What is lymphoma
The lymph system is a series of lymph nodes and vessels that move lymph fluid through the body. Lymph fluids contain infection-fighting white blood cells. Lymph nodes act as filters, capturing and destroying bacteria and viruses to prevent infection from spreading.
While the lymph system typically protects your body, lymph cells called lymphocytes can become cancerous. The names for cancers that occur in the lymph system are lymphomas.
Doctors classify more than 70 cancer types as lymphomas. Lymphomas can affect any portion of the lymphatic system, including:
- bone marrow
- lymph nodes
Doctors typically divide lymphomas into two categories: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma (NHL).
A number of medical specialists collaborate to treat lymphoma. Hematologists are doctors who specialize in blood, bone marrow, and immune cell disorders. Oncologists treat cancerous tumors. Pathologists may work with these doctors to assist in treatment planning and identify if a particular treatment is working.
Lymphoma treatments depend upon the cancer’s stage. Doctors will “stage” a tumor to signify how far the cancerous cells may have spread. A stage 1 tumor is limited to a few lymph nodes, while a stage 4 tumor has spread to other organs, such as the lungs or bone marrow.
Doctors also “grade” NHL tumors by how fast they’re growing. These terms include:
- low-grade or indolent
- intermediate-grade or aggressive
- high-grade or highly aggressive
Treatment for Hodgkin’s lymphoma includes radiation therapy to shrink and kill cancerous cells. Doctors also prescribe chemotherapy medications to destroy cancerous cells. Read more about these chemotherapy medications and other drugs used to treat lymphoma.
Chemotherapy and radiation are also used to treat NHL. Biological therapies that target cancerous B-cells also can be effective. An example of this drug type includes rituximab.
In some instances, a bone marrow or stem cell transplant is used to build up healthy immune system cells. Doctors may harvest these cells or tissues before beginning chemotherapy and radiation treatments. Relatives may be able to donate bone marrow too.
Lymphoma may not always cause symptoms in its early stages. Instead, a doctor may discover enlarged lymph nodes during a physical examination. These may feel like small, soft nodules under the skin. A person may feel the lymph nodes in the:
- upper chest
Likewise, many of the symptoms of early lymphoma are not specific. That makes them easy to overlook. These common early symptoms of lymphoma include:
- bone pain
- enlarged spleen
- night sweats
- pain when drinking alcohol
- itchy rash
- rash in skin folds
- shortness of breath
- skin itching
- stomach pain
- unexplained weight loss
Because the symptoms of lymphoma are often easily overlooked, it can be difficult to detect and then diagnose it in an early stage. It’s important to know how the symptoms may begin to change as the cancer worsens. Read more about these symptoms and what you can expect.
Cancer is the result of uncontrolled cell growth. The average lifespan of a cell is brief, and then the cell dies. In people with lymphoma, however, the cell thrives and spreads instead of dying.
It’s unclear what causes lymphoma, but a number of risk factors are connected with these cancers.
Most diagnosed lymphoma cases have no known cause. However, some people are considered higher risk.
Non-Hodgkin’s lymphoma risk factors
Risk factors for non-Hodgkin’s lymphoma (NHL) include:
- Immunodeficiency. This could be due to a weak immune system from human immunodeficiency virus (HIV) or AIDs, or taking an immune system-suppressing drug after an organ transplant.
- Autoimmune disease. People with certain autoimmune disease, such as rheumatoid arthritis and celiac disease, have an increased risk for lymphoma.
- Age. Lymphoma is most common in people over 60. However, some types are more common in children and infants.
- Sex. Women are more likely to develop some particular types of lymphoma, and men are more likely to develop other types.
- Ethnicity. White Americans in the United States are more likely to develop some types of lymphoma than African-Americans or Asian-Americans.
- Infection. People who have had infections such as the human T-cell leukemia/lymphotropic virus (HTLV-1), Heliobacter pylori, hepatitis C, or the Epstein-Barr virus (EBV) are associated with an increased risk.
- Chemical and radiation exposure. Those exposed to chemicals in pesticides, fertilizers, and herbicides are also at increased risk. Nuclear radiation can also increase risks for developing NHL.
- Body size. Obesity has been connected to lymphoma as a possible risk factor, but more research is needed to understand this possible risk factor.
Hodgkin’s lymphoma risk factors
Risk factors for Hodgkin’s lymphoma include:
- Age. More cases are diagnosed in people between the ages of 20 and 30, and in people over 55.
- Sex. Men are more likely than women to develop this type of lymphoma.
