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What Is Lymphoma?

Lymphoma Symptoms,
Causes and Treatments
Lymphoma is a type of cancer that begins in immune
system cells called lymphocytes. Like other cancers,
lymphoma occurs when lymphocytes are in a state of
uncontrolled cell growth and multiplication.
Lymphocytes are white blood cells that move
throughout the body in a fluid called lymph. They are
transported by a network of vessels that make up the
lymphatic system, part of the immune system. The
lymphatic system - whose job it is to fight infections or
anything else that threatens the body - is also
comprised of lymph nodes that exist throughout the
body to filter the lymph that flows through them. The
lymph nodes swell and tenderize when a large
number of microbial organisms collect inside of them,
indicating local infection.
There are two primary types of lymphocytes: B cells
and T cells. Both are designed to recognize and
destroy infections and abnormal cells. B cells produce
proteins that travel throughout the body, attaching
themselves to infectious organisms and abnormal
cells and alerting the immune system that the
pathogen needs to be destroyed. T cells actually kill
the pathogens directly and serve a function in
regulating the immune system from over- or underactivity.

Interesting articles
What is cancer? What causes cancer?
What is function of the lymph nodes?
Lymphoma occurs when lymphocyte B or T cells
transform and begin growing and multiplying
uncontrollably. Abnormal lymphocytes collect in one or
more lymph nodes or in lymph tissues such as the
spleen or tonsils, and eventually they form a mass of
cells called a tumor. Tumors grow and invade the
space of surrounding tissues and organs, depriving
them of oxygen and nutrients.
If abnormal lymphocytes travel from one lymph node
to the next or to other organs, the cancer can spread
or metastasize. Lymphoma development outside of
lymphatic tissue is called extranodal disease.
In the United States each year, some 54,000 people
are diagnosed with NHL and 7,000 are diagnosed HL.
It is the most common type of blood cancer in the US.
The European Union sees over 50,000 cases of NHL
every year.
How is lymphoma classified?
There are two types of lymphoma: Hodgkin
lymphoma (HL, also called Hodgkin's disease) and
non-Hodgkin lymphoma (NHL). Both HL and NHL
can occur in the same places and have similar

symptoms. Their differences are visible at a


microscopic level.
Hodgkin lymphoma develops from a specific
abnormal lineage of B cells. There are five subtypes
of HL. NHL may derive from either abnormal B or T
cells, and its 30 subtypes are distinguished by unique
genetic markers. The large number of lymphoma
subtypes has led to a complicated classification
scheme that involves microscopic appearance and
well-defined genetic and molecular configurations.
Although several NHL subtypes look similar, they
function differently and respond differently to
therapies. HL subtypes are microscopically distinct,
and classification is based upon the microscopic
differences as well as the extent of disease.
What causes lymphoma?
Cancer is ultimately the result of cells that
uncontrollably grow and do not die. Normal cells in
the body follow an orderly path of growth, division,
and death. Programmed cell death is called
apoptosis, and when this process breaks down,
cancer results. Scientists do not know exactly what
causes lymphoma, but they have identified several
potential risk factors.
Genetics

Lymphoma can be the result of a genetic


predisposition that is inherited from family members. It
is possible to be born with certain genetic mutations
or a fault in a gene that makes one statistically more
likely to develop cancer later in life.
Carcinogens
Carcinogens are a class of substances that are
directly responsible for damaging DNA, promoting or
aiding cancer. Exposure to certain pesticides,
herbicides, and solvents such as benzene has been
associated with lymphoma. Similarly, black hair dye
has been linked to higher rates of NHL. When our
bodies are exposed to carcinogens, free radicals are
formed that try to steal electrons from other molecules
in the body. These free radicals damage cells,
affecting their ability to function normally, and the
result can be cancerous growths.
Other medical factors
As we age, there is an increase in the number of
possible cancer-causing mutations in our DNA. The
risk of NHL increases as we age, and HL is most
common between ages 16-34 and 55 years and older.
Additional medical conditions that have been
associated with higher lymphoma rates include
infection with HIV, human T-lymphocytic virus type 1
(HTLV-1), Epstein-Barr virus, Helicobacter pylori, or
hepatitis B or C; autoimmune disease (such as lupus);

diseases that require therapies that suppress the


immune system; and any other immunodeficiency
diseases.
What are the symptoms of lymphoma?
Cancer symptoms are quite varied and depend on
where the cancer is located, where it has spread, and
how big the tumor is. Lymphoma usually first
presents with swelling in the neck, underarm, or
groin. Additional swelling may occur where other
lymph nodes are located such as in the spleen. In
general, enlarged lymph nodes can encroach on the
space of blood vessels, nerves, or the stomach,
leading to swollen arms and legs, to tingling and
numbness, or to feelings of being full, respectively.
Lymphoma symptoms also include nonspecific
symptoms such as fever, chills, unexplained
weight loss, night sweats, lethargy, and itching.
How is lymphoma diagnosed and staged?
In order to diagnose lymphoma, physicians will
request a complete physical exam as well as personal
and family medical histories. An oncologist (cancer
specialist) will usually be consulted to review the
results of several tests.
Blood tests will be used to test blood cell, kidney, and
liver performance. They can also detect a chemical
called lactase hydrogenase (LDH), of which high

levels have been associated with an aggressive form


of NHL.
Several imaging techniques are employed in order to
see if cancer exists and to find out how far they have
spread. Common imaging tests include:

X-rays

Computerized tomography (CT) scans

Magnetic resonance imaging (MRI)

Lymphangiogram

Gallium scan

Positron emission tomography (PET) scans


Physicians may also perform bone marrow
examinations to see if the lymphoma has infected the
bone marrow. Bone marrow samples are often taken
from the hip and examined for the presence of
abnormal B or T cells.
The only absolute way to make a cancer diagnosis is
to remove a small sample of the tumor and look at it
under the microscope in a procedure called a biopsy.
Doctors may gather the sample by inserting a needle
through the skin, surgical methods, or laparoscopic
methods. A pathologist examines the sample under a
microscope to determine if cancer exists.
After a diagnosis is made, doctors analyze the tissue
samples and test results to find out how far the cancer
has spread and to determine the stage of the cancer.
The stage lets oncologists know which choices will be

available for treatment and it informs prognoses.


A common and simple classification scheme for
Hodgkin's lymphoma considers it to be bulky (large
tumor, worse prognosis) or nonbulky (small tumor,
better prognosis). Non-Hodgkin's lymphoma is
classified according to its microscopic appearance,
location in the body, and genetic and molecular
features. It is frequently divided into three grades.
Low grade, or indolent, lymphomas grow slowly and
often do not require immediate treatment.
Intermediate grade lymphomas are rapidly growing
and require immediate treatment. They are often
curable. High grade lymphomas are aggressive and
rapidly growing, require intesive and immediate
treatment, and are often uncurable.
HL and NHL use a similar staging system to describe
the extent of the disease.

Stage I or early disease is when lymphoma is


found in a single lymph node region or in a single
organ outside the lymph node.

Stage II or locally advanced disease is when two


or more lymph node regions on the same side of the
diaphragm or one lymph node region and a nearby
tissue or organ carries lymphoma.

Stage III or advanced disease is when two or


more lymph nodes or a lymph node and an organ on
the opposite side of the body are affected by
lymphoma.

Stage IV or widespread, disseminated disease is


when the lymphoma has spread to the spleen, bone
marrow, bone, or central nervous system.
Both types of lymphoma may also receive an A
classification to indicate no symptoms like fever and
weight loss, a B classification to indiciate such
symptoms, or an E classification to indicate that the
tumor has spread directly from a lymph node to an
organ.
How is lymphoma treated?
Cancer treatment depends on the type of cancer, the
stage of the cancer (how much it has spread), age,
health status, whether or not one has received
previous cancer treatment, and additional personal
characteristics. Lymphoma treatment is usually
designed to result in complete remission of the
disease - a state where there may be lymphoma cells
in the body, but they are undetectable and cause no
symptoms. Common lymphoma treatments include
chemotherapy, radiation therapy, and biological
therapy.
The ultimate goal of lymphoma treatment is durable
remission, or remission that lasts a long time. If the
cancer comes back, this is called recurrence. After
therapy the patient may see improvement (lymphoma
shrinks), a stable disease (lymphoma is the same
size), progression (lymphoma worsens), or a
refractory disease (the lymphoma resists treatment).

Patients may also undergo induction therapy that is


designed to induce remission, salvage therapy that is
designed to take over for a failing treatment, or
maintenance therapy that is treatment meant to
prevent recurrence.
Chemotherapy
Chemotherapy utilizes chemicals that interfere with
the cell division process - damaging proteins or DNA so that cancer cells will commit suicide. These
treatments target any rapidly dividing cells (not
necessarily just cancer cells), but normal cells usually
can recover from any chemical-induced damage while
cancer cells cannot. Chemotherapy is generally used
to treat cancer that has spread or metastasized
because the medicines travel throughout the entire
body. Treatment occurs in cycles so the body has time
to heal between doses. However, there are still
common side effects such as hair loss, nausea,
fatigue, and vomiting. Combination therapies often
include multiple types of chemotherapy or
chemotherapy combined with other treatment options.
Radiation
Radiation treatment, also known as radiotherapy,
destroys cancer by focusing high-energy rays on the
cancer cells. This causes damage to the molecules
that make up the cancer cells and leads them to

commit suicide. Radiotherapy utilizes high-energy


gamma-rays that are emitted from metals such as
radium or high-energy x-rays that are created in a
special machine. Radiotherapy can be used as a
standalone treatment to shrink a tumor or destroy
cancer cells, and it is also used in combination with
other cancer treatments.
Side effects of radiation therapy may include mild skin
changes resembling sunburn or suntan, nausea,
vomiting, diarrhea, and fatigue. Patients also tend to
lose their appetites and have trouble maintaining
weight, but most side effects subside a few weeks
after completing treatment.
How can lymphoma be prevented?
There are no known ways to prevent lymphoma.
However, physicians recommend avoiding known risk
factors and avoiding viral infections or conditions that
suppress the immune system.
Lymphoma video discussion - University of
Maryland Medical Center