, spleen, and liver.

Lymphoma Risk Factors 

Even though the condition's cause remains challenging to be analysed, diverse risk factors can enhance the likelihood of developing both forms of lymphoma cancer. These risk factors include : 

1. Age: The majority of lymphomas occur in adults aged 60 and up. Certain varieties, however, are more prone to emerge in children and young people.

2. Gender: Certain types are more common among women. Other types are more common among men.

3. Weakened Immune System: Individuals with weakened immune systems, such as those with HIV/AIDS, organ transplant recipients taking immunosuppressant medications, or individuals with certain inherited immune disorders, have a higher risk of developing lymphoma.

4. Chemical Exposure: Exposure to nuclear radiation and certain agricultural pesticides might increase the risk of developing non-Hodgkin lymphoma.

5. Autoimmune Disease: These are conditions in which the immune system starts attacking the body's cells. Rheumatoid arthritis and celiac disease are two examples.

6. Infections: Infections that convert lymphocytes, such as the Epstein-Barr virus (EBV), enhance the risk. This virus causes glandular fever.

7. Family history: A close family member, such as a parent or sibling, with lymphoma increases the risk of developing the disease. However, the overall risk is still relatively low.

8. Breast Implants: They can cause anaplastic large-cell lymphoma in breast tissue. 

9. Body Weight and Diet: Obesity and being overweight may affect the development of lymphoma. More research, however, is required to confirm the connection between the two.

   
   

With the adoption of the right methods, one can significantly reduce the risk of having this ailment. While there are no assurances, some activities can fix overall health and well-being and reduce the risk of lymphoma cancer. Let's look at some preventive actions and lifestyle decisions that can be helpful:

1. Maintain Physical Activity: Regular physical activity, such as walking, jogging, cycling, or engaging in one's favourite sports, is recommended. Exercise improves circulation, boosts the immune system, and enhances general health.

2. Limit Alcohol Consumption: Alcoholism has been related to an increased potential risk of some kinds of lymphoma. It is, therefore, essential to drink alcoholic beverages in limit or to avoid them entirely.

3. Keep a Balanced Weight: Strive to keep the body weight within the acceptable range for height and shape. Excess weight can lead to diverse health problems and raise the risk of getting cancers such as lymphoma.

4. Say No to Tobacco and Smoking: Avoid smoking and exposure to secondhand smoke, as smoking has been associated with an increased potential risk of lymphoma cancer. 

5. Avoid Exposure to Environmental Toxins: When possible, reduce exposure to dangerous chemicals, insecticides, and other poisons. In vocations or situations where disclosure is likely, follow safety requirements and take protective measures.

6. Vaccinations: Maintain a vaccination schedule since some diseases, such as Epstein-Barr virus (EBV) and hepatitis C, have been associated with an increased potential risk of lymphoma. Consult the doctor to determine which vaccinations are the most suitable.

There are no routine lymphoma cancer screenings. If a person experiences chronic viral symptoms, they should seek medical attention. The doctor will inquire about the patient's personal and family medical history to discover other illnesses.

If the doctor suspects lymphoma, the patient is asked to undergo a series of tests to determine the disease's presence, type, and stage. These tests help diagnose lymphoma and provide important information for developing an appropriate treatment plan:

1. Blood Tests: The patient would be asked to undergo certain blood tests, including complete blood count (CBC), erythrocyte sedimentation rate (ESR), Lactate dehydrogenase (LDH), and liver and kidney function tests, to understand the degree of spread.

2. Positron Emission Tomography (PET) Scan: The healthcare professional injects a radioactive tracer into the body. The tracer aids in the detection of early cancer indications.

3. Magnetic Resonance Imaging (MRI): This test produces highly clear images of organs and basic structures within the body using a powerful magnet, radio waves, and a computer.

4. CT Scan: This test creates three-dimensional images of the soft tissues and bones using a series of X-rays and a computer.

5. Biopsy: A biopsy is a key diagnostic procedure for lymphoma cancer. It involves the removal of a sample of affected lymph tissue for laboratory examination. There are different types of biopsies, including 

1. Excisional Biopsy (removal of an entire lymph node)

2. Incisional Biopsy (removal of a portion of a lymph node)

3. Needle Biopsy (using a thin needle to extract cells from a lymph node or other affected area)

6. Bone Marrow Biopsy: A bone marrow biopsy may be conducted to check for lymphoma involvement in the bone marrow. This procedure involves the removal of a small sample of bone marrow from the hipbone or another suitable site. The sample is examined under a microscope to detect the presence of lymphoma cells. 

7. Spinal Tap (Lumbar Puncture): In some cases, a lumbar puncture may be performed to assess whether lymphoma cancer has spread to the central nervous system. The healthcare professional inserts a needle into the lower back to get a sample of cerebrospinal fluid. The transparent liquid that covers the spine and brain is cerebrospinal fluid.