- Family history. If asibling is diagnosed with this type of cancer, your risk for also developing it is higher.
- Infectious mononucleosis. An EBV infection can cause mononucleosis. This infection can increase the risk for lymphoma.
- Affluence. Individuals that come from a background with a higher socioeconomic status have a greater risk for this type of cancer.
- Immunodeficiency. Individuals with HIV have a greater risk for developing lymphoma.
A biopsy typically is taken if a doctor suspects lymphoma. This involves removing cells from an enlarged lymph node. A doctor known as a hematopathologist will examine the cells to determine if lymphoma cells are present and what cell type they are.
If the hematopathologist detects lymphoma cells, further testing can identify how far the cancer has spread. These tests can include a chest X-ray, blood testing, or testing nearby lymph nodes or tissues.
Imaging scans, such as a computed tomography (CT) or magnetic resonance imaging (MRI) scans may also identify additional tumors or enlarged lymph nodes.
The two major lymphoma types are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma (NHL). A pathologist in the 1800s named Dr. Thomas Hodgkin identified the cells in what is now called Hodgkin’s lymphoma.
Those with Hodgkin’s lymphoma have large cancerous cells called Reed-Sternberg (RS) cells. People with NHL don’t have these cells.
According to the Leukemia & Lymphoma Society (LLS), NHL is three times more common than Hodgkin’s lymphoma.
Many lymphoma types fall under each category. Doctors call NHL types by the cells they affect, and if the cells are fast- or slow-growing. NHL forms in either the B-cells or T-cells of the immune system.
According to LLS, most NHL types affect B-cells. Learn more about this type of lymphoma, who it affects, and where it occurs. Types include:
Diffuse large B-cell lymphoma (DLBCL) is the most aggressive type of NHL. This fast-growing lymphoma comes from abnormal B cells in the blood. It can be cured if treated, but if left untreated, it can lead to death. The stage of DLBCL helps determine your prognosis. Read more about the stages and how this lymphoma is treated.
T-cell lymphoma is not as common a B-cell lymphoma; only 15 percent of all NHL cases are this type. Several types of T-cell lymphoma exist. Learn more about each one, what they cause, and who is more likely to develop them.
Burkitt’s lymphoma is a rare type of NHL that is aggressive and most common in people with compromised immune systems. This type of lymphoma is most common in children in sub-Saharan Africa, but it does occur in other parts of the world. Learn more about this rare type of non-Hodgkin’s lymphoma.
One in 5 lymphomas diagnosed in the United States are follicular lymphoma. This type of NHL, which starts in the white blood cells, is most common in older individuals. The average age of diagnosis is 60. This lymphoma is also slow-growing, so treatments begins with watchful waiting. Read more about this strategy.
Mantle cell lymphoma
This aggressive form of lymphoma is rare — only about 6 percent of NHL cases are this type. Mantel cell lymphoma is also more commonly diagnosed at a later stage, and it usually occurs in or involves the gastrointestinal tract or bone marrow. Discover the risk factors and symptoms of mantle cell lymphoma.
Primary mediastinal B cell lymphoma
This subtype of B-cell lymphoma accounts for almost 10 percent of DLBCL cases. It predominantly affects women in their 20s and 30s.
Small lymphocytic lymphoma
Small lymphatic lymphoma (SLL) is a type of slow-growing lymphoma. The cancer cells of SLL are found mostly in the lymph nodes. SLL is identical to chronic lymphocytic leukemia (CLL), but with CLL, the majority of cancer cells are found in the blood and bone marrow.
Waldenstrom macroglobulinemia (lymphoplasmacytic lymphoma)
Lymphoplasmacytic lymphoma (LPL) is a rare type of cancer that accounts for just 1 to 2 percent of all lymphomas. It mostly affects older adults. Waldenstrom macroglobulinemia is a subtype of LPL. It causes the abnormal production of antibodies. Many people with LPL have anemia; read more about other common symptoms and risk factors.
Hodgkin’s lymphomas typically start in B-cells or immune system cells known as Reed-Sternberg (RS) cells. While the main cause of Hodgkin’s lymphoma is not known, certain risk factors can increase your chances of developing this type of cancer. Learn what these risk factors are.
Hodgkin’s lymphoma types include:
Lymphocyte-depleted Hodgkin’s disease
This rare, aggressive type of lymphoma occurs in about 1 percent of lymphoma cases, and it’s most commonly diagnosed in individuals in their 30s. In diagnostic tests, doctors will see normal lymphocytes with an abundance of RS cells.