How to Prepare for Doctor's Consultation?

A doctor consultation is a valuable opportunity to discuss health concerns, seek medical advice, and develop a collaborative action plan with the healthcare provider. 

Preparing for this appointment can maximise one's time and ensure a productive and informative discussion. Here are some basic things to prepare:

1. Compile the medical history and test results.

2. Write down all the questions and concerns which are a cause of botheration.

3. One must research and educate themselves a bit about lymphoma from reliable sources. They can write down any points that come to their mind while researching.

4. Take a support person or trusted family member to discuss the condition better. 

What to Expect from the Doctor?

When facing a lymphoma diagnosis, it's natural to have questions, concerns, and a need for guidance. The doctor's role is pivotal in the healthcare journey, providing vital information and support. One can expect many things during their interactions with the doctor:

1. Answer the Questions: The doctor will clarify doubts and discuss the diagnosis's concerns. They will ensure that the person precisely understands the overall condition.

2. Treatment Options: The doctor will discuss the available treatment options for lymphoma cancer based on the specific diagnosis, including chemotherapy, radiation therapy, immunotherapy, targeted therapy, and stem cell transplantation.

3. Benefits and Risks: The doctor will explain each treatment option's potential benefits and risks. They will discuss possible side effects and address any concerns that one may have.

What to be Asked of the Doctor?

While the doctor progresses with physical examination and tests, the patient must also be ready with the right set of questions. Here is a list of questions one can discuss with their healthcare providers. 

1. What are the potential causes of my condition?

2. What preventive measures should be taken to reduce the risk of my condition?

3. How can I identify the stage of my condition?

4. What is the best treatment method for my condition?

5. What are the risks associated with the treatment method recommended to me?

6. What is the success rate of the specific treatment method?

7. For how long would I need to undergo the treatment? 

Treatment for lymphoma is influenced by a number of factors, such as the kind and stage of the illness, general health, and personal preferences. A multidisciplinary team of experts, which may include radiation oncologists, haematologists, and other medical professionals, usually creates a thorough treatment plan. The most common lymphoma treatments include

1. Steroids: Steroids may be used as part of lymphoma treatment. They can help in the reduction of inflammation and suppress the immune system. This, in turn, stops the growth of cancer cells in our body.

2. Chemotherapy: Chemotherapy uses powerful medications to destroy cancer cells. It is a typical lymphoma treatment that can be given orally, intravenously, or intramuscularly. 

1. Depending on the type and stage of the lymphoma, different medications and treatment times are used.

3. Radiation Therapy: High-energy radiation, such as X-rays or other types, is used in radiation treatment to target and kill cancer cells. 

1. It is frequently used as a stand-alone treatment for localised lymphomas or in conjunction with chemotherapy. 

2. To minimise damage to healthy tissues, the radiation is targeted precisely to the afflicted area.

4. Targeted Therapy: Drugs that selectively target particular molecules or processes involved in cancer progression are used in targeted therapy. 

1. These treatments aim to hinder the development and survival of cancer cells while posing the least possible risk to normal cells. 

2. For some forms of lymphomas, targeted therapy can be applied alone or in conjunction with other therapies.

5. Immunotherapy: A type of treatment known as immunotherapy uses the body's immune system to combat cancer cells. 

1. It comprises other immune-stimulating treatments and monoclonal antibody therapy, which targets and kills cancer cells selectively with artificial antibodies. 

2. Certain lymphomas, including Hodgkin lymphoma and several non-Hodgkin lymphomas, can be successfully treated with immunotherapy.

6. Stem Cell Transplantation: Stem cell transplantation may be recommended in cases requiring high-dose chemotherapy or radiation therapy. It involves replacing damaged or destroyed bone marrow with healthy stem cells, which can develop into new blood cells and restore the immune system.

Cost of Lymphoma Treatment

The cost of lymphoma treatment in India varies depending on several factors, including the type and stage of cancer, the treatment method used, the patient's age, the hospital's location and type, and the doctor's level of experience.

The table below shows the cost of different lymphoma treatment options:

Lymphoma Survival Rate 

The survival rate of lymphoma can vary based on several factors, including the type and stage of the disease, age, overall health, and response to treatment. Here are some general statistics on the survival rates of lymphoma based on the American Cancer Society:

1. Hodgkin Lymphoma: The overall five-year survival rate for Hodgkin lymphoma is around 87%. The survival rate varies depending on the stage of the disease, with early-stage Hodgkin lymphoma having a higher survival rate of over 90% and advanced-stage cases having a slightly lower rate.

2. Non-Hodgkin Lymphoma: The five-year survival rate for non-Hodgkin lymphoma varies depending on the subtype and other factors. It is around 70% for adults and is generally higher for children.

Lymphoma, like many other cancers, can present certain risks and complications. Awareness of and managing these challenges is crucial in providing optimal care and support. Let's dive into some key aspects related to the risks and complications of lymphoma

1. Chemotherapy Side Effects: Chemotherapy, a standard treatment for lymphoma, can lead to various side effects such as nausea, hair loss, fatigue, and increased risk of infections.

2. Radiation Therapy Side Effects: Radiation therapy, used in some instances of lymphoma, can cause skin changes, fatigue, and long-term complications in nearby organs.

3. Immunotherapy-Related Complications: Immunotherapy, while beneficial in treating lymphoma, can lead to immune-related side effects, including inflammation of organs and autoimmune reactions.

4. Weakened Immune System: Lymphoma and its treatments can weaken the immune system, making individuals more susceptible to infections.

5. Late Effects of Treatment: Some individuals may experience long-term side effects of lymphoma treatment, such as organ damage, secondary cancers, or fertility issues.

Risks of Delayed Treatment

Like any other cancer, lymphoma requires prompt medical attention and intervention to achieve the best possible outcomes. Delays or avoidance in seeking treatment can significantly affect health and prognosis. Here are some critical risks associated with not treating lymphoma on time:

1. Uncontrolled Growth: Without treatment, lymphoma cells can continue to multiply and spread throughout the body, leading to the progression of the disease.

2. Advanced Stages: Delayed treatment may result in cancer reaching advanced settings, making it more challenging to achieve remission or control the disease effectively.

3. Increased Complications: Advanced lymphoma can lead to organ damage, compromised immune function, and a higher risk of infections.

4. Diminished Chances of Cure: Delaying treatment reduces the likelihood of achieving complete remission or cure, decreasing the overall survival rates for lymphoma patients.

5. Lower Treatment Response: Advanced lymphoma may be less responsive to treatment, resulting in decreased effectiveness and compromised outcomes.

6. Limited Therapeutic Options: Delayed treatment may limit the possibilities, as specific therapies may be more effective in the earlier stages of lymphoma.

When to Consult a Doctor?

Living with lymphoma requires being attuned to the body and recognising any changes or symptoms that may indicate the need for medical attention. Here are some situations and symptoms that should prompt one to consult a doctor:

1. Fatigue and Weakness: Persistent fatigue and unexplained weakness that interfere with daily activities should not be ignored.

2. Night Sweats: If one is regularly waking up drenched in sweat, especially when accompanied by other concerning symptoms, it is crucial to seek medical advice.

3. Skin Changes: New or changing skin lesions, rashes, or itching should be examined by a dermatologist or oncologist, as lymphoma can manifest in the skin.

4. Side Effects of Treatment: If one is undergoing lymphoma treatment and experience severe or intolerable side effects, it is important to speak or talk with the healthcare team.

5. Infection or Complications: Lymphoma and its treatment can weaken the immune system significantly, making one more vulnerable to infections. If one develops a high fever, persistent cough, or signs of infection, seek immediate medical attention.

Maintaining a balanced and nutritious diet is important for overall health and well-being, including during lymphoma treatment. It is recommended to follow a diet that includes:

1. Fruits and Vegetables: Incorporate a variety of colourful fruits and vegetables into the diet. They provide essential vitamins, minerals, and antioxidants that support immune function and overall health.

2. Whole Grains: Opt for whole grain products such as whole wheat bread, brown rice, and whole grain cereals. They are a good source of fibre and can help maintain energy levels.

3. Lean Proteins: Choose lean protein sources such as poultry, fish, beans, legumes, and tofu. These provide important nutrients for cell repair and maintenance.

4. Healthy Fats: Include sources of healthy fats in the diet, such as avocados, nuts, seeds, and olive oil. These fats can help with nutrient absorption and provide energy.

5.  Hydration: Drink plenty of water throughout the day to stay hydrated. Water helps in maintaining proper bodily functions.

Lymphoma is a complex and challenging condition, but we can navigate this journey more confidently with knowledge and support. Throughout this blog, we have explored the different aspects of lymphoma, starting with its definition and classification into Hodgkin lymphoma and non-Hodgkin lymphoma. We discussed the importance of recognising lymphoma symptoms, causes, and treatment options, and we empower you and your loved ones to navigate this challenging journey with knowledge and confidence. 

HexaHealth is one of the most promising and accurate medical and health-oriented platforms that allow you to make the right decisions regarding your well-being. A team of dedicated professionals, our experts are always readily available to help you with all your questions and clear your many confusions. To find out how we can assist you in many aspects, we at HexaHealth are a one-stop destination for you.

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