Patients with a compromised immune system, such as those with HIV, are more likely to be diagnosed with this type of lymphoma.
Lymphocyte-rich Hodgkin’s disease
This type of lymphoma is more common in men, and it accounts for about 5 percent of Hodgkin’s lymphoma cases. Lymphocyte-rich Hodgkin’s disease is typically diagnosed at an early stage, and both lymphocytes and RS cells are present in diagnostic tests.
Mixed cellularity Hodgkin’s lymphoma
Like with lymphocyte-rich Hodgkin’s disease, mixed cellularity Hodgkin’s lymphoma contains both lymphocytes and RS cells. It’s more common — almost a quarter of Hodgkin’s lymphoma cases are this type — and it’s more prevalent in older adult men.
Nodular lymphocyte-predominant Hodgkin’s disease
Nodular lymphocyte-predominant Hodgkin’s disease (NLPHL) type of Hodgkin’s lymphoma occurs in about 5 percent of lymphoma patients, and it’s characterized by an absence of RS cells.
NLPHL is most common in people between the ages of 30 and 50, and it’s more common in males. Rarely, NLPHL can progress or transform into a type of aggressive NHL.
Nodular sclerosis Hodgkin’s lymphoma
This common type of lymphoma occurs in 70 percent of Hodgkin’s cases, and it’s more common in young adults than any other group. This type of lymphoma occurs in lymph nodes that contain scar tissue, or sclerosis.
Fortunately, this type of lymphoma is highly treatable with a high curate rate.
An individual’s prognosis after a lymphoma diagnosis depends on the stage and type of lymphoma. Many types of lymphoma are treatable and highly curable. However, not all are.
Some types of lymphoma are also slow-growing, or indolent. In this case, doctors may choose not to treat because the prognosis, even with the lymphoma, is still good in the long-term picture.
Both NHL and Hodgkin’s lymphoma can be classified into four stages. The state of lymphoma is determined by where the cancer is and how far it has or has not spread.
- Stage 1. Cancer is in one lymph node or one organ cite.
- Stage 2. Cancer is in two lymph nodes near to one another and on the same side of the body, or the cancer is in one organ and nearby lymph nodes.
- Stage 3. At this point, cancer is in lymph nodes on both sides of the body and in multiple lymph nodes.
- Stage 4. The cancer can be in an organ and spread beyond nearby lymph nodes. As NHL progresses, it may begin to spread. The most common sites for advanced NHL include the liver, bone marrow, and lungs.
While stage 4 lymphoma is advanced, it’s still treatable. Learn more about how this stage of lymphoma is treated — and why it’s not always treated.
Many of the same risk factors for lymphoma in children are risk factors for adults, but certain types of lymphoma are more common in children.
For example, Hodgkin’s lymphoma is more common in children ages 15 and younger, but the type of NHL that occurs in children are typically aggressive and fast-growing.
Children who have immune system deficiencies, such as HIV, or those who take immune-suppressing drugs are at an increased risk for lymphoma. Likewise, children who’ve undergone radiation therapy or chemotherapy have a higher risk for developing this type of cancer.
Both leukemia and lymphoma are types of blood cancer, and they do share some common symptoms. However, their origins, treatments, and specific symptoms set the two types of cancer apart.
People with both lymphoma and leukemia experience fever and night sweats. However, leukemia is more likely to cause excessive bleeding, easy bruising, headaches, and increased infections. People with lymphoma are more likely to experience itchy skin, loss of appetite, unexplained weight loss, and swollen lymph nodes.
Leukemia typically begins in the bone marrow; it causes the marrow to produce too many white blood cells. Lymphoma begins in the lymph nodes, and it progresses as the abnormal white blood cells spread.
Doctors may choose to practice watchful waiting for both lymphoma and leukemia. That’s because some types of these cancers are slow-growing and not aggressive. If your doctor decides to treat either cancer, chemotherapy and radiation are used to treat both, but leukemia has two other common treatments. These are stem cell transplants and targeted drug therapy.
Leukemia and lymphoma are similar, but their differences set them apart. Learn more about the risk factors, diagnosis, and other important factors.
According to the Leukemia & Lymphoma Society, Hodgkin’s lymphoma is a highly curable cancer. Survival rates for both NHL and Hodgkin’s lymphoma depend upon how far the cancerous cells have spread and the cancer type.
According to the American Cancer Society (ACS), the overall five-year survival rate for NHL patients is 70 percent and the 10-year survival rate is 60 percent. The survival rate for Hodgkin’s lymphoma depends upon its stage.